Negotiating learner–teacher boundaries in medical education

Abstract

During a third year medical student seminar on renal failure, Dr. Sara Ender is facilitating a group discussion. One of the medical students, James, puts up his hand. ‘‘Sara, I have a question’’, he says. She is immediately aware that other students may be wondering why James used her first name. Was it intentional? Should she address it? We write this personal view from the perspective of both faculty and learners recently involved in a participatory curriculum development process. While the experience was rewarding on many levels, it has prompted our reflection on some of the unintended, perhaps challenging, outcomes related to more actively involving learners in these processes. Learner engagement is widely recognized as key to their achievement in higher education. Actively involving learners in the co-creation of curriculum offers one way to facilitate this engagement (Bovill 2013). Offering learners the opportunity to contribute their knowledge and experience to curricula in an authentic participatory process has many potential benefits, including: increasing learner responsibility for their own learning; engaging learners in critical exploration of teaching processes; enhancing learner performance; and improving faculty satisfaction (Huppatz 1996). While the argument for learner involvement in curricular design is not new within education and critical pedagogy literature (Rudduck & Fielding 2006), it remains an emerging idea within the higher education and medical education literature. Often, learner engagement in this context is reduced to gathering learner feedback through standard evaluation method, while greater more in-depth attention is paid to the opinions of faculty as ‘experts’ in faculty-led curricular design (Coates 2005). In an attempt to move beyond faculty-led curriculum design and in response to calls at our institution for learner involvement, we recently engaged in a participatory curriculum development process. Our team, consisting of faculty, postgraduate and undergraduate learners, aimed to develop an innovative faculty development program for teachers. The knowledge, perspectives, and experiences of each team member informed all aspects of the curriculum design process. The boundaries of the participatory process evolved organically. From the outset, faculty engaged in a deliberate sharing of roles and encouraged informality with the learners. Ownership and empowerment were fostered through co-creation of the program’s vision and decision-making by consensus. Learners’ opinions and real-life experiences informed and guided the development of the curriculum, resulting in a more relevant and authentic tool for clinical teachers. Reflecting on this experience, the faculty described an enriched understanding of the learner learning experience. Learners felt that the partnership afforded them opportunities to explore educational processes and theory while under the guidance of faculty role models, thus enhancing their current experiences as learners and creating a foundation for their future roles as teachers. Throughout the process, as relationships grew and trust was established, the traditional power differential between faculty and learners (Lempp & Seale 2004) was ‘flattened’. We no longer felt like experts (faculty) and novices (learners) but rather like colleagues working together towards a common goal. Indeed, our involvement in participatory curriculum development changed the nature and boundaries of our relationships. Although these changes furthered the curricular development agenda, they also produced unintended outcomes related to the manner in which we navigated between our different roles within the medical education system. Faculty were faced with feelings of vulnerability when they acknowledged that learners from the project would be present during their clinical teaching sessions, and thus evaluating their roles as effective teachers. Similarly, learners perceived a heightened expectation from faculty and felt increased pressure to perform in the clinical context when faculty from the project were present. Both faculty and learners shared concern that our previous experience working together may be construed as favoritism, and struggled with how to interact with each other in front of peers and colleagues. Learners who were on first name basis with faculty during the co-creation of