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Advancing Diversity and Inclusion in Canadian Medical Education

23 Oct 2020 | Becky Smith Becky Smith, Advance HE Assistant Director International, shares her first-hand knowledge from her time working at the University of Toronto of a successful initiative being used to support and increase the numbers of Black students enrolled on medical degree programmes, and which is now being adopted more broadly in Canada in medicine and law.

In October 2016, the University of Toronto had one black student in its first-year Medicine (MD) degree cohort of 259 students despite being located in the Canadian city with the largest Black population.

Historically, there has been an under-representation of Black medical students in Canadian universities and the Association of Faculties of Medicine of Canada has specifically asked Canadian medical schools to increase the abilities of under-represented groups to enter medical school.

There has been a Summer Mentorship Program at the University of Toronto’s Temerty Faculty of Medicine for over 25 years to encourage high school students from under-represented backgrounds to explore the health sciences. The programme has been successful in supporting participants such as Dr. Jabari Jones who credits the programme for providing him with opportunities, support and guidance to fulfil his ambitions. However, the Faculty recognised more needed to be done to elicit real change.

Of the factors affecting students from under-represented backgrounds in terms of their success in pursuing healthcare education, a key factor identified was limited access to opportunities often afforded to students from other backgrounds. This may be due to a lack of family connections, inadequate social support or deeper systemic issues regarding race and expectations. 

Aquila Akingbade, an aspiring neurosurgeon who emigrated to Canada from Nigeria as a child, noted of the preparation process for medical school, "It’s a bit intimidating because I feel like I have to compete against all these people who have so many connections…no one in my family is a medical doctor or is in the medical field.”

A Community of Support (COS) programme was established to support prospective students who are indigenous, Black, Filipino, socio-economically disadvantaged, or who identify as having a disability, and have an interest in applying to study in the healthcare fields across Canada, the US and Caribbean - not just at the University of Toronto. Ike Okafor, Senior Officer of Service Learning and Diversity Outreach said, “COS is positioned near the end of a ‘long-game’ diversity outreach plan that aims to level the playing field.”

The COS, which is backed by a wide range of community partners, provides multi-faceted guidance and practical support for prospective students. This includes specific expert and peer-led preparatory courses, applications advice and support, mentoring, work experience and research opportunities to build students’ application strength. Over 2,500 students have participated in the scheme since its inception and it has successfully supported students in their journey, and 15% of admitted students into the Temerty Faculty of Medicine’s MD program were COS participants.  

Iman Yousuf found that the support provided by the COS boosted her confidence. “It’s sometimes hard because I don't have those same connections to those people in the medical field or well-connected individuals that can provide valuable information about opportunities that exist. I was always told that I would have to work hard to achieve my goals. The COS program makes me feel like I am worth it,” she says. “It’s just a great feeling.”  

A further initiative was to create the Black Students Application Program (BSAP), launched in 2017. The BSAP was adapted from an existing Indigenous Students Application Program (ISAP) model which had been set up to counter systemic or non-systemic negative bias towards indigenous (First Nations, Inuit, and Métis) populations that might exist throughout the lengthy and rigorous application assessment process to enter medical programmes. The ISAP was designed to reassure indigenous applicants that cultural heritage differences in background and experience would be understood by those conducting the assessments. Learnings from the ISAP’s implementation indicated the significant need for outreach work, longitudinal support for accepted indigenous medical students and the need to develop an indigenous medical education curriculum and programming for the benefit of all medical students.

Significantly, participation in the BSAP is optional and based on self-identification, there are no quotas and applicants must meet the same minimum admission requirements as all other students applying to the medical degree programmes. These emerged as essential components during extensive community consultation and a concern to reduce stigma for applicants. Opting to apply to the medical school via the BSAP means that each participant’s application is assessed by at least one Black member of the health community.

“I was excited to discover the existence of this program because it showed me that the University of Toronto recognized the importance of recruiting and promoting Black individuals to apply to their medical school,” said CJ Lindo, a successful BSAP applicant. 

In summer 2020, it was announced that more than twenty Black medical students had been accepted by the University of Toronto - the largest cohort of Black medical students in Canadian history and a significant increase on 2016. Some of the successful applicants had previously participated in the Summer Mentorship Program. Semir Bulle, MD student and Co-President of the Black Medical Students’ Association at the University of Toronto, noted, “In the last couple of years, we’ve had a complete transformation of the make-up of our medical school class, going from having only one Black student in the incoming class of 2016 to having 30+ currently within the first two years of pre-clerkship.”

Semir Bulle

MD student and Co-President, Black Medical Students' Association at the University of Toronto
“In the last couple of years, we’ve had a complete transformation of the make-up of our medical school class, going from having only one Black student in the incoming class of 2016 to having 30+ currently within the first two years of pre-clerkship.”




One of the newly-accepted Black medical students, Fatimah Roble, said, “This news means that things are starting to change and things are starting to change for the better, and that one day we’ll be proportionately represented in the entire field of medicine.”

Getting into medical school is one thing, but as Dr. Onye Nnorom, Black Health Theme Lead for the Faculty’s MD Program and the Equity, Diversity and Inclusion Lead for the Faculty’s Department of Family and Community Medicine noted, “…we need to ensure that there is a cultural shift in medicine so that we’re not only increasing the number of Black medical students, but we’re also ensuring that they are in a space that values equity and offers Black medical students equal opportunities for advancement.” The Faculty has therefore put in place support to deal with mistreatment, to foster mentorship and will be adding a counsellor with expertise in anti-oppression and anti-Black racism. Dr. Nnorom’s role as Black Health Theme Lead was created to ensure the curriculum also reflects the diversity of healthcare needs.

The BSAP model has recently been adopted by the Faculty of Law at the University of Toronto and other Canadian medical schools, including those at the University of Calgary and University of Alberta, are also rolling out similar models to diversify their student body.

Research shows that diversity in the field of medicine leads to improved access to health care and higher quality care for minority patients, who tend to seek out minority physicians. Professor Lisa Robinson, Associate Dean for Inclusion and Diversity at the University of Toronto’s Temerty Faculty of Medicine, noted, “Studies show that increased diversity of medical students provides students with unique learning opportunities and ultimately leads to better physicians with a greater ability and understanding of diverse communities.” 

Find out more about Advance HE's work in Equality, Diversity and Inclusion, and the common issues in further and higher education to design inclusive support services, develop accessible campus environments and make everyone feel welcome at your institution.

Photo credit: Semir Bulle by Julia Soudat, Temerty Faculty of Medicine, University of Toronto.

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