Andrew Schmelz

Diversity, Equity, and Inclusion in Pharmacy Education: Diversity and Inclusivity in Healthcare Course

About the Program

The Diversity and Inclusivity in Healthcare course explores the intersection of health care and marginalized cultures, races, ethnicities, and gender identities. Students begin learning overarching ideas such as the way health can be socially defined, the impact of bias and privilege on health and healthcare experience, the systemic nature of healthcare and the world, and how these all impact social determinants of health. The course then focuses on the ways people are grouped (such as by race, culture, religion, sexuality, gender identity, age, ability status, etc.), the historical context behind groupings, the way these groupings impact patients' health, and what pharmacists can do in their practices to help people who face challenges because of their identities. It is a required 3 credit-hour course for first professional-year (P1) pharmacy students in the Doctor of Pharmacy curriculum and has received the university's SJD designation. The course is currently offered in a hybrid format and includes online lectures and live, face-to-face continuances (i.e., recitations). During each continuance meeting, students discuss readings, apply knowledge to specific case situations, participate in group activities to simulate and explore issues in the class, and even engage in debates on controversial issues lying at the intersection of DEI and healthcare.

About the Institution

Butler University began work many years ago to ensure all of its graduates received instruction related to diversity, equity, and inclusion, well before the events of 2020 prompted widespread attention to these issues. Faculty from across the university were involved in developing a designation for courses sufficiently addressing the topic (which they termed "social justice and diversity" courses, or SJD courses), and in 2020 the University announced the new graduation requirement would be implemented. At the same time, faculty in the Doctor of Pharmacy program had long recognized health equity as an important topic that needed strengthened. Additionally, cultural awareness and confidence in caring for patients from different backgrounds were frequently identified by students as areas to which they felt they needed more exposure. With this opportunity to accomplish the goals of the faculty and the University, a new course was approved to address the topic.

Program Reach

We have now offered the course twice and expect to continue doing so. Because the course was first offered while the university was under strict COVID precautions, it was initially developed to be completed fully online. As precautions were loosened, the second offering was conducted in a hybrid format, with students completing online modules in place of lecture and then engaged in in-person recitations in small classes. The course is currently taught with two faculty and one support staff, though the number of faculty may fluctuate in the future as teaching loads are continuously reassessed. For perspective, about 80-120 students in each cohort are enrolled in the course each year, and students meet in smaller (20-30 students) sections for recitation.

Program Implementation & Resources

The pharmacy program identified faculty who had a strong interest in the topic and who had completed (or would be completing) additional training in the area, including a fellowship program created by the university to foster faculty expertise in DEI. Without a program like this, it would have been very difficult to identify faculty internally with sufficient expertise to teach the course, and due to budgetary constraints surrounding COVID, it would have been unlikely an external candidate could have been hired, further delaying course implementation. In the spirit of DEI, the course was designed to use only class resources that were available through the University's library or were freely available online. This includes a wide variety of media (audio podcasts, video recordings, readings from scientific journals, articles from lay media, etc.) and perspectives from a wide variety of disciplines (sociology, psychology, medicine, public health, social work, etc.).

Program Assessment

Students in the course are assessed on knowledge and ability to apply DEI principles through examinations, a group debate assignment, and written reflections. The first year the course was offered, a pre- and post-survey was administered to measure changes in attitudes and beliefs toward DEI principles. Results from this survey are expected to be submitted for publication soon, and although preliminary findings suggested that while this course is a great first step, providing additional opportunities for students to engage in experiences (whether through IPPE or through service learning opportunities) will be crucial to ensure students develop these professional attitudes.

Program Feedback

General student feedback about the course has been overall really positive, both informally and via course evaluations. Many students say they recognize the importance of including a course on DEI in the pharmacy program, and they appreciate the attention we pay to the topic in the program.

Closing Advice

Speaking with faculty from other universities, it is clear that the support we had developing and implementing the course has been the exception rather than the rule. Unfortunately, because of the political nature of the subject matter, other faculty have faced resistance in drawing attention to DEI issues in healthcare, or even talking about just talking about health equity. When considering a course like this, it would be extremely important to get buy-in and support from leadership as well as other faculty. It is probably better to do something rather than nothing, meaning if a whole new course is not feasible, finding a place for even a lecture within an existing course would still be incredibly worthwhile. Additionally, many topics in the course are still active areas of research, and professional opinions about some of them (for instance, the use of race in clinical algorithms) are shifting. There is a need for faculty who teach in other courses to also understand these issues and how they apply to their individual areas of expertise.

About the Author

Dr. Andy Schmelz graduated from Purdue University with a Doctor of Pharmacy degree in 2008 and stayed to complete a post-doctoral fellowship in academia and ambulatory care. He practiced as a staff pharmacist with Walgreen Co., and after becoming a board-certified ambulatory care pharmacist, he worked as an ambulatory care pharmacist with Indiana University Health and Community Health Network. He is currently an Assistant Professor of Pharmacy Practice with the Butler University College of Pharmacy and Health Sciences and practices at Eskenazi Health with vulnerable populations on the west side of Indianapolis.

Dr. Schmelz has maintained a long-standing interest in caring for underserved patients, and after starting at his current institution, he completed a university-based fellowship in social justice and diversity vocation. He is now the course director for Diversity and Inclusivity in Healthcare, a required course in Butler University’s Doctor of Pharmacy program, has given numerous presentations on DEI-related topics, and serves on the DEI Task Force for the American College of Clinical Pharmacists.