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

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.

Rewriting the Hidden Curriculum via Addiction Consult Services: Meeting Patients Where They Are At

“…Educational experiences crafted to reduce stigma among early trainees have been shown to decrease stigma and should be incorporated in curricula to reduce the likelihood that students will fall prey to the hidden curriculum and emulate biased instructors. 14,23,24 ACS offer an opportunity for students to learn about caring for patients who use substances from experts in addiction medicine and psychiatry who use MI and harm reduction approaches to meet patients where they are at; cultivating compassion and respect for this marginalized population. 25 Integrating medical students into ACS sends the message that learning how to care for patients with SUD is important and a priority for the clinical institution.…”