Co-Creation in Medical Education: Leadership Roles for Medical StudentAs stated in a recent medical teacher publication, “To develop the front-line leaders necessary to advance medicine, student leadership opportunities must be fostered by faculty, institutions, and the academic medical community.” (Burk-Rafel, Harris, Heath, Milliron, Savage, & Skochelak, 2020). To access a webinar to the topic as provided in January 2021, click here. One such opportunity is educational program improvement and progression. The significance of formally involving medical students in curricular decision-making, oftentimes recognized as a value-added approach, is not new and has been recognized since the 1960s, a time of major social and cultural change. Medical students demanded a say in the changes that would affect them and future students, and the United States held its first National Student Conference on Medical Education in Chicago in 1969. That unique conference brought together, for the first time, medical educators, medical students, and practitioners (Huppatz, 1996). The three conference objectives were teaching experience opportunities, issues in medical education discussion forums, and encouragement of participation in curriculum planning, undoubtedly unchanged in their importance since the 1960s. I find interesting that the value-added theory was developed in the same dynamic time period, stating that “collective actions are the response to a strain (…) in a system (or society).” Those strains originate from, e.g., “stress, tension, or anxiety from a situation that violates their expectations of what is acceptable or just” (Smelser, 2011; Saffer, 2018). Recently, student leadership in medical curriculum design experienced a renaissance, as others recognized and appreciated their stakeholder status as value-adding collaborators, using terms such as “co-creators” and “co-designers” of content and curricula (Burk-Rafel, Harris, Heath, Milliron, Savage, & Skochelak, 2020; Geraghty, Young, Berkel, Wallbruch, Mann, Park, Hirshfield & Hyderi, 2020). Co-creation: Benefits for All Involved Bovill and colleagues explain that co-creation of learning and teaching occurs when educators and students work collaboratively to create components of curricula and/or pedagogical approaches. Co-creation can include a variety of forms and levels of change, such as redesigning sessions or courses, or developing assessment components. Thus, roles of co-researcher and pedagogical co-designer are part of the co-production framework (Bovill, Cook-Sather, Felten, Millard & Moore-Cherry, 2016). Unsurprisingly, both the learner and the educator derive significant benefits from working collaboratively on teaching and learning, such as enhanced engagement, motivation, and learning, as well as enhanced meta-cognitive awareness and sense of identity. Thus, providing learners with the tools and expertise (such as, e.g., curriculum design or assessment development) early on may indeed prove valuable to both students and teachers. Perhaps combined learner/faculty development would be a step in the right direction? Overall, co-creation closes the circle that originated from the 1960s: Medical students are enabled to include and contribute their insights from previous learning experiences for the betterment of medical education: from the user/audience – for the user/audience (Badwan, Bothara, Latijnhouwers, Smithies & Sandars, 2018). In the business world, co-creation is well established. Mostly due to the internet, consumers have been progressively engaging in an active and frank dialogue with companies offering products and services. Even more, consumers take on increasingly assertive roles, and the dialogue now starts with the consumer – and is no longer controlled by corporations (Prahalad & Ramaswamy, 2000; Ramaswamy & Ozcan, 2014). Companies such as Apple, Google, IKEA, Lego, Heineken, BMW, and Coca-Cola approach customers as stakeholders and invite them to participate in a design or problem-solving process. Collaboration may be offered in the form of a boot camp with entrepreneurs or university projects, or through customers-turned-co-creators online platforms. Just in case you are a Lego enthusiast: Submit your design for a new playset on Lego’s IDEAS platform https://ideas.lego.com/. If a project receives over 10,000 votes, Lego may consider marketing the design! Healthcare as Industry What started as co-created education can continue as collaborative training that prioritizes co-productive partnerships with colleagues, patients, and families. Patient-centered care is not possible without including the patient’s voice, and health care as a service must be co-created with the receiver. Here, it is important to see the influence of training on the practice of the junior doctor. Thus, effective co-productive relationships are preferred models for health care services, starting by “cultivating co-productive partnerships in health professions education between teachers, learners, and the systems and communities in which they reside” (Englander, Holmboe, Batalden, Caron, Durham, Foster, Ogrinc, Ercan-Fang & Batalden, 2020). The patient now becomes a stakeholder and is invited into the dialogue. Co-creation surpasses the institutional scope and recognizes the expression of human potential and values such as change, ideation, human-centeredness, social capital, and agency. Albert Bandura emphasizes agency as intentional influence on one’s functioning and life circumstances, recognizing people are self-organizing, proactive, self-regulating, and self-reflecting. Co-creation invites and challenges stakeholders to join proactively in organizational improvement (Bandura, 2006; Tams; 2018). Organized and programmatic collaboration of students and faculty can be very successful. Recent surveys of 563 medical students after structured participation in curriculum development were analyzed, and, not surprising, the resulting themes aligned with the expression for human agency, such as students identifying and feeling empowerment and ownership, student voice and advocacy, and the request for increased visibility and updates (Geraghty, Young, Berkel, Wallbruch, Mann, Park, Hirshfield & Hyderi, 2020). However, co-creation cannot occur in a vacuum. These are the conditions I found in academia and business that must be present for co-creation to succeed:
*** ES: Susie and Nigel – You are two alumni of the first cohort of the Zucker School of Medicine National Medical Student-as-Teacher rotation offered in 2020. What has been your experience with curriculum co-development? Were you able to apply or talk about your knowledge in a co-production partnership? Any thoughts? SG: I have always been involved in teaching through tutoring, working as a teaching assistant, and serving on the curriculum committee; however, after learning the tools and procedures involved, I came to appreciate the effort put into the development of a medical curriculum from the ground up. On the first day of the Medical Student-as-Teacher rotation, we were asked to select a topic of choice to teach, then throughout the next sessions, we were guided to develop our own curriculum through the application of Kern’s Six Steps of Curriculum Development. We also learned of ways to implement a positive learning environment into our curriculum to promote learning. I feel this course has opened my mind to the many ways to deliver a lesson, and make it enjoyable where students can truly gain the most from it. This experience was invaluable, and I am confident I will apply what I have learned throughout my career as a physician when teaching medical students, residents, and, of course, patients. ES: Thank you, Susie! Nigel – what are your thoughts? NJ: When I taught high school chemistry prior to entering medical school, I also had my students evaluate my teaching style and strategies, which I consequently altered based on their feedback and reflection. Over time, my students became better learners, and I became a better instructor, constantly adding new teaching methods to my “teaching toolbox.” This experience highlighted the importance of knowing the needs of the learner when considering delivery of instruction. During my medical school years, I was able to turn the concepts and tech terms I heard in class into drawings with a story line for effective learning, which turned into popular learning tools for my peers. I even created a shared online workspace for hard-to-memorize concepts and offered nifty tables and charts to help organize and delineate different medical diagnoses, supporting different learning styles. Most important: Whenever you are about to help facilitate learning in whatever scenario, you must consider who your learners are, and what their specific learning needs are. You are essentially entering a collaborative project with them where they are comfortable enough to tell you what’s working and what’s not. This is indeed the essence of a ‘Co-production partnership’…designing effective education. ES: Thank you! *** Overall, in academia as well as in industry, there has been an upward trend to include students, consumers, or recipients of services as active stakeholders who are more intensively engaged in value creation. We must be mindful, however, that this novel, engaging dialogue will at first cause a disruption in organizational flexibility. Newer organizations (e.g., medical schools, enterprises) are likely to be more welcoming to include this new value-adding dialogue. However, co-creation can be accomplished, assuming that supporting structures are put in place. In addition, environments can change fast, and yesterday’s students may be fast-tracked to become today’s life savers, as evidenced by the COVID-19 pandemic. Do we have really a choice? I look forward to your thoughts! 1) What benefits of co-creation in medical education do you perceive as most advantageous? 2) What elements needed for co-creation seem most feasible to be implemented, and which ones seem most difficult? I thank Susan Ghobrial and Nigel S. Jagoo for their valuable contributions to this blog post. Susie Ghobrial was born and raised in Niagara Falls, New York, and attended the University at Buffalo for her undergraduate degree where she majored in Biomedical Sciences. She is currently a fourth-year medical student at the Touro College of Osteopathic Medicine in Middletown, New York, and is applying for residency in internal medicine. Nigel S. Jagoo is currently a fourth-year medical student at VCOM - Auburn. Prior to medical school, he worked as a teacher mentor and evaluator in Tampa, FL. He is excited to pursue family medicine for residency and to further explore his passion in academic medicine, immigrant health, and advocacy. 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