CRICOS Provider No 00025B Working with Student Partners to Establish Understanding of the Social Determinants of Health as a Threshold Concept CAPHIA, Auckland, 2018 Lisa Fitzgerald, Allyson Mutch and Charlotte Young School of Public Health, University of Qld

Threshold Concepts? “Concepts that bind a subject together, being fundamental to ways of thinking and practising in a discipline” (Land et al 2005, 54) Characteristics of the conceptual gateway: Troublesome - challenge the learner to let go of previously held positions to discover unfamiliar and often disconcerting new terrain Transformative - involve a shift in understanding, Integrative - highlight interrelatedness of the topic or discipline Irreversible - cannot be unlearned or forgotten, (Land et al. 2005).

Why are the Social Determinants of Health a Threshold Concept? Troublesome: Challenges students ontological and epistemological positioning. Understanding ‘wicked problems’, derived from complex, multiple social causes - fundamentally challenging for biomedically trained students Transformative: the individualised view of health is fundamentally challenged, as students acknowledge the social and structural foundations of health inequalities. Integrative: Integrates the social and cultural with the psychological and biomedical. Provides a framework for understanding the transdisciplinary nature of complex PH problems. Irreversible: Once they have incorporated an understanding of the social, it is unlikely that this way of knowing will be reversed. Meyer and Land (2005; 2003)

Working with Student as Partners to examine the SDH The student voice is a notable omission from research in this field. Felton (2016) argues: The emotional terrain of threshold knowledge as the most challenging Tensions between the liminality and uncertainty experienced through learning ‘troublesome knowledge’ and classrooms that privilege correct answers and competencies.

What is Student as Partners? A collaborative, reciprocal process through which all participants have the opportunity to contribute equally, although not necessarily in the same way, to curricula or pedagocial conceptulisations, decision making, implementation, and investigation or analysis (Cook-Sather et al, 2014, 67)

Research Questions What is the role of Students as Partners in facilitating the learning of social determinants of health as a threshold concept? How does this learning differ for postgraduates and undergraduates? How can we facilitate the teaching and learning of threshold concepts such as the SDH in a multidisciplinary curriculum?

Methods Phase 1 - Conceptual Mapping with colleagues and Focus Groups with past students Phase 2 - Baseline Survey at start of semester identifying student’s assumptions about health inequalities Phase 3 - Engaging Student Partners – Journaling and fortnightly meetings Phase 4 - Follow-up Survey Phase 5 – revisiting and revising curriculum

Our Students First year Health Systems and Policy (250 students) and postgraduate Social Perspectives (120 internal and external students) 5 Undergraduate and 5 postgraduate students Aged 18 to 30+ 8 women and 2 men 3 international students 1 Indigenous student 1 external student 1 part-time student Across the spectrum of academic performance

Students as Partners: Working through the Liminal State For us: Challenging for us to see the challenges they identified. Constant questioning of who we are and what we’re doing. Some loss of confidence “I keep questioning what we’re doing” Supported through collaborative teaching For the students: Moving beyond consumer satisfaction towards an ontological reflection of their learning Showed the ‘stuck’ places where the learning was most troublesome and where they became unstuck Supporting students to deal with uncertainty “I realise I’m having to sit a little uncomfortably for a bit as we engage with the reality that ‘wicked problems aren’t just an easy/straightforward apply the formula fix”

The process of Curriculum Review and Revision Opening the ‘black box’ of teaching and learning Expanding the living classroom Ongoing curriculum review and change Reinvigorating the active classroom to also support practice

Opening the black box of teaching and learning SAP opened the ‘black box’ of teaching and learning” for us and the students Being open and honest about the curriculum development to empower students and ourselves Continuing the conversation with students, engaging them in curriculum design and development SAP opened the ‘black box of teaching” Our focus is on an active learning community, which includes the teaching team and students as co-producers of learning who will play an active role in ameliorating the social determinants of health. Being open and honest about the curriculum and seeing the course as a living changing entity - not set in stone/ no ‘correct’ answers. Slow down, pare back and provide space for students to engage in emotional content - and support them as they struggle with their positioning and question their ability to facilitate change We model the learning of complexity actively debating among the team and with students – emphasis on critical thinking, praxis and what can be achieved (strengths approach)

Establishing a living classroom Seeing the course as a living, changing entity. Adaptive and responsive to students’ learning Adaptive and responsive to the external environment – eg., SDH facebook page to map current events, debates and writing. Bringing the real world into the classroom and going into the real world “Outside the class I’m more aware of public health issues and I’m able to understand current affairs with a deeper understanding, which is really cool!” Using authentic assessment and feedback, to scaffold learning and gain feedback from students that directly informs teaching SAP opened the ‘black box of teaching” Our focus is on an active learning community, which includes the teaching team and students as co-producers of learning who will play an active role in ameliorating the social determinants of health. Being open and honest about the curriculum and seeing the course as a living changing entity - not set in stone/ no ‘correct’ answers. Slow down, pare back and provide space for students to engage in emotional content - and support them as they struggle with their positioning and question their ability to facilitate change We model the learning of complexity actively debating among the team and with students – emphasis on critical thinking, praxis and what can be achieved (strengths approach)

Reinvigorating active learning to incorporate practice Reinvigorating an active learning community - the teaching team and students as co-producers of learning. Slow down, pare back and provide space for students to engage in emotional content. Modelling the learning of complexity, active debate and discussion Recognition of students’ future roles in PH – they want to play a role in ameliorating the SDH. Fostering a strengths approach. Engaging students in the applicability to practice, particularly for postgrads, who are seeking ways to deal with complexity and uncertainty. “It provides the opportunity for us to learn to be comfortable with the uncertainties” SAP opened the ‘black box of teaching” Our focus is on an active learning community, which includes the teaching team and students as co-producers of learning who will play an active role in ameliorating the social determinants of health. Being open and honest about the curriculum and seeing the course as a living changing entity - not set in stone/ no ‘correct’ answers. Slow down, pare back and provide space for students to engage in emotional content - and support them as they struggle with their positioning and question their ability to facilitate change We model the learning of complexity actively debating among the team and with students – emphasis on critical thinking, praxis and what can be achieved (strengths approach)

Thank you to our student partners Tony, Gillian, Christina, Zoe, Maisie, Brenna, Matt, Nicole, Dishka, Yinling.