Dismantling Systemic Bias and Stigma in Medical Education: A Case Review Process
Micaela K. Roy, Rita S. Lee, Kristin FurfariIntroduction
Medical education can perpetuate systemic bias and stigma when patient teaching cases omit diverse patient identities or include stigmatizing language. These practices can reinforce implicit bias, alienate historically marginalized learners, and inadequately prepare future physicians to address health inequities. To address potential direct and indirect harms to students and patients, the University of Colorado School of Medicine developed a systematic case review process to promote equity and inclusivity in medical teaching materials used across the medical school curricula.
Methods
Faculty and students co-created a case writing template which emphasized person-first language and required the inclusion of explicit demographic information such as race, ethnicity, and gender identity. A diverse committee of 12 faculty and 12 student representatives reviewed all cases across the four-year teaching curriculum. Each case underwent iterative review for bias, stigmatizing language and demographic omissions until they were accepted by the committee without revisions. Finally, a curriculum-level demographic analysis was performed to ensure adequate representation of diverse identities across all teaching cases.
Results
The case review committee reviewed a total of 133 unique teaching cases. Of these, 30.1% were accepted without changes, 64.7% required minor revisions, and 5.3% required major revisions. Sixty-two cases contained stigmatizing language and 34 cases included stereotypes or biased content. Most original cases did not specify race, ethnicity, or sexual orientation, and defaulted to cisgender (a person whose gender identity aligns with their sex assigned at birth) and white identities. Through the case review process, bias and stigmatizing language were identified and suggestions were made for revision. Cases were modified to explicitly include diverse identities and underrepresented populations, such as patients who identify as transgender and those who identify as American Indian or Native American. Through this process, faculty case writers gained exposure to equity-focused language standards, and both students and faculty contributed to creating a more inclusive curriculum.
Conclusions
Implementing a structured case review process successfully removed stigmatizing language and improved representation of historically marginalized identities in medical cases used in a medical school curriculum. This model provides a practical, replicable approach to help dismantle systemic bias and racism in medical education. Sustained success will require ongoing faculty development, demographic tracking, and evaluation of downstream outcomes such as student sense of belonging and preparedness to care for diverse patients. While this intervention was necessary, it was not sufficient on its own to eliminate systemic and structural racism in the medical school curriculum. Next steps should include pairing a detailed case review process with related institutional, policy, and clinical learning-environment reforms.