Lived and Learned

Bringing Diverse Perspectives and Challenging Assumptions to CPD/CE: An Interview with Morag Paton, PhD

As 2023 comes to a close and we welcome 2024, I have been reflecting on my learnings in the CPD/CE community in the last year. I have been fortunate to connect, collaborate, and learn from so many brilliant and passionate CPD/CE professionals.  For example, at my first SACME Annual General Meeting in March 2023, I connected with Dr. Morag Paton who is a recent PhD graduate in Higher Education from OISE.  She is the newly appointed Associate Director, Maintenance of Certification & Education Consultation Services at Continuing Professional Development, Temerty Faculty of Medicine, University of Toronto.  Further, Morag is an Education Scholar at the Wilson Centre (University of Toronto, University Health Network) and an Investigator at the Equity in Health Systems Lab (Bruyère Research Institute).

Over the past year, Morag and I have collaborated and engaged in thought-provoking and productive discussions. In speaking with Morag, I have learned much about CPD/CE systems, structures, and operations, as well as strategies for challenging assumptions and integrating diverse perspectives in CPD/CE. Morag was kind enough to be interviewed for “Lived and Learned” to share some of her insights.

Interview

Holly: How did your journey into CPD/CEunfold? What is your current role?

Morag:  I’m an administrative staff member in the Faculty of Medicine and have been with the University of Toronto for over twenty years, with eighteen of those years in the Faculty of Medicine. Most people who work in medical education have an interest in medicine, but my interest was mostly in higher education. In a previous role, I worked as an engineering student counselor, where I worked with very high-achieving, accomplished students. The students were amazing and incredibly smart. After working in engineering, I moved over to medicine taking on a maternity leave replacement position managing the MD program admissions process. I feel very privileged to have been able to work in these spaces – medicine and engineering programs are certainly some of the tougher programs to get into and I have always enjoyed working with the dedicated learners and teachers in these spaces.

After working in the admissions office, I took on a role with the Education Vice-Deans and was there for about seven years. Part of my job was coordinating many central committees that covered the continuum of medical education. I was first introduced to CPD/CE here when working with Dr. Ivan Silver. I noticed that there is a certain degree of glitz and glamour that is often applied to undergraduate and graduate medical education but not to CPD/CE even though it takes up most of people’s careers.

When I eventually came to work in the CPD office in 2017, I did so mostly because I was interested in learning more from those conducting research. My CPD/CE career started as a Research Coordinator and I held that role for about seven years until I became the Associate Director of Maintenance of Certification and Education Consultation Services. This is an administrative role that oversees the accreditation services that our office organizes, all of the education consultations, and it also involves a research component.

Holly: In your work, I understand that you’ve devoted attention to challenging underlying assumptions in CPD/CE. Could you elaborate on your work in this area?

Morag: I started a master’s degree while I was working in an operational role within the Vice Dean’s office. I pursued a master’s, partly because I couldn’t understand the reasons behind some aspects of my work. For instance, I was drafting policy for faculty but did not know the purposes or history behind those policies or the reason behind the choices in language that the policy makers were making.

Then, my master’s studies exposed me to the principles and tenets of social science, and that shifted my thinking. For one, it illuminated the fact that there is not one single truth, but multiple perspectives. That changed how I perceived the work. I could see how, for example, a policy statement could be interpreted differently from one group to another, each with its own, distinct perspective. Social science has helped me understand that there are implications for every decision we make and the underlying assumptions for those decisions must be reviewed and questioned as they are not always clear or even inherently good. I like to question what the assumptions are that underpin what we do in CPD/CE. I think it is essential to ask why, to question the status quo, or we may miss an opportunity to make real improvement. Further, it’s about navigating your way through the maze of our inherited practices, and considering what changes may be necessary to create change and to ultimately make sustainable improvements in patient care.

Through engaging with social science literature and some wonderful teachers, I came to see that there are so many different ways to approach things. Some approaches are very privileged and dominant, and some are quite silenced. I appreciate the push to integrate different ideas and ways of knowing into the medical education curriculum because I think it broadens what and how we think, and that is where this dynamic, really interesting piece happens.

Holly: What do you see as the value of bringing diverse perspectives into CPD/CE?

Morag: I think bringing diverse perspectives allows us to question the assumptions that underpin our work in CPD/CE. You may not be able to change them because these are systems and structures that have been in place for a long time, but you can start to shift the thinking by asking why and examining the implications of what we do and why we do it. For example, Dr. Terry Soleas, Dr. Brian Hodges, and I wrote a paper about reimagining bias (2021). There are dominant ideas in CPD/CE about what bias means, how to declare it, and what we are doing when we declare it. We wanted to bring a different perspective to that and say, well, maybe there are other forms of bias beyond commercial and we should be thinking about those as well. I think there is value in questioning the assumptions, even if the thing itself doesn’t change, but you understand why it has come to be like that, which you can then convey to other people. By understanding assumptions, we can make purposeful choices in deciding how to best proceed.

Holly: What are the barriers to engaging diverse perspectives in CPD/CE?

Morag: There are many and I will not be able to list them all, but I think one of them is time. It takes a lot of time to effectively engage diverse perspectives and so many people have the CPD/CE components as only a portion of their entire job. They’re busy clinicians. Some of the leadership positions have just one day a week devoted to the CPD/CE function. There are pressures to move things along quickly and there are also pressures to produce a product for which people are willing to pay. People may not want to pay for the extra time it takes to engage diverse perspectives or for a product that challenges the status quo.

Some challenges in CPD/CE don’t necessarily exist in the same way they do in other parts of the education continuum. For example, in my opinion, in undergrad and postgrad, there seems to be more opportunity to bring out new ideas because of how the curriculum is structured and funded. In contrast, in CPD/CE, there’s pressure to produce a product that is aligned with the cost recovery nature of a lot of our offices. Overall, I think that some of the barriers are in how CPD/CE is structured, with limited availability of the people who design the programs, and these contribute to the pressures on CPD/CE.

Holly: From your standpoint, what strategies would you recommend for individuals or institutions seeking to actively integrate diverse perspectives into the realm of CPD/CE?

Morag: I think we need to actively think about the assumptions we are bringing into decisions and the impact of our decision-making processes. I would encourage people to ask why things are the way they are. Try to think of a different approach. Are you assuming that everyone has the same resources that you do? Are you assuming that everyone has the same knowledge that you do? For example, through SACME, I have had the opportunity to connect with American colleagues and we come with different assumptions. I work and live in a place with largely socialized medicine. In the U.S., there are different pressures and assumptions. It must seem obvious to everybody else, but, I began to consider that this might be why certain decisions are being made in some institutions and not in others. I now realize that while we have the time and the space to do a certain thing at our school, other schools may not as they face a different set of constraints. Connecting with different colleagues can help us understand the assumptions that inform their decisions and illuminate our thinking as well.

We also make decisions about systems or processes and do not necessarily consider the domino effect. A small change can have a lot of impact. It is important to try to understand what those changes are doing to the larger system. You can think about it on a very large scale or a very small scale. Often we can easily see the impact of other’s decisions  on us, but it is harder to sit there and be reflective about the implications our decisions have on others.

Holly: You are the lead author of the paper entitled “Dismantling the master’s house: New ways of knowing for equity and social justice in health professions education” (Paton et al., 2020). Tell me about the collaborative process of writing this paper and the value that engaging diverse perspectives added to this manuscript.

Morag: That paper came out of my comprehensive exam for my PhD and then I worked with all of these wonderful co-authors and my supervisor to turn it into this manuscript. It is about different ways of seeing a system. In my graduate work (Paton, 2023), I focused on the experience of administrative staff. I traced the history of medical education within my institution – in particular learning about and problematizing the embedded and assumed hierarchical structures that originate from its Eurocentric origins. The paper we published out of my comprehensive exams is an intentionally provocative piece around the assumptions and origins of the systems in which many of us work.

Working with other co-authors brought so much to the paper. I got to work with Dr. Thirusha Naidu from South Africa and she pushed me in my thinking other ways of knowing. She was key to challenging a lot of the assumptions that I was making in the writing of the paper. Bringing different perspectives into the writing of a paper makes it so much stronger. It is hard to write in that manner, but it makes for such a richer paper.

In that paper, in particular, we were trying to be very deliberate and very transparent about who we were because, in the first draft of my writing, I wrote we did this, we said this, and we think this, and every time I wrote that Dr. Naidu would write back who is we?  She would say don’t assume that we are all the same.

As we were writing the paper, we were dismantling the way that we wrote while simultaneously trying to share those lessons in the paper. We wanted to show the play within the play a little bit which made it a fascinating and challenging paper to write. I think that may be part of the reason why it seems to be resonating with people. It’s not just about what is happening in medical education, but also about what ‘we’ see, even just in our writing. I think it is helpful to get a sense as to who the people are, why they’re writing about certain things and why they feel one thing over another.

There is a way of writing that seems to be widely accepted in medical education, which often feels more disembodied to me. This way is quite objective, and it’s a perfectly valid genre of writing but there are other ways to approach one’s work too. I tend to bring in more of myself into a paper, and try to be more reflective about what I’m writing, who I’m writing with, why I’m writing it, and what my motivations are. It is sometimes tough with word limits and editing but I try to share these reflections in the papers that I write. Even if it doesn’t end up in the final paper, it’s still there. It’s how I wrote the paper. Everything in the final paper is infused with all of this stuff whether or not it’s transparently exposed in a part of the paper or not. There are motivations for everything we do. There are joys, reasons, and frustrations and I can’t always leave that stuff at the door so I think that there’s value in talking about it and writing about it.

I recognize that in medicine, many people have been trained to avoid the subjective statements and not bring themselves into their writing. There is probably a lot of discomfort with that idea. But at the same time, we often hear that people come into medicine as compassionate applicants and leave without that compassion. By integrating a little more reflexivity and subjectivity we might be able to open the door for more compassion. We can recognize the shared humanity amongst ourselves, our colleagues, and ultimately, the patients and communities we are here to support.

References

Paton, M. C. (2023). Carving Space for Staff Agency in a Faculty of Medicine: A Foucauldian inspired discourse analysis of administrative staff and faculty relations (Doctoral dissertation,University of Toronto (Canada)).

Paton, M., Naidu, T., Wyatt, T. R., Oni, O., Lorello, G. R., Najeeb, U., Feilchenfeld, Z.,Waterman, S. J., Whitehead, C. R., & Kuper, A. (2020). Dismantling the master’s house: new ways of knowing for equity and social justice in health professions education. Advances in Health Sciences Education: Theory and Practice, 25(5), 1107–1126.

Paton, M., Soleas, E. K., & Hodges, B. D. (2021). Reimagining Bias: Making Strange WithDisclosure. The Journal of Continuing Education in the Health Professions, 41(2), 139–144.