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Letters to the Editor

Race and Culture in Teaching Cases

Azer, Samy A. MD, PhD, MEd, MPH

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doi: 10.1097/ACM.0000000000003068
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To the Editor:

I agree with Krishnan and colleagues1 that sociodemographic identities, despite their significance in patient health outcomes, could be presented in teaching cases in ways that inadvertently reinforce stereotypes. The involvement of medical students, as shown by the authors, in developing a systematic approach to guide case revisions and advance teaching about race and culture looks impressive. Although the guide may provide a framework and highlight areas of deficiencies in teaching cases, depending on such a guide to revise cases may not be ideal. The involvement of medical students in reviewing cases may enhance their critical thinking and writing skills. However, there are 3 strategies to be considered:

First, the involvement of stakeholders and community representatives in the revision process is vital. Writing and reviewing cases is an art.2 When my former colleagues and I reviewed our teaching cases at the University of Melbourne, we asked the aboriginal liaison officer and members from the community to join the review process. Cases involving indigenous people, refugees, or minority groups need such involvement to edit the language, changing case titles as needed and removing stereotypes concerning race, gender, and social class.3

Second, staff development and faculty training,4 particularly for those involved in facilitating these cases, is vital to ensure successful implementation. This means the tutor’s guides should clearly explain the changes to the cases. The aboriginal liaison officer and members from the community who helped revise the cases should also be involved in briefing the cases.

Third, such revisions should not only focus on students’ learning—as the authors emphasize. The revision process is a great learning opportunity for faculty, students, and the institute and could contribute to building community-engaged curriculum.5

Thus, in this regard, the guide the authors developed should not be aimed at limiting the scope and direction of teaching case revisions but at encouraging the team reviewing such cases to work with the stakeholders and community representatives to get such reviews and implementations right.

Samy A. Azer, MD, PhD, MEd, MPH
Chair of curriculum development and research unit and professor of medical education, King Saud University, Riyadh, Saudi Arabia. Formerly, senior lecturer in Medical Education, Department of Medical Education, Melbourne Medical School, University of Melbourne, Victoria, Australia;; ORCID:


1. Krishnan A, Rabinowitz M, Ziminsky A, Scott SM, Chretien KC. Addressing race, culture, and structural inequality in medical education: A guide for revising teaching cases. Acad Med. 2019;94:550–555.
2. Cohen DA, Newman LR, Fishman LN. Twelve tips on writing a discussion case that facilitates teaching and engages learners. Med Teach. 2017;39:147–152.
3. MacLeod A. Six ways problem-based learning cases can sabotage patient-centered medical education. Acad Med. 2011;86:818–825.
4. Langlois JP, Thach SB. Bringing faculty development to community-based preceptors. Acad Med. 2003;78:150–155.
5. Strasser R, Worley P, Cristobal F, et al. Putting communities in the driver’s seat: The realities of community-engaged medical education. Acad Med. 2015;90:1466–1470.
Copyright © 2019 by the Association of American Medical Colleges