The encouragement of diversity is an inclusive process of appreciation of the unique contributions different individuals with differing backgrounds bring to an organization.⁵ For example, an educational program encouraging diversity values the differences among students and asserts that their uniqueness contributes to the formation of more knowledgeable and experienced professionals who will provide a higher standard of care for imaging patients.

The encouragement of diversity requires individuals to move beyond the Western tradition by broadening their learning and opening their minds to new forms of thought.⁶ As teachers mentor students through the educational process, they must also assist the students in moving beyond any self-centered worldviews. Even students from similar geographic locations and of similar races bring unique insights to the class as a result of their differing experiences and backgrounds. As they share these differences, they increase their knowledge base, which provides them with greater empathy for their patients and one another. This intellectual broadening is a crucial component in establishing an appropriate educational and working environment for people of many backgrounds.

Adaptation of resources for people of all backgrounds is termed multiculturalism. All the variables identified in issues relating to diversity also must be considered in discussions of multiculturalism.

MULTICULTURALISM

Multiculturalism is respect for the diversity of the many ways of knowing beyond the Western model, brought about by a broadening of learning and an opening of the mind to new ways of thought.

Interaction Patterns

Imaging professionals should be able to recognize the interaction patterns commonly encountered when issues of diversity are discussed. These interaction patterns are labeled -isms because of their common word endings. Each -ism involves a tendency to judge others according to a standard considered ideal or presumed to be “normal.” The -isms are grounded in bias, prejudicial in attitude, and discriminatory in their behavioral expression. An -ism is centered on personal judgment, regardless of evidence (Box 9-1).⁷

BOX 9-1

THE -ISMS

ableism

The assumption that people who are able bodied and of sound mind are physically or developmentally superior to those who are physically or developmentally disabled or otherwise different. Ableism occurs when medical professionals do not offer choices to patients who are chronically ill because they assume such patients do not want to or cannot make decisions.

adultism

The assumption that adults are superior to youths and can or should control, direct, reprimand, and reward them or deprive them of respect. Children in American society are often interrupted or ignored by adults. They may not be given choices that allow them to feel they have some control over a situation.

ageism

The assumption that members of one age group are superior to those of others. Young patients and staff members may not be taken as seriously as those who are older; in other circumstances, older persons may be discredited in favor of those who are younger.

classism, or elitism

The assumption that certain people are superior because of their social status, economic status, or position in a group or organization. This prejudgment assumes that those with more money or education are superior to people lacking in money or formal schooling. Elitism may occur in medicine if a poorly dressed high school dropout is not given the same treatment options offered to a well-dressed college graduate.

egocentrism

The assumption that oneself is superior to others. Egocentrism has occurred if a person (e.g., a staff member) who has never been diagnosed with a mental illness feels superior to a patient with a mental illness.

ethnocentrism

The assumption that one’s own cultural or ethnic group is superior to that of others. (Ethnicity refers to cultural differences other than race.) An organization or country may be ethnocentric if it expects all persons regardless of country of origin to speak a certain language or know a set of implicit rules for conduct that may be peculiar to that organization or country.

heterosexism

The assumption that everyone is, or should be, heterosexual and that heterosexuality is superior and expectable. Only recently was homosexuality redefined as a lifestyle rather than a disease.

racism

The assumption that members of one race are superior to those of another. (Race refers to presumed biologic differences based on skin color.)

sexism

The assumption that members of one sex are superior to those of the other. For example, women have historically been viewed as being less rational and more emotional than men.

sizism

The assumption that people of one body size are superior to or better than those of other shapes and sizes. Positions involving interaction with the public, for example, may be denied to individuals who are very heavy or otherwise fail to meet arbitrary standards of ideal appearance.

sociocentrism

The assumption that one society’s intellectual methods or actions are superior to the ways of other societies. For instances, Western medical practitioners may feel that biomedicine is effective and folk medicines are not, even when strong evidence exists that this is not always the case. Many traditional societies have highly effective, community-oriented forms of treatment.

From Creasia J, Parker B: Conceptual foundations of professional nursing practice, ed 2, St Louis, 1996, Mosby.

-ISMS

-isms are prejudgments entailing a tendency to judge others according to a standard considered ideal or presumed to be “normal.”

IMAGING SCENARIO

An imaging student from an affluent background is assigned to a clinical rotation providing chest radiographs in an urban medical center. The center provides care to many indigent and homeless people who require imaging services. The student has a great deal of difficulty understanding why these patients are unable to provide homes for themselves and why they are not employed. This lack of understanding affects the student’s ability to communicate with patients and project the caring attitude that is essential to high-quality imaging services. After clinical grades have been given for this rotation, the student is dismayed to receive a much lower score than he anticipated. He approaches his instructor and questions the grade.

Discussion questions

• What issues might the instructor discuss with the student?

• In what way do these issues affect ethical problem solving for this student?

• Can the student’s attitudes and perceptions be remedied? Should they be?

A Study in Diversity

A study conducted in a midwestern state concerned the incorporation of diversity topics into the imaging sciences curriculum.⁸ Researchers gathered information with a survey that asked a variety of questions of the program’s directors and students. The majority of respondents answered that topics relating to diversity were important and should be included in the curriculum. A sampling of the comments that were provided in answer to the survey and may be of interest to imaging professionals is included in Boxes 9-2 and 9-3. A small percentage of students enrolled in the programs believed that issues of multiculturalism and diversity are not important to the imaging curriculum. The researcher was concerned about this result. If students do not believe that an understanding of the differences among patients is important, patient care may suffer. Students who do not support multiculturalism may hold that all patients should be treated equally and medicine should be color blind or blind to other differences. This implies that all patients have the same needs. Imaging students would do well to remember that patients are unique and deserve imaging professionals able to recognize individual needs, but they do also all deserve quality imaging services. Program directors need to investigate issues of diversity early in the educational program. Caring requires an identification with and respect for the needs of all patients. When students respect differences, they are better able to care for patients.

BOX 9-2

PROGRAM DIRECTORS’ UNEDITED INDIVIDUAL COMMENTS

“We are beginning to explore these issues and how to integrate them into the curriculum.”

“JCAHO [Joint Commission on Accreditation of Healthcare Organizations] requirements include in-service education involving diversity.”

“ASRT [American Society of Radiologic Technologists] educators’ group listed diversity issues as important to core curriculum development.”

“I believe that if you would add this topic as a part of the curriculum, it would be important to have the class at the start of the first year.”

“Multiculturalism and diversity could be interlaced into current patient care classes.”

“In patient care there is some discussion about language barriers, age, and ability problems. Also, there are some ethics discussion dealing with sexuality, race, and religion, but no actual unit on cultural differences.”

“I agree that multiculturalism and diversity should be included within the program, but may be added to an already existing class.”

“We do very little and should do more on this subject. I don’t think we have the time to include an entire course but guest lecturers from other cultures would be beneficial. I may incorporate this into our class.”

From Towsley D: Assessing the skill requirements for radiographers in the traditional and patient-focused care settings, Radiol Sci Educ 2(1), 1995.

BOX 9-3 STUDENTS’ UNEDITED INDIVIDUAL COMMENTS