By Anushka Shenoy
Larissa Guran wrote last month about our “Leadership, Education, and Structural Competency” course at OHSU, and I would like to add to her thoughts. As a reminder, we developed the course to learn facilitative leadership skills, strengthen our understanding of social determinants of health, and develop and facilitate five small-group sessions about structural competency for the new MS1 curriculum. After a session on implicit bias, we introduced the concept of taking an “Affective Time Out” to reflect on the emotional, mental, and intellectual preconceptions we bring to each patient encounter. As we approach our final MS1 session, I wanted to take my own “time out” of sorts and reflect on this experience.
Here’s what I’ve learned:
Collaborative learning works if it’s authentic and student-driven. For this class, three to four students developed the curriculum for each MS1 session, and we workshopped each session for over two hours as a large group. I learned how best to engage with my peers on sensitive issues; for example, we had a somewhat tense discussion during one workshop after which a classmate provided candid feedback about my communication style and body language.
I also learned when to remain quiet: Our curriculum development sessions became increasingly efficient as we each streamlined our comments and compromised on most issues, allowing time to discuss the few crucial ones in depth. Most important, I saw the innovation and passion of my classmates firsthand and raised my own performance to meet them. We each had skin in the game and were working on a real, sometimes daunting project with a tangible outcome (hours of the new curriculum!), so the collaboration felt authentic, necessary, and tremendously educational.
Near-peer teaching has tremendous inherent value. My co-facilitator, Jeff, taught our material as though it was as central to our success as physicians as learning about statins or idiopathic hypertension, and his passion was contagious. I think the MS1s enjoyed our enthusiasm, as well as the low-risk environment, and engaged in genuine, heated discussion and debate in every session. They also provided candid feedback on our content and facilitation, giving us an opportunity to adapt. There’s something about near-peer teaching that raises the stakes for everyone: We respected our students’ time and energy at least as much as our own, and they respected our motivations for building and sharing this curriculum.
Most of us are more in agreement than we think or let on. We used a “spectrum exercise” in several of our small groups, wherein you pose a question with a spectrum of answers and ask participants to stand in lines indicating their positions. For example, we asked, “Is homelessness a product of personal factors or overlying structures?” Those who believed homelessness is caused 100 percent by personal factors stood on one side of the room. Those who believed it is caused 100 percent by overlying structures stood on the other side, and most picked spots in between. Then students explained why they picked their spots. We discovered that when people speak purely for themselves (not for all those on one “side” of an issue) and articulate their own nuanced beliefs, it becomes easier to find agreement while clearly recognizing difference. For example, one student stood very close to the “personal factors” end of the spectrum because he thought that many people become homeless because of mental health problems, while another student stood on the other end for the same reason. This led to a conversation about where the responsibility for mental health care lies, which was far more productive than a general conversation about the causes of homelessness might have been. It’s easy to think our classmates and peers disagree with us on a basic, human level, but we share at least some values and hopes.
In conclusion, I am proud of the curriculum that we built and the experiences that we gained and provided for the MS1 class. I encourage others to think outside the box in developing curriculum, and trust that your subject matter, peers, and learners are worthy of respect and capable of challenging and inspiring you in ways you couldn’t have imagined. I know mine are.