This is Teresa Chan (@TChanMD) the e-editor intern for the journals Medical Education & The Clinical Teacher. This month we are delighted to bring you more reflections via the Conversations in Medical Education blog.
I am happy to present to you a featured blog post from Dr. Ellie Hothersall, a medical education researcher and member of our blog’s e-Council. She has written a thought-provoking piece to get the conversation started here on the blog about one of the recent articles in Medical Education‘s most recent issue.
Keep reading below to see what Ellie has to say about the article, and then join in the conversation via the blog comments below! Also feel free to tweet me using the hashtag #MedEdJ.
How do we get medical students and medical trainees to understand the effect poverty has on health? I can’t believe that there’s anyone in the medical sphere who hasn’t grasped that poverty is bad for you (and again, and again), but how do we get people to act on that, to actually behave in a way that takes this into account when they deal with patients? Better yet, how could we get medical students and trainees to be advocates for this vitally important issue?
Photovoice may be part of the answer to those questions. By getting students to take a video diary and reflect on issues relating to poverty, a small number of students in a primary care setting in Quebec found new insights into poverty and felt that it became easier to discuss issues of poverty with each other, and (the authors write) “opened up the possibility of exploring the resources available instead of avoiding the patient’s problem.” It sounds like it has had a reasonable impact. But also, it sounds time-consuming, and although the authors mention at the end of the paper that they have now developed a resource to teach others about poverty, there’s no detail about that. So great: lots of photos, discussion and thus reflection, and you might feel better able to talk about poverty, and try to help patients find ways to improve their situation.
I do find myself wondering how this exercise would work if rolled out to a whole cohort of medical students. Perhaps I’m being cynical, but it has been observed previously that students can “game” reflective exercises. How do we get over that hump? Is it realistic to expect students to develop a profound understanding of so many complex aspects of human existence? After all, if we want students to reflect upon the effect of poverty, why not also literacy, chronic disease, loneliness? It seems like we pick a couple of big topics, and hope that they act as proxies for all other mature insights into the human condition. Of course we do, the curriculum it too long for anything else.
So do we need to go to such lengths to get insight into poverty? I’d argue we probably do. Poverty is normally filed away as “too hard”, or beyond our ability to have any impact. Most medical schools teach very little specifically about poverty, reinforcing the hidden curriculum message that it’s not our problem (although there have been calls to include screening for poverty in the medical curriculum). We (clinicians, including students) switch off from thinking about problems such as poverty because we teach ourselves not to be distracted by issues we feel we can’t control. Furthermore poverty is far from the experience of most clinicians, making it easier for us to overlook. Perhaps this is the way to counter that. I’d like to see how these students respond over time – perhaps it’s a candidate for the “you’ll thank me when your older” category of teaching. After all, if the outcome is that patients who are suffering due to poverty have that suffering alleviated, then we will all be better off.