An Undergraduate Elective Course That Introduces Topics of Diversity, Equity, and Inclusion into Discussions of Science

The community of scientists has never been as diverse as the population at large in the United States (1). The current culture and practices of science are not always welcoming, leaving women, people of color, individuals with disabilities, and those who identify as LGBTQIA+ minimized or left out completely. This can mean the advancement of science does not benefit from their potential contributions. Our classrooms and laboratories become more accessible, engaging, active, inclusive, and equitable when we encourage and promote diversity. Some excellent strategies for doing this have been previously published (e.g., 2–5).

The purpose of this article is to share an approach that incorporates the topics of accessibility, inclusivity, and equity as part of the subject matter of a science course itself. Our science classrooms and the practice of science will continue to reflect the broader and systemic inequities of society and education unless we specifically create structures to recognize, challenge, and change them. Our elective upper-level science course, Science, Ethics, and Society at the St. Louis College of Pharmacy, is constructed to help students discuss that scientists do not represent the composition of the public and to explore what could have led to this. They begin to wrestle with how racist, sexist, and classist mindsets and policies have led to science incidents and scenarios, such as the Tuskegee Study, the eugenics movement, few women and minorities at the top of science and medicine, and health disparities in the population. Purposefully discussing these topics can position students to see what is at play in our system and culture of science and how they may become agents of change in their future positions in science or medicine.

This elective course affords students an opportunity to read primary and secondary material that presents research and evidence to address questions that scientists face. It explores the intersection of science, policy, and the public in addressing topics such as vaccines, genetically modified organisms, climate change, and stem cell research. This promotes dialogue about the impact of science denial by the public, how approaches of scientism (6) that purport science as the only way of explaining and understanding the world do not make science publically accessible, and the importance of framing science and of science communication. The discussion-based and writing-intensive course encourages undergraduate students to create connections between their science coursework, our society, and their lives.

This course is offered as an elective to students who have had at least three semesters of biology science classes so that they are prepared for the content of the biology concepts. The more coursework the students have had, the easier it is for them to grasp the science topics, but requiring too many courses can be a curricular restriction. Another model is for it to be a required senior capstone course (7; unpublished course materials). An ideal scenario may be aiming for a junior-level course with the recognition that students will have had different courses to prepare them and that the instructor may need to help guide students in filling in gaps in their biology training on certain topics (such as developmental biology to discuss stem cells, or molecular biology to discuss genetically modified organisms). The instructor should be prepared to informally assess previous student preparation for various topics, provide extra resources online for those who may not have covered certain topics in class or who want to learn more, and be prepared to present an overview of the key science areas in the classroom to be sure all students are ready for discussions that make use of these topics.

To prepare the students to engage in discussion, course readings are provided online through a course management system with a document that lists each of the readings, guidance as to the level of depth they should consider, and the maximum time they should spend (no more than 3 hours reading and writing to prepare for each 1.5-hour class). For each day’s reading collection, they are instructed to summarize each piece and then reflect on them as a set [summarized in the syllabus (see Appendix 1)]. Their summaries help them track what they learned from each piece, and the personal reflections often include how they may have experienced the topic, how it may be new to them, or how it strikes them. These class preparations are to be uploaded in advance of each class to demonstrate their effort. Class preparation notes are graded fairly generously, with a focus on seeing genuine effort to read and understand the pieces. Points may be taken off if not all pieces are covered, summaries are so vague it is not clear that they were read, or comprehension appears drastically off.

This is a discussion-based course [see example syllabus (Appendix I)] in which the students do the majority of the talking, with the instructor as the facilitator, and therefore all are seated in a circle to promote dialogue. Because the topics can sometimes be new, uncomfortable, or pushing at the students’ held beliefs and learning edges, it is important that class norms be shared in a syllabus and discussed as a group on day 1, such as: (i) invitation to full participation, (ii) respect for differences and listening for understanding, (iii) speaking in the “I” voice, (iv) confidentiality for personal information shared in the space, (v) making a space for all voices to be heard, (vi) acknowledge and embrace conflict and dissent, (vii) work the issue, not a person, (viii) trust the process, and (ix) lean into discomfort at our learning edges (8; see also the last page of the syllabus in Appendix 1). To help underscore these approaches to productive discussions, readings on a particular topic are often selected to hear from different viewpoints and that help prompt discussion. For instructors who have not had training in facilitating dialogue in the classroom of this sort, several resources are available that may be helpful (9, 10; https://igr.umich.edu/about ). Throughout the course, instructors can return to the norms as needed and request short reflections from the students, to help the class negotiate any challenges. The goal is to provide a safe and constructive way for students to wrestle with the topics, challenges, and potential solutions. An anonymous mid-semester feedback about how the course is going can help instructors gauge if the students are feeling heard, respected, and if they feel the classroom is a safe space for the discussions. Early in the course we discuss the concept of holding opinions versus claims for which you can make an argument (11) and how science is framed and discussed by different groups (12). These resources are valuable in setting the stage for the course, helping us see and practice the importance of the community norms on low-risk topics, and are often referred to by the students across the course. Since they are expected to upload their notes and reflections on the readings in advance of the class, they are informed and empowered with the information in—and their responses to—the readings, enhancing their ability to equally contribute in class to the discussions.

In the first section of the course, we look at how science and scientists are perceived by the public. We begin with the perception of women in science, as it has been studied from many angles and is a place where we can see measured progress. We explore how scientists are presented in obituaries, particularly how women may be presented differently than men, in terms of their personal lives and science (13, 14). We discuss the Finkbeiner test (15), which proposes a set of rules to avoid sex and gender bias in science writing. This conversation helps the students consider how we present individual scientists and how that impacts how we view their contributions and our expectations. We then look at the numbers of women who “make it to the top” of science. The explanations of why there are fewer women in the upper echelons of science vary, including suggestions of lack of interest or commitment, reduced aptitude, accumulation of discrimination, and patterns of socialization. We review studies that specifically look at each of these areas (e.g., 16, 17). From these studies, the students learn how different interpretations can be made from data, how analyses may be framed, and how socialization has shaped how we view others and ourselves. We further explore how society has had different expectations about leadership styles for women and men (18). We address the concept of imposter syndrome and not believing in our worth (19) and dig into how comments that “sound nice” may really be benevolent sexism (20) that continue to hold to stereotypes and role expectations of women. We ponder that while science strives to be unbiased, it is performed by humans who are, by nature, biased. We take the Implicit Association Test (IAT) for Gender-Science (21) in class (they are then encouraged to take a race-based one out of class) and probe our own biases. This test is usually new to them and requires some background. It is valuable for the instructor to verbally recognize that the test mechanism is frustrating (the system of keystrokes) and not perfect (as none are), but that it has been well-studied and documented as one of the most useful tools for this type of awareness training. Acknowledging that we all have biases and that being aware of them can help us think before acting on them is valuable in helping students accept and process what they may discover about themselves. It is also valuable to give them time to anonymously reflect on what they learned about themselves. The instructor can then comment to the class as a whole for anything that came out of the reflections. Often students need to be encouraged to just sit with the results for a while and to not feel distressed about them. We also discuss the studies that demonstrated that science faculty favor male students (22) and how stereotypes persist that do not help women stay and succeed in science (23). These are not topics that have been a part of the students’ discussions in their pure content courses, but they each have experiences and reflections to bring to the conversations.

We then look more closely at science and the experiences of people of color and of underrepresented identities and groups. We explore what affirmative action is and is not (24). We investigate how group stereotypes limit our view of an individual. We specifically look at challenges and hurdles for black women in science (25, 26) and black men in science (26, 27), and we explore contributions by individuals of color that the students may not have heard of before. We have also explored the impact of stereotypes and challenges faced by other groups, such as Asian and Hispanic Americans, as well as indigenous peoples of America. Our conversations here have often been varied, based on the composition of the class for that particular year and their experiences. We further consider how science and medicine has not always been welcoming to those of the LGBTQIA+ community (28) or those who have a disability (29). We articulate how diversity and inclusion in the workforce is a benefit on many levels (30) and to the scientific process itself. We read about the experiences of black women and infant mortality (31) and the incorrect beliefs in medicine about biological differences between blacks and whites (32). Here, the students can see how our biases and behaviors directly impact patient outcomes and the role that bias and misinformation have played in perpetuating health disparities. Students are generally quite empathetic to learning about the experiences of individuals and quick to recognize and acknowledge they haven’t thought about particular hurdles or challenges that others may face.

When we address human subjects in research and ethical codes (e.g., 33, 34), we discuss some of the cases in history that led to the necessity of these documents and events since then that have violated them. We deliberate upon the issues of informed consent, the challenges of study recruitment, outsourcing drug trials to other countries, the differences for some emergency scenarios, and public perception of science. The students are often horrified by the incidents we discuss and the actions of scientists and medicine, but they also come to appreciate the complexity and challenges of what goes into drug trials and the medical process. This brings us to how accessible or not science and medicine make science to the public, selective science denial by members of the public, and how medical research has been conducted largely with a white male population. Through these discussions, students wrestle with the role of science, scientists, and the media in shaping science. This also brings us back to the challenges of recruiting to science and the impact of public perception and consumption of science.

In addition to the readings and discussions, the course is a writing-intensive one with several opportunities for informal writings and three formal essays, one to conclude each section. While not the focus of this article, these essays are described briefly here to give the reader more context of the course. For the first section, with a focus on how science and scientists are perceived by society, the students choose a popular portrayal of science in the public realm (such as a movie, television series or episode, or novel) and analyze it using their scientific knowledge and awareness lenses from class to critique their selected piece for scientific accuracy and the portrayal of scientists and science (for details on Essay 1, see Appendices 2 and 6). For the second section, with a focus on who has participated in science, they are instructed to write a response to discussed hypotheses (such as those presented in reference 35 and discussed in reference 36) as to why the make-up of scientists doesn’t more closely reflect that of the population of the United States. This essay is citation and evidence-based, and they are expected to use the works that were discussed in class to support their claims (for details on Essay 2, see Appendices 3 and 7). The third essay addresses ethics in science. As a class, we discuss and methodically analyze case studies presented in which individuals were on the edge of committing acts of plagiarism or data fabrication, issues of disclosure, and relationships demonstrating power dynamics (37). For this essay, the students are given a new case to analyze using their practiced skills. They summarize the case, discuss the key areas using a published approach, and conclude with their recommendations of how to resolve and avoid the issue (for details on Essay 3, see Appendices 4 and 8). Across the semester, time is given in class to outline or prewrite for the essays, drafts are spaced across the semester, opportunities are provided for peer review using a guided rubric, and writing center feedback on each essay is encouraged.

In addition to the course discussions and essays previously described, the students each have the opportunity to present a set of readings to the class and to read and discuss (in an online format) two books that underscore the topics of the course. For their reading presentation, students are presented a list of topics and dates at the beginning of the semester and they sign up based on a topic (and timing) of their choice. The two books used to support the course material are The Cutter Incident: How America’s First Polio Vaccine Led to the Growing Vaccine Crisis by Paul A. Offit and The Immortal Life of Henrietta Lacks by Rebecca Skloot. Online discussion of these books are prompted by a posted list of discussions questions and they are to post four original responses (one for each book section) and reply to four posts made by their comments. Additional information about these aspects of the course can be found in the syllabus (see Appendix 1) and the presentation rubric (Appendix 5).

The course learning outcomes and their assessments are as follows:

Because the course is a writing-intensive one, writings must make up at least 50% of the grade. Formal essays make up 45%, informal writings (consisting of preclass notes and other in-class prompted reflections) make up 15%, online discussions (pertaining to the two course companion books) make up 15%, oral presentations (discussed above in which the student presents a series of readings) are worth 10%, and attendance and participation are worth 20%. To monitor the attendance and participation portion, daily contributions to the discussions are tracked both in number and in substance. These latter comments would be ones that clearly related to the day’s reading, making a connection to a previous topic, or provide thoughtful insight to the topic. With the expected preparation, each student should be able to contribute one or two (depending on the length of discussion and number of contributions across the class) substantial contributions to any particular day’s topic. Often students are invited to contribute in an “around the room” style to give each student a chance to offer their thoughts (see syllabus, Appendix 1, for details).

The use of pre- and post-surveys to investigate “The impact of studying diversity in science in an undergraduate science course at a co-educational institution” was reviewed and determined to be exempt by the St. Louis College of Pharmacy Institutional Review Board (IRB-2017-14). The questions and data from these surveys goes beyond the scope of this article. The end-of-semester student course survey responses, however, provide insight to the class impact with the answers to the questions of “How has this class changed how you think about topics of science, scientists, society, and ethics of science?” and “How has this class changed how you behave, act, or respond to related topics or events around you?” Their responses (Appendix 9) collectively suggest that they have met the learning outcomes of thinking of these topics more often, being aware of how science and society intersect, the challenges faced by individuals and groups of scientists, and a better understanding of the ethical challenges faced by scientists. Throughout the course, students expressed that they “haven’t thought about this before” or that they now have a better understanding of these topics and their importance to their field of study (largely pharmacy and other healthcare careers). Some think the course should be required for all students. On the other hand, some students express fatigue with the extensive readings or with continually examining challenging areas. The fact that students make comments on the daily reading sets allows for insight by the instructor into which pieces are most accessible, what topics need more framing, which readings are difficult, and so on. One challenging aspect of the course is the ever-changing nature of current events and how that can bring about new readings. This requires removal of older readings, or re-grouping of single reading sets for presentation, while still maintaining key readings for essays. While challenging, this ever-changing portion of the course is also exciting for the students, as it shows relevance and they are actively engaged in finding related topics in the news.

Some faculty had initial questions about the proposal of this course, wondering if it was really sociology instead of science. It is both, as it includes the sociology that has shaped science, and addresses scientific content through the lenses of who does the science and how that shapes how science is done. This faculty push-back is inherently rooted in scientism and is, in fact, part of why course material like this is critical for the student curriculum and our future generation of scientists and health care professionals. Some of the things that I will be considering when I next offer the class will be to incorporate discussion of the companion books into the class discuss and the shifting of points to the preclass work notes and in-class discussions, as these are where students spend the most effort. When I taught this class at my previous institution, the informal writings about the readings were not required to be uploaded before class, so this portion is new in the last few years. It was previously a required capstone as well, and not an elective, so I continue to re-evaluate the student load. In addition to being offered as a stand-alone elective, the topics of this course could be used in pieces across other courses, in a capstone course, or as a collaborative effort between faculty and departments.

Special thank you to Audrey Ettinger, my course colleague when we taught this course at Cedar Crest College (an all-women’s college) in Allentown, PA, where it was a required capstone course. Thank you to Margaret Weck for her feedback and support on the conception and focus of the manuscript, to Elizabeth Coker for editing the original manuscript, to NCCJ St. Louis and their Certified Facilitrainer program for inspiring me to take my work in this direction, and to the students in my classroom. The author has no conflicts of interest to declare.