Examining EDI in PA Education: Building an Inclusive Culture and Organizational Structure 

Individuals who work and learn in inclusive environments thrive academically and professionally. and educational research shows wide agreement about the benefits of an inclusive learning environment; however, what that looks like and how to achieve it is often less clear to program leaders. 

Skylar Stewart-Clark, PhD, PA-C, associate program director at Frostburg State PA program, shared some thoughts with PAEA members on the topic.  

“I think it’s the right thing to do as educators,” she said. 

She said that inclusion is a broad topic, primarily she looks at the issue through the lens of race and ethnicity; although, she acknowledged there are other identities that need to be considered. 

Stewart-Clark said she thought it was important for programs to define “inclusion” in order to take steps to reach a specific goal. 

“We can think about the antithesis of ‘inclusion’ which is exclusion. That tends to make people feel unwelcome and, in the context of race and ethnicity, tends to generate feelings of discrimination and racism,” she said. 

Stewart-Clark said she was struck by a definition of inclusion she heard from Lily Zheng, who defines themself as a diversity, equity, and inclusion strategist. At a conference she attended, Stewart-Clark said she heard Zheng describe inclusion in a way that truly resonated with her. 

“(Zheng said) inclusion is when the most marginalized individual or group of individuals within a particular landscape feels included. …  It really pushed forward the human element of it all. Inclusion really is just about how you’re treating other people,” she said. 

This definition helps to define the importance of inclusion as “centering the well-being of the individuals at the margins,” Stewart-Clark added. 

Inclusion leads to well-being, Stewart-Clark said, so if PA educators want to produce clinicians who are mentally healthy, inclusion should be a priority. 

“If we think about psychology and Maslow’s hierarchy of needs, at the very bottom, we need food, water, shelter, clothing. At the middle, not at the top, but it’s a building block to self-actualization, well-being, and being your best self. People need to be included,” she said. 

Under the hierarchy, “Love and Belonging” includes a sense of connection and “Self Esteem” includes respect of others. 

 As Stewart-Clark advanced in her career and took on a leadership role, she found that it was critical that programs had some kind of structure in place. 

“It’s not enough for the leaders in the organization to be committed and the individuals are not, and the department is not. I think about micro-level individual interactions and ways to govern those interactions and relationships and hold people accountable,” she said. 

Stewart-Clark said she has doubts about a program’s ability to commit to inclusion if the leadership isn’t involved at all levels to be sure that leadership, individuals, and the department are working together toward a common goal. 

Stewart-Clark added that she would like to see more research into inclusion, using Zheng’s definition, determining what a program that pursued that goal would look like and how to measure ways it met those would meet that goals. 

Training in emotional intelligence and conflict resolution for leaders in a PA program might also help address situations before they grow divisive, Stewart-Clark added. 

Mindful of Zheng’s definition that an environment is not inclusive if the most marginalized do not feel included, Stewart-Clark shared some final advice. 

“Organizations, programs, hospital systems, need to start evaluating what voices they are listening to.” she added. If all they are hearing is “Oh, yeah, I totally feel included” they may be listening to the wrong voices. “I think if they move the curtain aside just a little bit, they might see that they’re not hearing from the individuals who really need those supportive structures, need to know that their perspectives are valued, need to know that they are supported in a way that they can thrive.” 

Stewart-Clark said that leaders of programs who want to make their spaces inclusive need to be willing to confront inequities. 

“We have to not only acknowledge the racist past of the United States and the racist history of medicine, but we have to start holding people accountable and making them come face to face with these issues in a way that cannot just be avoided,” she said.