Aquifer is committed to serving as a leader in addressing healthcare disparities and barriers encountered in clinical practice through our approach to developing, delivering and optimizing online health professions education and continuous learning.
The virtual cases in our curriculum have been created to represent a varied population made up of individual persons with their own identities. This means that each virtual person presenting to the healthcare environment for care has been given certain characteristics which are represented through narratives and photos. We strive to use person-centered language (e.g., a “person with diabetes”, rather than “a diabetic”) to recognize the shared humanity of our characters, who serve as representations of real people who exist beyond their disease states. We have also made every effort — through thoughtful creation, extensive faculty and student review, ongoing learning, changes in response to user feedback, and personal reflection and rewriting as needed — to avoid perpetuating stereotypes or bias through the pairing of individual personal characteristics with health or disease. Still, we are unable to completely avoid such pairing in portraying our virtual patients as real people and we recognize that any creative process, despite our best efforts, inherently may imply such a bias.
We recognize that there are variations in how individuals self-identify, that individuals within groups may have different personal preferences, and that those preferences may change over time. Since individuals have the right to to define their own identities, we include a dashboard (similar to that found in a typical Electronic Health Record) at the beginning of each case which reflects each virtual person’s self-identified name, age, gender and pronouns, language chosen for medical communication, as well as sex assigned at birth. These particular descriptors are included up front due to their importance in fostering appropriate communication (e.g., the use of the preferred name and pronouns) with the healthcare team and in understanding a given virtual person’s underlying anatomy and physiology.
For those virtual persons whose stories and characters are fully developed within a particular case, we also include self-identified race/ethnicity as part of the social history. We include this here, rather than in the dashboard, to acknowledge that while race/ethnicity is not a biological or genetic construct that is relevant to medical decision-making, it may impact a particular person’s experience in the world and in the healthcare system. When race and ethnicity correlate with clinical outcomes (e.g. differing rates of disease), we strive to make explicit that these disparate outcomes are not due to biological phenomena and may be due to environmental, community and institutional factors that should be addressed as part of the person’s care.
Where we have been perceived to be unsuccessful, we invite the thoughtful student or educator to leave us constructive feedback and alternative suggestions. We also recognize that a given virtual scenario may pose a painful situation or story for an individual learner. Should this occur, we acknowledge this unintended impact with sympathy and invite feedback on our approach to this issue. We deeply value learning from and improving together with our educational community. To this end, we strive to offer a thoughtful and productive learning experience that belongs to everyone, and to practice respectful engagement in all that we do.
