Student Surgical Skills Training with PRIDE: Preclinical Redesign with Inclusion, Diversity and Equity

Introduction: setting, background and identification of needs leading to the initiative
Surgery is notorious for its lack of inclusivity and diversity. A recent scoping review reports that women do not feel safe, and feel a lack of good mentorship, leading to a loss of diversity [1]. A major barrier is surgical training, and can therefore be tackled by innovative educational redesign.
Next, diversity in people of colour and inclusivity is lacking in leadership positions in Dutch academic medical centres, and leads to selective hiring of new staff [2].
Visibility of LGBTQ+ role models for students is poor, as many feel unequally treated or even discriminated [3]. People with disabilities form the largest of all minority groups, with a major impact on school access for e.g. persons with a walking disability [4].
Everyone experiences and interacts with the environment in their own way, without one “right” way [5]. Unfortunately, learning environments are often not designed to accommodate sensory needs, not allowing for neurodiversity in a student population.
Specifically for simulation-based training, manikin simulators modelling the human body (i.e. cardiac resuscitation, vein puncture arms) are predominantly young pale-skinned male models [6]. Medical training scenarios have unconscious bias towards mainstream individuals and groups. Best-practices are available around the world, but are not yet adopted
in higher education in the Netherlands or more specifically, in mandatory Technical Medicine student surgical training courses.
Thus, there is a need for increased accessibility for people with physical, visual, and hearing impairment, and for fostering neurodiversity, racial and sexual equality, and improve LGBTQ+ inclusion in education, which should ultimately lead to a more diverse profession.

Description of initiative and approach/methods used
A multi-axes SIM-EDI tool will be used [7], including accessibility for people with physical, visual, and hearing impairment, fostering neurodiversity, racial and sexual equality, and LGBTQ+ inclusion. Students and staff from these domains, and educational consultants are included in both assessment and redesign as co-creators. A self-assessment
on equity-focused teaching will follow. Course redesign for academic year 2024-2025 will be evaluated after next year’s course.

Discussion of the impact/outcome, and novelty of the initiative
Developed teaching materials, activities and practical models to improve accessibility are shared with the educational, medical, and Diversity, equity and inclusiveness (DE&I) community under Open Access, and during the SESAM 2026 conference as workshop.

Keywords
Surgery; Diversity, equity and inclusiveness (DE&I); course redesign; student learning

References/Acknowledgements
1. Ferrari L, Mari V, Parini S et al. Discrimination Toward Women in Surgery: A Systematic Scoping Review. Annals of surgery. 2022;276(2):246-55.
2. Yakar D, Schuit S, Kahmann M, Kwee T, Mourits M. Zo komen we er niet met diversiteit in de UMC’s. Ned Tijdschr Geneeskd. 2022;166(D6659):1-4.
3. Renkema M. Inclusiviteit van LHBTQ+-medewerkers vraagt meer dan een regenboogvlag: Chief Human Resources Officer (CHRO). 2021/07/08. Available from:
https://chro.nl/artikel/inclusiviteit-van-lhbtq-medewerkers-vraagt-meer-dan-een-regenboogvlag.
4. Rochette A, Loiselle F. Successfully performing a university student's role despite disabilities: challenges of an inclusive environment and appropriate task modification. Disabil Rehabil. 2012;34(25):2201-6.
5. Mkatini S, Pascual-van der Landen L, Neys M. Diversity | Equity | Inclusion (DE&I) Action Plan 2022 - 2024. Enschede: University of Twente, Team DI; 2022/07/11.
6. O'Connor P, Byrne D. Fostering diversity in healthcare simulation. International Journal of Healthcare Simulation. 2022:1–2.
7. Purdy E, Brazil V, Symon B. International Clinician Educators (ICE). 2021 2021/09/14/. Available from: https://icenetblog.royalcollege.ca/2021/09/14/equity-diversity-and-inclusion-in-simulation-a-reflexive-tool-for-simulation-delivery-teams.