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.Type
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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.
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Scholars@Duke
Andrew Muzyk
Dr. Andrew Muzyk is an Associate Professor of the Practice of Medical Education at Duke University School of Medicine and an Associate Professor in the Department of Pharmacy Practice at Campbell University College of Pharmacy and Health Sciences. He also holds a Clinical Associate appointment in the Duke University School of Nursing. His professional responsibilities span teaching across multiple health professions programs, serving as a clinical pharmacist on the Medicine–Psychiatry service at Duke University Hospital, and advancing scholarship in health professions education and clinical outcomes research.
Teaching
At Duke University School of Medicine, Dr. Muzyk directs pharmacology content and serves as course director for the Foundations of Patient Care II course, which integrates pharmacology, pathology, microbiology, immunology, and clinical medicine, in the first-year medical school curriculum. He lectures extensively in the first-year medical student curriculum, focusing on central nervous system pharmacology, and previously directed the Biological Psychiatry course for Duke psychiatry residents.
At Campbell University, he teaches pharmacotherapy with an emphasis on psychiatric and substance use disorders, men’s health, and neurology–psychiatry. He co-coordinates the Pharmacoepidemiology and Health Informatics modules and precepts pharmacy students in internal medicine and psychiatry clerkships at Duke University Hospital. Beyond these roles, he contributes to physician assistant, nursing, osteopathic medicine, and other health professions programs at Duke and Campbell, and he mentors graduate students in the University of Michigan’s Master of Health Professions Education program.
Clinical Practice
Dr. Muzyk practices as a clinical pharmacist in the Duke University Hospital Department of Pharmacy. He rounds on the Medicine–Psychiatry inpatient service and provides consultative expertise to the inpatient psychiatry unit and the opioid use disorder consult service.
Scholarship
Dr. Muzyk has authored more than 70 peer-reviewed publications addressing health professions education, psychopharmacology, and hospital-based medication outcomes. His research has appeared in journals such as Academic Medicine, Substance Abuse, Psychosomatics, Academic Psychiatry, American Journal of Pharmaceutical Education, CNS Drugs, and Pharmacotherapy. He has secured over $200,000 in research and educational funding, including support from the National Institute on Drug Abuse, Duke Academy for Health Professions Education and Academic Development, Duke Division of Addiction Medicine, Duke Bass Connections, the Josiah Charles Trent Memorial Foundation, and Campbell University. He is a frequent national speaker on psychiatric and substance use disorders and interprofessional education and regularly lectures for the North Carolina Area Health Education Centers.
Awards
Dr. Muzyk’s contributions have been recognized with numerous honors, including the Dean’s Award for Excellence in Teaching and Educator of the Year from Campbell University, the Association of American Medical Colleges Curricular Innovation Award, the Association for Multidisciplinary Education and Research in Substance Use and Addiction New Educator/Investigator Award, the Duke University Hospital Educator and Researcher of the Year Award, the Duke AHEAD Interprofessional Excellence Award, the Association of Academic Psychiatry Psychiatric Education Award, and the North Carolina Association of Pharmacists Distinguished Young Pharmacist Award.
Education and Training
Dr. Muzyk earned his PharmD from Mercer University College of Pharmacy and completed two years of residency training, culminating in a psychiatric pharmacy residency at UNC Medical Center. He received his Master of Health Professions Education from the University of Michigan and completed the Climate Health Organizing Fellowship through Harvard Medical School and Cambridge Health Alliance.
Sneha Arun Mantri
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.
John Matthew Velkey
Deborah Reisinger
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 currently serves as Dean of Undergraduate Education 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 Provence, Duke in Provence-virtual, Duke 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.
Kathryn Marijoan Andolsek
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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