Transformative Learning and Critical Consciousness: A Model for Preclerkship Medical School Substance Use Disorder Education.

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2023-04

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Abstract

Objective

Preparing medical students to provide compassionate person-centered care for people with substance use disorders (SUD) requires a re-envisioning of preclerkship SUD education to allow for discussions on stigma, social determinants of health, systemic racism, and healthcare inequities. The authors created a curricular thread that fosters the development of preclerkship medical students' critical consciousness through discussion, personal reflection, and inclusion of lived experiences.

Methods

The authors used transformative learning theories to design and implement this thread in the 2021-2022 academic year in the Duke University School of Medicine preclerkship curriculum. Content included lectures, person-centered workshops, case-based learning, motivational interviewing of a standardized patient, and an opioid overdose simulation. Community advocates and people with SUD and an interdisciplinary faculty were involved in the thread design and delivery and modeled their lived experiences. Students wrote a 500-word critical reflection essay that examined their personal beliefs in the context of providing care for people with SUD.

Results

One hundred and twenty-two students submitted essays and 30 (25%) essays were randomly selected for a qualitative analysis. Seven major themes emerged: race/racism, systemic barriers, bias and stigma, personal growth/transformation, language or word usage, future plans for advocacy, and existing poor outcomes. Students were able to link material with prior knowledge and experiences, and their attitudes towards advocacy and goals for future practice were positively influenced.

Conclusion

By aligning the thread design with the principals of transformative learning, students developed their critical consciousness toward people with SUD and cultivated a holistic understanding of SUD.

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Published Version (Please cite this version)

10.1007/s40596-022-01737-7

Publication Info

Muzyk, Andrew, Sneha Mantri, Phillip Mitchell, J Matthew Velkey, Deborah Reisinger and Kathryn Andolsek (2023). Transformative Learning and Critical Consciousness: A Model for Preclerkship Medical School Substance Use Disorder Education. Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, 47(2). pp. 152–158. 10.1007/s40596-022-01737-7 Retrieved from https://hdl.handle.net/10161/27283.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Muzyk

Andrew Muzyk

Associate Professor of the Practice of Medical Education

Dr. Andrew Muzyk is an Associate Professor of the Practice of Medical Education at Duke University School of Medicine in Durham, NC and an Associate Professor in the Department of Pharmacy Practice at Campbell University College of Pharmacy and Health Sciences in Buies Creek, NC. Dr. Muzyk also holds a Clinical Associate appointment in the Duke University School of Nursing. Dr. Muzyk's responsibilities include teaching students across numerous health professions programs, rounding as a clinical pharmacist at Duke University Hospital, and conducting educational research.

Teaching
Dr. Muzyk is the director of pharmacology content and the course co-adminstrator for the Foundations of Patient Care II course, a semester long course that includes pharmacology, pathology, microbiology, immunology, and clinical medicine content. He teaches pharmacology to first-year medical students at Duke University School of Medicine with a focus on CNS medications. For five years, Dr. Muzyk served as the director for the Biological Psychiatry course for psychiatry residents in the Duke Department of Psychiatry and Behavioral Sciences.

At Campbell University College of Pharmacy and Health Sciences, he teaches pharmacy students about the treatment of psychiatric and substance use disorders and men's health. Dr. Muzyk is the course co-coordinator for the pharmacoepidemiology, health informatics, and neurology-psychiatry modules. He precepts fourth-year pharmacy students completing an internal medicine or psychiatry clerkship at Duke University Hospital.

He teaches students in other health professions programs at Duke and Campbell including doctor of osteopathy, physician assistant, and nursing. His teaching in these programs focuses on the management of psychiatric and substance use disorders. Dr. Muzyk serves as a mentor for graduate students enrolled in the University of Michigan Master of Health Professions Education program.

Clinical
Dr. Muzyk's clinical responsibilities include rounding at Duke University Hospital on the Medicine-Psychiatry inpatient service and providing consultation to the inpatient psychiatry unit and the opioid use disorder consult service. He is a clinical pharmacist in the Duke University Hospital Department of Pharmacy.

Research
Dr. Muzyk has over 70 publications from research projects focused on health professions student education and hospital based medication outcomes. His work has been published in journals including Academic Medicine, Substance Abuse, Psychosomatics, Academic Psychiatry, American Journal of Pharmaceutical Education, CNS Drugs, and Pharmacotherapy. He has received approximately $170,000 in grants to support his educational research developing an interprofessional substance use disorder course for health professions students and continuing education programs for healthcare professionals. Educational research support has come from Duke Academy for Health Professions Education and Academic Development, Duke Division of Addiction Medicine, Duke Bass Connections, the Josiah Charles Trent Memorial Foundation Endowment Fund, Duke-Southern Regional Area Health Education Center, and Campbell University College of Pharmacy and Health Sciences. Dr. Muzyk has given numerous presentations throughout the United States on topics related to psychiatric and substance use disorders and health professions education. He is a speaker for the North Carolina Area Health Education Centers (AHEC).

Awards 
Campbell University College of Pharmacy and Health Sciences Dean's Award for Excellence in Teaching; Association of American Medical Colleges (AAMC) Curricular Innovation Award (2020); Association for Multidisciplinary Education and Research in Substance use and Addiction (AMERSA), New Educator/Investigator award (2019); Campbell University College of Pharmacy and Health Sciences, Educator of the Year (2018); Duke University Hospital Department of Pharmacy, Educator and Researcher of the Year (2018); Duke Academy for Health Professions Education and Academic Development (Duke AHEAD), Interprofessional Excellence Award (2016); the Association of Academic Psychiatry (AAP), Psychiatric Education Award (2012); and, the North Carolina Association of Pharmacist (NCAP), Distinguished Young Pharmacist Award (2012).


Education
Dr. Muzyk received his Doctor of Pharmacy (PharmD) degree from Mercer University College of Pharmacy in Atlanta, GA. He completed two years of post-doctorate pharmacy residency training at DCH Health System in Tuscaloosa, AL and at UNC Medical Center in Chapel Hill, NC. His second year of residency training was focused on psychiatric pharmacy practice. Dr. Muzyk obtained a Master of Health Profession Education degree from University of Michigan. In 2023, he completed a year long Climate Health Organizing Fellowship through the Center for Health Equity Education and Advocacy at Harvard Medical School and Cambridge Health Alliance.



Mantri

Sneha Arun Mantri

Associate Professor of Neurology

I am a movement disorders specialist with a clinical practice focused on the care of people with Parkinson disease (PWP) and other movement disorders. I am interested in ways to improve the quality of care for patients with chronic neurodegenerative conditions, particularly translating clinically effective treatments and lifestyle modifications (e.g. exercise) into the “real world.”  While a growing body of evidence demonstrates that physical activity, including high-intensity exercise, is feasible for PWP and leads to improved motor and non-motor outcomes, translating that knowledge into practice has been challenging. My research in this area focuses on the impact of patient/doctor communication and social determinants of health on promoting or preventing physical activity among PWP.

 In addition to my clinical training, I hold a Master of Science in Narrative Medicine from Columbia University. This unique program, which grew out of the larger field of medical humanities, expands the conceptual framework of clinical medicine to incorporate patient perspective and social experience. I conduct mixed-methods research to design and implement interventions that are actually meaningful to the target population(s). As an example, in my study of Veterans with PD, I was able to conduct qualitative cluster analysis of Veterans’ self-reported barriers and motivators of adherence to exercise recommendations, reporting for the first time the unique barriers faced by this patient population. Additional funded projects using a narrative medicine approach have included (1) exploring the lexicon of burnout among clinical and non-clinical employees; (2) understanding the experience of fatigue and psychosis among PwP and their care-partners; (3) exploring the interactions between border-crossing in literature and border-crossing in medical education/practice.

In particular, narrative medicine offers guideposts toward a revitalized practice of medicine and medical education. In 2020, I was appointed Director of Medical Humanities at Duke, leading a team of clinician scholars in understanding moral injury and structural inequities in medicine. Under this umbrella, I co-direct the interprofessional course Moral Movements in Medicine; teach in the first-year Clinical Skills Immersion, the second-year Cultural Determinants of Health Disparities, and the fourth-year Medical Humanities courses; and mentor third-year students in the Medical Humanities study track.

Reisinger

Deborah Reisinger

Professor of the Practice of Romance Studies

Deb Reisinger, Ph.D., is Professor of the Practice in Romance Studies and affiliate faculty in the Duke Global Health Institute. She is Director of Duke's Language Outreach Initiatives, overseeing the Cultures and Languages Across the Curriculum (CLAC) program and the Shared Course Initiative for Less Commonly Taught Languages with UVA and Vanderbilt. She is currently serving as Interim Dean of Academic Affairs for Trinity College.

Deb is lead author of Affaires globales: S'engager dans le monde professionnel en français - niveau avancé (Georgetown Press, 2021), co-author with Joan Clifford of Community-based Language Learning: A Framework for Educators (Georgetown Press, 2019), and author of Crime and Media in Contemporary France (Purdue Press, 2007). She has published numerous articles on language pedagogy, community-based learning, and French for Specific Purposes. 

Deb teaches courses in service-learning, global displacement, and French for Specific Purposes, including global health, public policy, and marketing. Her current research focuses on transformative learning and community-based pedagogies.

She chaired the College Board's World Languages Academic Advisory Committee from 2016-2023 and served as co-chair of the AP French Language and Culture Exam development committee from 2018-2021. From 2013-2018, she served as Chair of the American Association of Teachers of French (AATF) Commission on French for Specific Purposes. 

Deb regularly directs Duke summer study abroad programs, including Duke in ProvenceDuke in Provence-virtualDuke in Aix-en-Provence, Duke in Montréal, and Duke in Paris.  

In 2022, she was named Chevalier dans l’Ordre des Palmes Académiques by the French Republic.

Andolsek

Kathryn Marijoan Andolsek

Professor in Family Medicine and Community Health

My career focuses on interprofessional medical education, and collaboration in community and population health.  These are critically important areas with tremendous potential for creativity, innovation, and learning from one another.  These are also strategic tools to advance health equity.


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