Background

I have recently returned from a visit to the Faculty of Medicine at Memorial University, Newfoundland. One of the purposes of the visit was to follow up the audit projects on (a) social accountability and (b) student engagement. In my discussions with students from the MD program and with faculty members it was heartening to see the possible rise of cosmopolitanism.

Definition

In this context, cosmopolitanism describes the way students and faculty recognise multiple networks in their lives and consequently they see the value of inclusive democratic processes, of diversity of individuals, lifestyles and societies, and of multiculturalism, inter alia. This definition has been adapted from Inglehart and Norris (2016) and informed by Granovetter’s concepts of network theory and weak ties (1983).

Methods

I had a series of discussions with students and faculty. The discussants were not scientifically selected. They were based on the many contacts I had developed during the social accountability audit in 2013/14 and during the student engagement audit in 2014/15. Also I revisited the background papers and more recent information on the Faculty’s website http://www.med.mun.ca/ From these methods, I have derived the following results and conclusions.

Results

Social accountability: there was widespread scepticism about the overall situation as regards excellence in social accountability by the Faculty of Medicine. Pockets of excellence were recognised with examples including initiatives in support of refugee health, aboriginal health, and global health; and rural medicine placements, clerkships, and electives.

However weaknesses were recognised in the society and practices of the Faculty including:

– at admission interviews applicants mention their commitment to rural medicine and a common response from the interviewers is “I come from a rural area and I would not want to work there”

– an overwhelming emphasis on the CanMEDS role of the medical expert in much of the preclerkship teaching; see http://www.royalcollege.ca/rcsite/canmeds-e

– undervaluing the practices of the family physician which were frequently dismissed as “to prescribe or to refer” by lecturers and denigrating community projects

– minimal attention to the social determinants of health, to health inequalities and to the CanMEDS roles of health advocate, collaborator and communicator.

I have written about my views on the low value of the alleged award of excellence in social accountability by the ASPIRE project; see –

http://www.iainrobbe.com/case-study-of-apparent-failures-of-governance/

None of the discussants believed the hyperbole and misleading propaganda from the ASPIRE machinery; see www.aspire-to-excellence.org

I doubt that my views influenced the discussants because they are more than capable of judging the impacts of the apparent low validity, low reliability, inconsistencies over time, and conflicts of interest by the ASPIRE social accountability panel and the weaknesses in governance in the awards processes by the ASPIRE board.

Student engagement: the discussants could fully understand why the Faculty of Medicine had not submitted an application for the award of excellence in student engagement. There was recognition that some faculty saw student engagement as a way to improve learning as I have described; see –

http://www.iainrobbe.com/student-engagement-oxymoron-and-patronage/

However the discussants have first-hand experiences of the the silo working practices in the Faculty and of the Faculty’s management with its authoritarian dispositions, top-down behaviours and secrecy. The students particularly recognised the patronage towards them throughout the activities of the MD program.

Discussion

In view of these weaknesses in social accountability and student engagement in the Faculty of Medicine, the question arises – why am I heartened by the possible rise of cosmopolitanism (Inglehart & Norris, 2016) that I observed?

I am heartened because the students and faculty showed a willingness to increase their activism in the democracy of the Faculty in support of social accountability and student engagement. Contrary to the emphasis on the CanMEDS medical expert role and the influences of Granovetter’s weak ties (1983), many discussants saw the relevance of the MD qualification to the whole person, to diversity of lifestyles, to local communities and to the wider society; all issues related to social accountability.

Also, many discussants saw activism in democracy as the way to promote negotiations and compromises and to counter the authoritarianism of the Faculty management. They saw the scope for these democratic processes to involve the use of more evidence to inform Faculty policies, strategies and practices and to reduce the use of intuition and arbitrary, opaque decision-making; all issues related to student engagement.

Conclusions

It seems to me that the Faculty of Medicine at Memorial are at a cross-roads due to the possible rise of cosmopolitanism and the appointment of a new dean. There are opportunities to change the society to make it more outward-looking, to make new appointments to key roles in the Faculty, and to be more inclusive and tolerant of diverse views. Taking this progressive route from the cross-roads would increase cosmopolitanism, encourage more openness about values and decisions, and promote an inclusive democracy.

Alternatively the Faculty of Medicine could take a regressive route from the cross-roads and thereby continue the present authoritarianism, secrecy, and censorship. Maintaining the current traditional values and behaviours of the management hierarchy will prolong the hypocrisy and tokenism as regards social accountability and student engagement.

References

Granovetter, M. (1983). The Strength of Weak Ties: a Network Theory Revisited. Sociological Theory, 1, 201-233.

Inglehart, R. & Norris, P. (2016). Trump, Brexit, and the Rise of Populism: Economic Have-Nots and Cultural Backlash. HKS Working Paper No. RWP16-026. Retrieved November 25, 2016, https://ssrn.com/abstract=2818659