Quick facts

• Year: 2022-2024

• Country: Scotland

• Institution: West of Scotland Genomic Medicine Centre, NHS Greater Glasgow & Clyde , NHS Scotland

• Learners: Postgraduate trainee genetic counsellors (pre- and post-qualification), qualified genetic counsellors undertaking continuingprofessional development, and members of the multidisciplinary genomics team involved in case-based learning andsupervision (including clinical scientists, SpRs and clinical geneticists contributing to training activities).

• Aims: Improve learner understanding of racialised health inequities in genomic medicine, increase confidence in discussing race, power and inequality in clinical encounters, embed anti-racism as a core dimension of clinical competence, improve equity, trust and safety in patient care through more inclusive practice, create psychologically safe spaces for trainees and staff to raise concerns about inequity

Why was the education intervention developed?

This intervention was developed in response to repeated observations of racialised inequities within genomic healthcare and genetic counselling education.

Within the service, there were inconsistencies in how cultural, religious and social contexts were recognised in high-stakes clinical pathways such as prenatal testing.

Racialised patients were more likely to experience misunderstanding, reduced trust, and unequal access to options.

At the same time, trainees and clinicians reported low confidence in discussing race, racism and power in clinical encounters. Equity was often treated as a personal value rather than a core clinical competence, and concerns about inequitable practicewere frequently minimised or avoided at a senior departmental level.

These patterns reflected wider national evidence that structural racism in healthcare education contributes to persistent health inequalities. As genomic medicine becomes increasingly central to diagnosis and treatment, the failure to embed anti-racism into training risked reproducing inequity in a rapidly expanding field.

The intervention was therefore introduced to integrate anti-racist principles directly into genetic counselling education, supervision and case governance.

The aim was to move beyond generic “diversity training” and instead support learners to recognise how racialised assumptions, power and structural inequality shape clinical decision-making, communication and patient outcomes.

What was involved in the education intervention?

The intervention was embedded within routine postgraduate genetic counselling education and clinical supervision rather than delivered as a one-off training session. Learning took place in clinical teaching rooms, multidisciplinary meetings and supervision settings.

Anti-racism was integrated into case-based teaching, reflective practice and supervision frameworks. Real clinical scenarios were used to explore how race, culture, faith and structural inequality influence risk interpretation, consent, communication and decision-making.

Learners were encouraged to reflect on their own positionality and how power operates within healthcare encounters. Teaching methods included facilitated case discussion, guided reflection, supervision-based learning and portfolio work rather than didactic lectures.

The design prioritised psychological safety, recognising that racially minoritised learners may be disproportionately affected when racism is discussed. The educator’s positionality and lived experience were acknowledged aspart of the learning environment.

The intervention was longitudinal and integrated into core training rather than optional. Content included structural racism,cultural safety, bias in risk communication, and the relationship between inequity and patient safety.

Alongside education, an equity-focused case review approach was introduced, allowing clinical teams to reflect on whether patient pathways were equitable, culturally safe and consistent.

How was the education intervention evaluated? 

Evaluation was primarily qualitative and practice-based. Methods included learner feedback, reflective portfolios, supervision discussions and observation of changes in clinical practice.

Learner outcomes assessed included confidence in discussingrace and inequity, depth of reflection, and ability to identify bias in case formulation and communication.

Service-level indicators included changes in documentation of cultural and religious needs, inclusivity of option-discussions, and patient engagement in consultations.

While early impact was evident, further formal evaluation was limited by organisational and governance constraints. This highlighted the importance of leadership and institutional support in sustaining and evaluating equity-focused educational work.

What was the impact of the education intervention?

Learners demonstrated increased confidence in discussing race, power and inequality in clinical settings. Reflective portfolios showed greater awareness of bias, structural factors and ethical complexity in genomic care. Trainees reported feeling better equipped to navigate culturally sensitive conversations and challenge inequitable practice.

There were also observable practice-level changes. Cultural and religious contexts were more consistently documented, and discussions of uncertainty, testing options and consent became more inclusive. Patient engagement and trust improved, particularly in high-stakes pathways.

However, departmental engagement was uneven. While individual learners and some team members embraced the work, there remained reluctance within parts of the organisation to fully engage with race and racism.

This limited the sustainability and formal evaluation of the intervention and highlighted the need for structural leadership support.

No formal quantitative comparison between racially marginalised and white learners was undertaken, but both racially minoritised staff and white staff reported that the intervention created safer spaces for discussion and validation of lived experience.

Key learnings

• This case demonstrates that anti-racism can be meaningfully embedded into healthcare education when integrated into core learning and supervision.

• Psychological safety is essential for this work, particularly for racially minoritised learners.

Challenges

• Challenges included organisational reluctance, limited governance support, and restricted capacity for formal evaluation.

• Education alone cannot overcome structural barriers.

Recommendations

• Future interventions should be supported by leadership, formal evaluation frameworks and accountability mechanisms to ensure sustainability and impact.