As I noted in my previous post, recently I participated in the inaugural BC Forum of the Canadian Coalition for Global Health Research in Vancouver, British Columbia. One of the great things about this conference for me was meeting many students and residents that are interested in global health, mainly from Canada, but also from the United States. This was also an opportunity for me to meet with Jonathan Smith, who while he was an Masters in Public Health student at Yale University created a film called “They Go To Die” http://theygotodie.com/ to focus on the plight of South African miners infected with TB+HIV that brought attention to their plight. His film was financed and publicized through social media, and I was one of his early supporters. Before the conference there was a screening of his film at the University of British Columbia, where one of the attendees was Alia Dharamsi, a 2nd year medical student. When it was mentioned that I was one of the films early supporters, and that I was on Twitter, she looked me up and invited me out to visit her medical school.
Even better than the beautiful campus of the university, however, was the conversation that we were able to have as we walked. University of British Columbia’s Medical School http://med.ubc.ca/ is taught via a systems oriented, problem based learning model, and integrated into the studies is a class designed to enhance the affective component of the medical education process (in other words, teach compassion & values) that is now becoming ubiquitous in medical education. The character of these classes, and the way they are used in medical education is a common topic of discussion when students from different schools get together. My conversation with Alia was no different. First I asked what her course was called and what it entailed:
Alia: “At UBC Medicine our clinical and science-based courses are supplemented by a course called "Doctor Patient and Society (DPAS)." It really is the only class we get in our first two years of medicine where all the scientific and clinical knowledge we learn is applied to the "bigger pictures" of ethics, global health, epidemiology, healthcare systems and resource allocation. It is one course, with some pretty lofty goals, and the idea is to get students questioning, integrating, reflecting, and thinking about their future roles as physicians in an ever-changing healthcare system. Over two years we attend plenary lectures and discussion groups, working through cases and presentations on issues that are currently being addressed in the medical community--like whether tanning beds should be banned for teens, ethical dilemmas in clinical practice, or addressing the social and primary determinants of health in a medical interview. In second year, students have the option of undergoing a community-service learning project, or a self-directed project in lieu of attending discussion groups, which gives students an opportunity to explore ideas or issues about which they are passionate. As a student who came from a global health undergraduate degree (BSc: Integrated Sciences in International Health) this course most related to me because I am used to big picture thinking, and addressing global problems in integrated and interdisciplinary ways. In my second year I took on an independent project to develop modules on the Millennium Development Goals (MDGs) http://www.un.org/millenniumgoals/ to be integrated into high school curriculum, because I would like to see more bridging between the fields of education, health and medicine; this project was partially accomplished through DPAS and was the opportunity I was looking for to bring my undergraduate and medical educations together into a capstone project for my first half of medical school.”
I responded that we had a course called “Community Doctoring” that was very similar to scope and intent at my school, and I that I have many discussions with my peers about effective these courses really are. Then I asked her what she thought:
Alia: “One major part of DPAS is the mandatory reflective writing pieces that students have to submit over the course of the year. While DPAS can be a lot of things to a lot of students--and one of the hardest parts of a course is to appeal to as many students as possible--I wonder if there is a more effective way of accomplishing the goal of increasing student reflection in the DPAS curriculum, instead of setting word counts and deadlines. I myself struggle a lot with the reflective writing pieces, not because I hate reflection or even writing, but mainly because I found myself to be restricted in the way I was being asked to reflect. Recently, I have started using Twitter as a way of reflecting on the world and global health topics I have been keeping up with--like access to essential medicines, public health, neglected diseases and child health--these topics weren't addressed in curriculum per se, but they were posted on Twitter by the experts and role models I follow. I found that the dialogue, the ability to see what leaders in scientific and development fields were talking about, and being able to engage with them in a way that would not have been possible without Twitter (indeed, I may never have, or may never in the future meet these individuals). Looking back this term, I have spent hours contemplating international drug patent laws, or discussing the MDGs online, or connecting with students and researchers around the world who are experts in the fields of global health and development--all of that is reflection! So all in all I think the course is successful, but there is room for growth.”
“Exactly!” I responded. I know that all of this reflection helps people become better physicians, but sometimes we are so confined in our thinking about what should be used for education. Basically, the standard “Write 2000 words on how to be compassionate.” is a one size fits all solution to a very individual problem. I then asked Alia what she saw as the role of social media to solve this dilemma:
Alia: “As the world of social media changes, and even the world of medicine, I think reflection can take on new meanings. I would love to see how students in my class would reflect on their lives and careers in medicine through a variety of media--writing, poetry, music, painting, spoken word, blogging, tweeting...the list goes on! Each individual student in medical school is unique, and a course like DPAS can be the opportunity that students are looking for to bring a part of themselves and their identity into their studies. Reflection is not something you can force someone to do a certain way, it's something that is inherent to all of us as human beings. I am pretty excited and hopeful about the future of medicine with social media, because now more than ever we are able to connect with others who can support and nurture our passions, as well as challenge us to articulate our ideas. DPAS is such an integral and valuable part of our curriculum: it's a framework for connecting us to the roots of what brought us into medicine, and a foundation for growing our future careers and practices in a way that constantly reminds us that we are one piece of a very large health pie.”
As we were talking, I realized we were doing exactly what our instructors wanted us to do, reaching out an connecting, assimilating different viewpoint, respecting diverse opinions…not using the same tools they were given as instructors 10-20-30 years ago, essays, journals, group reflective work…but instead using tools fit for the 21st Century, we were using tools of our own making. This would be the real power of social media in medical education, connecting strengths and weakness, shared visions and goal in ways that will allow us to focus on what we really should be focusing on. Not focusing on the next test, rotation, or other “hoop of flame” we have to jump through to become physicians. Instead focusing on becoming the kind of person a patient would want as their physician.
Alia Dharamsi is a member of the Class of 2014 at the University of British Columbia Medical School in Vancouver, British Columbia, Canada. She can be found on Twitter at @alia_dh.