News and Commentary Co-creating a New Paradigm in Health Professions Education

One of the most powerful themes that emerged from the 2021 Macy Conference on COVID-19 and the Impact on Medical and Nursing Education was the need for educators to engage learners in partnership and to work together to co-create learning experiences and consequently improve learning environments—in the classroom, in the clinic, and in the community.

As members of the conference working group that focused on the essential role of learners, learner-centeredness, and co-creation/production, Robbie Henson, PhD, Jennifer Dias, BA, and Subani Chandra, MD, were instrumental in developing recommendation #1, which speaks to the idea of co-creation: 

Recommendation 1: Leaders and educators in academic health systems and health professions education [HPE] institutions must collaborate with their learners to enhance HPE by redesigning learning environments to prioritize antiracism, diversity, equity, inclusion, and cultural humility; working with learners to co-create HPE learning experiences; and defining meaningful roles for learners in the local community.

In this Macy Notes blog post, I begin our year-long series of posts focused on the 2021 Macy Conference recommendations by interviewing Dr. Henson, Ms. Dias, and Dr. Chandra about their thoughts related to co-creation and its potential for the future of health professions education.  

HJH: Robbie, can you start by defining “co-creation”?

RH: Co-creation is an intentional plan to involve multiple stakeholders (teachers, learners, clinical healthcare systems, patients) in actively contributing to the process of health professions education (HPE). The current model of HPE moves primarily from instructor to student. This unidirectional methodology does not tap into the values, intentions, and potential of the emerging providers who are our current learners. Encouraging all stakeholders to have a voice in the teaching/learning process and curriculum (co-creating) will introduce innovative ideas that could more effectively impact patient outcomes and health care system effectiveness.

HJH: Subani and Jenn, can you speak to the benefits of co-creation in health professions education?

SC: There are so many—both in process and in outcomes! Co-creation leads to better educational design, and a successful co-creation process strengthens the relationship between teachers and learners, increases learner engagement, and cuts through the traditional hierarchical structures of health professions education to create a more collaborative and inclusive learning environment.

JD: Co-creation is both a privilege and responsibility for health professional educators and learners alike. Co-creation is an intentional collaborative practice that allows learners to optimize their educational experiences based on their personal interests, strengths, and opportunities for growth. It emphasizes the true value of each individual learner by deconstructing power dynamics and enhancing their ability to foster meaningful relationships and formulate a vision of what they might become through and after formalized training. Co-creation improves team performance by empowering learners to gain agency, be creative problem-solvers, and gain critical skills necessary to address the ever-changing challenges of health care in the United States. The COVID-19 pandemic has highlighted that health professionals can utilize their training to employ a myriad of diverse roles, and the process of co-creation can be an incubator for innovation.

HJH: Are there basic principles that faculty and learners should follow when co-creating?

SC: Yes, absolutely. Co-creation is an active collaboration between teachers and learners rather than the passive feedback processes for curricular improvement that have been prevalent in health professions education. For co-creation to be successful, this shift in learners’ roles must be done thoughtfully. Here are some basic principles for faculty to consider:

  • Define clearly what part, or parts, of the curriculum will be co-created. If this is your first time co-creating, I would recommend starting small.

  • Decide who will participate. Of course, learners. And depending on the specific circumstances, you may want to consider other key stakeholders such as other members of the health care team, patients, and administrators. Participants should be diverse, willing to participate, and invested in creating a better learning experience.

  • Outline the process clearly. Co-creation in health professions education is new to many and challenges the traditional teacher-learner relationship. This change can be confusing to learners and, if not redefined, can limit participation. Participants must feel safe speaking up and have equal opportunity to contribute. Psychological safety is essential.

  • Come with an open mind, listen genuinely, and establish trust. Learners need to know, and see, that their input is valued.

  • Engage learners not just in the design of the curriculum but also in its implementation and evaluation. Co-created curricula are dynamic and responsive to the experience of stakeholders. Longitudinal participation in the process can increase learner engagement in co-creation, as well as in their own learning.

  • Invite participant feedback on the process of co-creation itself. Taking the time to reflect on the process is a key part of the professional development of learners and teachers.

RH: The primary and foundational principle of co-creation is mutuality—a recognition of the value of varied contributions to the learning experience and the learning environment. Both learner and instructor bring something to the table that is both unique and critical to successfully moving health care forward innovatively and effectively in a changing world. While the instructor may have content and skill expertise, the learner has lived experience expertise. The understanding of both is necessary to achieve the outcome we seek.

Second, at this moment and for the foreseeable future, global society is evolving with incredible speed. HPE must stay tightly connected to this process to prepare providers who can adapt, evolve, and innovate in this emerging environment.

HJH: The COVID-19 pandemic highlighted the significant role that learners can play in their own education. What are some of the key contributions that learners made during the pandemic in advancing their education and contributing to their institutions during this most recent, highly challenging circumstance?

JD: James Clear writes that we do not rise to the level of our goals, but rather, we fall to the level of our systems. As the harsh realities of the pandemic rapidly ensued and clinical experiences were disrupted, many learners individually and collectively assumed a breadth of roles to fill the gaps of a failing healthcare system and public health infrastructure. Learners actively sought service-learning opportunities to mitigate PPE shortages, coordinate community donations, distribute medications, connect with patients remotely, research COVID-19 impacts on health outcomes, serve on committees, lead institutional efforts to addresses racism and oppression, and promote morale during a complex and challenging time. Learners’ commitment to meet the increased needs and demands of the pandemic showed their adaptive capabilities to not only impact the healthcare workforce but also teach those around them in the process.

In cultivating a learning environment in which co-creation is not just possible but also successful, we know that psychological safety is critical to achieving such success. Can you speak to other factors that are important to have in place as institutions, teachers, and learners strive to enhance HPE through co-creation?

RH: There must be a recognition and management of power differentials, an embedded mindset of collaboration and mutuality rather than hierarchy. All must feel they have permission to contribute, and there must be accountability so that all stakeholders can be heard.  We need a growth mindset that values and seeks flexibility, adaptability, and innovation.

JD: There are “degrees of safety” within every learning and work environment. Cultivating brave spaces rather than safe spaces for learning and critical analysis are essential for co-creation. A brave space is built on the understanding that we cannot divorce our personal lived experiences from our day-to-day work. Features of a brave space include owning intentions and impacts, respecting another’s personhood, open dialogue, and resolving conflict regardless of positionality.

In addition to a brave space, it is also crucial that we build processes and structures for shared decision- and policy-making, as well as data collection and monitoring of outcomes that support mutual trust, transparency, and accountability with learners. There should be ample opportunities for bi-directional communication, recognition of effort, and flexibility in learning modalities.

SC: Institutions need to be open to the idea of co-creation or at least be willing to experiment with it. Co-creation, especially as a new process, takes time, which institutions can provide. They can also provide support in other ways such as administrative help and space.

As co-creation places the experience of learners at the center, it is critical to think about which learners will participate. For instance, all learners, or some? Current or former learners, or both? How are they selected? It is important to know if learners have prior experience with co-creation. For those who are new, the change in traditional dynamics between teacher and learner and lack of familiarity with the process can be uncomfortable and even challenging. To motivate learners to participate meaningfully, pick projects that learners are excited and passionate about and provide training in processes that are central to co-creation, such as giving and receiving feedback, working with other stakeholders, and problem-solving.

Teachers can experience many of the same challenges as learners. Many health profession educators may be new to co-creation and redefining the teacher-learner relationship can feel difficult. It helps to start with projects that teachers also feel motivated to improve. They need to be willing to learn the co-creation process along with their learners and understand that they are not giving up control of their content and pedagogy, rather they are collaborating to create a better experience for everyone involved. Psychological safety is important for teachers as well.

Some faculty and teachers may be skeptical of the value learners can bring to the co-creation process. What would you say in response to those educators or administrators who are hesitant to fully engage in the co-creation process due to such concerns?

RH: The speed at which the world is changing hastens the evolution required of instructors and of their curricula. Understanding the sociopolitical world, the lived experiences, and the learning needs and styles of today’s learners is increasingly challenging. We can no longer teach the way we were taught or teach the content we were taught.

Additionally, the opportunity for professional formation for rising health care providers is much augmented when learners are embraced in the HPE creative process. The faculty impact on the next generation of providers is enhanced by improved networking and a more interactive link between learners and mentors. To impact the health of communities, we must allow the younger learners today to be the teacher in those areas in which they are well prepared—technology, areas of social dissonance for their generation, the best thinking/learning processes for today—while instructors teach knowledge and skill, situating these ideas in context saliently and with wisdom.

JD: Throughout one’s career trajectory, an individual will always find themselves in the position of both learner and educator, thus the will to collectively learn, improve, and work toward shared goals are imperative to achieving high-quality, equitable care and successfully addressing the pitfalls of our academic institutions. Co-creation centers on the larger “we,” with the notion that when we empower learners to bring their awareness and perspective to participate and support the work and learning environment, we are modeling behaviors to “be the change” and transform the future of healthcare.

SC: Teachers want their learners to be engaged, to learn and have fun doing it. Co-creation has been shown to do exactly that. Not only does it promote learner engagement, but it also strengthens teacher-learner relationships and builds mutual respect. It contributes to a more positive learning environment and fosters inclusion and belonging. Try it! 

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