Received date: November 30, 2011; Accepted date: January 28, 2012; Published date: January 30, 2012
Citation: Siderits R, O’Donnell MB, Roche M (2012) Our Experiences in Community Health Education – “Questions and Examples Gleaned from Our Experience with the Community Mini Medical School Program”. J Community Med Health Edu 2:121. doi:10.4172/jcmhe.1000121
Copyright: © 2012 Siderits R, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Mini Medical School; Mini Med program; Community education; Public health literacy
We have supported a Mini-Med program for over 10 years and provide up to 300 educational encounters per year. The audience ranges from high school students to retired university professors. The spring “term” lasts 4 weeks and is topical; the fall session lasts 8 weeks and presents a broader range of topics in medicine. Each “session” usually provides one or two speakers and lasts up to 45 minutes with time for discussion. Speakers are drawn from hospital, community, professional services and the university academic faculty. There are generally no honoraria for presenters. There is a small fee to cover minimal expenses. We use a question based assessment tool for evaluating pre and post presentation effectiveness.
Many times doctors are asked, or volunteer, to present topics in the Mini Med program. Mini Med programs are public education programs now offered by many medical schools, universities, research institutions, and hospitals across the U.S. with the goal to educate the public on common healthcare issues . Most often, the need to present originates from a genuine interest to improve public health literacy, but can also stem partly from a business perspective to introduce practitioner’s individual or group practice to the community. Public health literacy is defined as the degree to which individuals and groups can obtain process, understand, evaluate, and act on information needed to make public health decisions that benefit the community . More often than not, the health practitioner is a well-credentialed professional with an interest in teaching but with little practical experience in community education. In this paper, we discuss common challenges that a health practitioner may encounter when presenting health topics and propose approaches to address these challenges.
For example, let us take a look at two very different types of teaching approaches that a healthcare practitioner, who wishes to provide health education to the community, might experience. The first teaching approach is long familiar and holds few surprises for the doctor.
Teaching for the medical student
A healthcare practitioner teaches a specific bio-physiologic pathway to a group of first year medical students. These students are by nature competitive, intelligent and eager to learn specific information related to one narrow aspect of medicine, for which they will be later thoroughly tested.
Now consider how this is different from teaching medicine in a community setting.
Teaching for the public
The Real World. The audience varies from high school students to retirees; from people who want specific information to those who just want something interesting to think about; from people who want to reconnect with the “community” to people with significant problems who are desperately looking for first-hand information. Regardless of the economic demographics of the community being served, some members of the audience have various types of mental illness, substance abuse, learning disorders, etc.
We have sponsored a Mini Med program for over a decade and we have had many opportunities over the years to talk with our faculty about their expectations and experiences. Our program educators were suddenly confronted with the realization that presenting in the public forum isn’t just offering information to those with shared terminology and medical perspectives, who are required to learn it. Several questions spring to mind. The most common questions that educators ask are: “What style of teaching can possibly connect with the needs of the widest range of learners in this community audience?; Who are constituents of community audience and what do they need as public learners?; How do I teach Mini-Med program material effectively in this forum?; What exactly is effective teaching method in this forum?; If I want to improve public health literacy, then who exactly are the Public?; How can I determine if my teaching has been effective?; and, Will I have made a difference?”.
Unlike the shared experience of students in a college, medical school or medical resident trainees, where everyone shares clear expectations, teaching to the “public” is in so many ways a wonderful mix of raw academics that draws on personal intellectual strengths and simple show man ship. Teaching to the Public presents as many opportunities to succeed as to fail and offers occasionally uncensored and frequently unanticipated interaction with the audience. In short, “do not claim to be an educator until you have taught in the community forum”.
After years of managing many of these rewarding, challenging and occasionally frightening interactions, we have consolidated our experiences and offer them as follows:
“Who you teach becomes as important as what you teach?” Understand who the Public are and what they expect of you? The Public may be retired university professors, high school students and people with significant life problems. Often, members of the community are “damaged souls”, and sometimes, these members are suffering from physical disabilities, mental disorders and or chronic illnesses. These encounters with members of the community serve more needs than can be addressed including those members who simply need to “enter or connect with any community.”
Be ready to cope responsibly with Public’s needs. From a teaching perspective, the audience’s broader range of life experience and less well-defined expectations effectively guarantee a lively teaching experience.
Our response: The following conclusions sounds simple but it turns out to be important: take the time to educate your presenters about the community that makes up a particular Mini Med program audience. Help presenters understand, in a diplomatic way, what they are about to face and how it might be different from a style that they may be more familiar with. Provide example of the kinds of issues that happened in the past and how these issues were managed.
Example: I was talking to a presenter shortly before a session and asked a question meant to illustrate and prepare the speaker. I asked “How would you have handled this?” and described a previous program where a member of the audience with Tourette’s syndrome had seemed to have had a particularly difficult time with their “Ticks”. The purpose of the question was to help the speaker appreciate that unanticipated interactions with the audience happen more often in the public forum and to help the speaker think about possible reactions of the audience.
Use disclaimers to protect the program and to define guidelines for communication with the audience: People in the community have individual needs. For example, they may require special accommodations for their disability. It is important that the educator be sensitive to accommodation requirements in such instances and that these requirements be clearly communicated internally among program’s staff members. It is equally important to set the initial guidelines for asking questions; next section discusses “Why”.
Our response: Ensure that each program participant has a way to communicate, at the point of registration, their disability and any special accommodation requirements. For example, have a clear section within registration sheet with a checkbox and an opportunity for registrant to either share the nature of their disability or communicate that information directly to the course organizer. This is an important part of the initial registration process. If the accommodation is possible then every reasonable effort must be made to provide the accommodation in a reliable and respectful manner, for each session. The accommodation should be consistent with the provisions of the “Americans with Disabilities Act of 1990” .
Example: One student of a Mini Med class required larger chair than those that were available in the conference room. We brought a larger office chair into the room before each session and reserved the chair for that particular student. The student was grateful for our consistent efforts in ensuring that the chair was available before the start of each class. This was because the student needed more time than others to take the seat and consequently arrived earlier. We were happy to clearly document student’s needs, communicate effectively these needs to our staff, and provide accommodation at the beginning rather than during the class.
Prepare your speakers to challenges of community presentations: A presenter may not have had the opportunity to speak to an audience with such a broad range of life experience. We have found that it helps to prepare them for this type of encounter in the following ways. Inform them about question that they may expect, using examples, so that teaching experience can be as positive for them as for the audience. Revise with them strategies on how to handle “personal” questions that a member of the audience might ask; some questions might make older or younger members of the audience, or people with strong religious and or cultural perspectives uncomfortable.
It is also important to be open about the nature of discussion and not just the content that relates to the presentation. For example, the topic of the discussion may include human organ systems and human behaviors that affect person’s health. With these topics in mind, it becomes important that people are told what the appropriate guidelines and options are for asking very “personal” questions in a public forum.
Our response: After two to three weeks people are becoming more comfortable with the Mini-Med school process and more confident about asking questions and entering discussion. This may lead some members of the audience to ask questions openly about their personal health concerns. The openness that program participants may show can be surprising and sometimes, given the religious or cultural sensitivities of a particular presenter, the questions that they ask can lead to a less than helpful response.
Example: “Welcome to Week 4 of Mini Med program. It is clear that some of you are starting to think about health from the ‘Healer’s perspective’. That’s great. One of the interesting things about the Fellowship of Healers is that there are many perspectives to consider and as many cultural-, religious- and gender-related sensitivities to respect. That being said, I’d like to remind everyone that if you have questions of a sensitive or personal nature, you can contact the faculty presenter, the medical director or the course organizer at any time before or after the class”.
Revel in the process; do not try to make every Mini Med class the same: Unlike the shared experience of students and professors in a college or medical school class where everyone shares clear expectations, teaching in the public forum is in a sense equivalent to the Wild West of academics. The responses and discussions can be uncensored and frequently unanticipated as people acquire new information; we feel that this type of dynamic discourse reflects educator having motivated the audience to actively participate and therefore will most likely facilitate the delivery of information that may impact public health literacy. The learning point here is to facilitate discussion and actively provide offline information.
Our response: We are constantly changing our curriculum, our speakers and our methods of delivering content. We have covered following topics in our Mini-Med program: Integrative Medicine, CSI Forensic Medicine, Women’s health and Men’s health. Special topics that presentation included were The History of Medicine, Human Experimentation, the Golden Age of Quackery, and Healers in The Media. Some topics had higher and some lower level of success than what we expected. All topics were well received and conclusion was not to be complacent about the curriculum or risk speaker burnout.
Example: We sought affiliations with high schools that are developing Science and Bioengineering programs and have made sure that our course materials are available in assisted living communities. We documented our impact on public health literacy by grading each presentation with a modified Likert scale, before and after the presentation, for content and increased knowledge of a specific topic. The questions include: “1) What do you know about this topic; 2) What two things have you learned; 3) Do you feel that you know more about this topic after the presentation; 4) where your questions answered?; 5) Do you need more information?...”. In addressing the last question we also incorporate QR codes into the presentations. We obtain the sites for the QR codes by asking each presenter to provide responsible websites for more information on a topic and assisted library search services for those not adept at running their own web searches. This helps audience members to access additional information at a later time;
Use humor to communicate information not distract from it. Culturally appropriate humor that serves to introduce a talking point or personal anecdotes that provide a human connection to the speaker do not trivialize the content but can make communication of information to a learner easier. One of the interesting things about the Mini Med program audience is that they represent a broad sampling of the public ranging from high school students to university professors. Even if they represent a member of the “fellowship of Healers” rarely do they have a chance to gain insight into the life and experiences of a Hospital or university based Physician. The presenter might share a few experiences about their medical training, things that surprised them or that made them sad.
Our response: Encourage the speakers to relate to personal anecdotes where appropriate; this approach can help the student gain some insight into the process of learning about the healing arts. It is important to remember that the students, especially younger or high school-age ones might want to gain insight into the way healthcare professionals learn and think and not only into what they know and can teach.
Example: One particularly memorable speaker drew on his background in the history of medicine and weaved-in anecdotes related to teaching the important differences between medical quackery and alternative philosophies of healing. Several funny stories served to help the audience differentiate the two, while providing valuable information about the “red flags” relating to consumer fraud in healthcare advertising.
Community Education is substantively different from many other types of teachings.
Presenters need to understand and respond to those differences. From one perspective, it may be instructive to consider the “Public” as one of the students in the class. This allows us to ask “What is the overall impact of the educational content on the public as a whole compared to only on individual students?”
We have found that presenters who approach these encounters with the idea that they can simply “dumb down” a standard medical presentation, only limit their own expectations and restrict their abilities as educators. In many respects, communication with the public in a community forum requires a much more sophisticated teaching style –one that relies more heavily on confidence and the ability to make human connections while simultaneously managing the audience as an entity, and individual interactions separately. In reviewing the minimed process with the faculty we often suggest that the presenter use a style of interaction that includes the following: ask a leading question; provide a clear answer then give an illustrative example. This format has demonstrably served to encourage audience participation.
It is important to recognize that members of the audience may not only want to be exposed to an aspect of medical education but also connected with and identified as members of one or more public communities. Presenter who observes approaches and communicates with the community “as a learner,” is well positioned to share not only specific content but also relevance of the content to the community. One of the best strategies for achieving efficient communication with the audience has been to create a welcoming community for the audience. For example, at the beginning and throughout the presentation series we welcome the audience into the “Fellowship of Healers” and encourage them to consider their health from the Healer’s perspective.
In summary, in response to the national agenda for providing educational content that improves health literacy for the public, we continue to recognize better ways to explore and address educational challenges by asking ourselves “Who is The Community and who is The Public?” . In practice, the more human connections we make and the more real life examples we use, the better we are in managing and addressing the many individual needs of the community. A core principle of “face to face” teaching remains: make human connections, understand the needs of your students, then (and only then) teach them something.
1. Know the community and seek an understanding of your Public.
2. Use disclaimers to strengthen and protect the program.
3. The “dumb down” perspective can limit expectations as an educator.
4. Use humor with sensitivity for cultural mores.
5. Presenting to the community is substantively different from teaching in a classroom.