An AMEE Presentation Report from the 2024 Annual Conference
By: Holly Harris, Rowen Shier, Gail Bellissimo, Elizabeth Lin, Jordana Rovet, Sam Gruszecki, Georgia Black, and Sophie Soklaridis
In loving memory of our dear colleague Anna Di Giandomenico who taught us about the importance of inclusion, validation, humor, belonging, and fun while working equitably in health education and research. She lives on through our work, and now through yours too.
Introduction
Despite increasing recognition of the value of involving people with lived experience (PWLE) of health system encounters in the development and delivery of continuing professional development (CPD), their engagement often remains tokenistic (Harris et al., 2023). Typically, PWLE are positioned as consultants or advisors who are asked to integrate into existing educational systems and support predetermined agendas. This approach impedes authentic engagement with PWLE and places limits on the transformational potential of their voices to improve education and care. Based on experiences and lessons from a mental health participatory action research project, the current article outlines a strategy for engaging PWLE as equal partners in CPD initiatives.
In 2019, our research team, composed of people with lived expertise related to mental health system encounters, people with learned expertise from professions and academia, and people spanning both perspectives, came together to co-produce a research project exploring Recovery College (RC) evaluation. RCs are low-barrier, mental health-oriented education programs rooted in the principles of peer support and co-production (Perkins et al., 2012). The project was overwhelmingly successful by academic standards (i.e., peer-reviewed publications and international presentations). More importantly, our team successfully did this academic work by intentionally adopting a deeply relational approach. By prioritizing relationships, we cultivated a strong sense of community, accountability, and a shared vision within the team.
Our team is often asked, “how did we do co-production?” This question prompted us to profoundly reflect on our process and journey together (Soklaridis & Harris et al., 2024). Some of these reflections and insights have been previously published in a peer-reviewed journal (see Soklaridis & Harris et al., 2024). However, while engaging in the dissemination of these findings, it became increasingly apparent that our multidirectional learning (MDL) approach formed a particularly foundational part of what made our team’s process unique and successful. It was through these discussions we realized the value that MDL could bring to health professions education. To this end, we presented at the Association for Medical Education in Europe (AMEE) 2024 Annual Conference (https://amee.org/amee-2024/amee-2024-programme/) focusing on the concept of MDL and its application to co-producing research in health professions education. In light of the overwhelmingly positive response to our presentation, we decided to share its relevance to CPD via this column.
What is Multi-directional Learning (MDL)?
MDL refers to a process where teaching and learning flow in multiple directions (Soklaridis & Harris et al., 2024). This involves all team members being recognized as teachers and learners and co-creating new knowledge at the intersection of perspectives through the collaborative process. Oftentimes, PWLE are seen as individuals who “need to be brought up to speed” (Harris et al., 2023). MDL contrasts with these models in that all team members—regardless of their professional expertise or background—leverage their skills, experiences, ( knowledge to contribute to, and shape the collective learning process (Soklaridis & Harris et al., 2024). This reciprocal exchange fosters an inclusive environment where diverse perspectives are encouraged and valued, becoming more than the sum of their parts. MDL democratizes learning, empowering all participants to influence project outcomes and authentically contribute to the co-creation of knowledge. From our experience, MDL takes two distinct yet complementary forms: direct formal learning and informal organic learning.
For our team, formal MDL encompassed structured learning activities, such as presentations and lectures, tailored to the team’s identified needs (Soklaridis & Harris et al., 2024). For example, methodological topics included how to conduct scoping reviews and qualitative interviews, while other sessions focused on using tools (e.g., Covidence, Dedoose) for data management and analysis. Some presentations centered on lived experiences, where team members shared their personal experiences navigating mental health challenges and systems. These presentations fostered open discussions where team members felt safe to raise inquiries, share reflections, and collectively explore materials. These exchanges facilitated deeper engagement and allowed for the co-creation of new knowledge and ideas through collaborative exploration.
In our experience, informal organic learning occurred more frequently than direct formal learning (Soklaridis & Harris et al., 2024). Informal opportunities included learning through everyday interactions and unstructured conversations during weekly project check-in and check-outs. It also involved more spontaneous learning opportunities such as informal poetry readings or storytelling. We also learned by doing. As we progressed through the research cycle, we continuously had open dialogue about how to navigate and work within an academic environment (i.e. the grant process, publishing, what it means to be a scientist). This involved shared decision making and reflexivity about how our collective values aligned with traditional processes and structures and how we wanted to be with one another given the expectations of all research teams. While typically unplanned, this type of learning proved highly valuable, as it enabled team members to learn from each other’s experiences and insights, in addition to engendering a deeper understanding of our individual and collective contributions to our work. We found these learnings also strongly influenced our academic productivity leading to highly creative papers and presentations that otherwise would not have been conceptualized. Informal MDL in particular, relies on an environment of mutual trust and respect—one where team members feel secure asking questions and sharing novel ideas without fear of judgment.
Why is MDL important?
MDL promotes a more comprehensive and equitable approach to knowledge creation and innovation (Soklaridis & Harris et al., 2024). Rather than imposing a singular “truth,” MDL supports a dynamic, inclusive, and collaborative process that values the unique contributions of all participants. It recognizes that all team members—whether they bring lived experience, learned expertise, or both—have something to teach and learn from each other.
An MDL approach allows us to co-create new spaces within our existing academic and educational environments for equitably acknowledging and harnessing diverse forms of expertise. It is within this new space where we can begin to unlock the transformative potential of co-production. This innovative approach is especially useful in developing high-quality CPD initiatives in resource-constrained environments.
Applying MDL in all aspects of CPD development enhances program design and implementation. Doing so ensures that initiatives are informed by a broader scope of knowledge, increasing their quality and relevance to diverse practical contexts. By integrating lived experiences, CPD initiatives are infused with real-world insights that allow CPD professionals to create education that is aligned with the needs of the communities and health systems they serve.
How can I integrate MDL into my collaborative process?
We offer the following practical suggestions to help teams engage in MDL within their collaborative endeavors:
- Invest time in building relationships
MDL requires trust, which can be cultivated by allocating time early in the collaborative process to build relationships amongst team members. This may involve conducting check-ins at the beginning of each meeting. Check-ins invite team members to share life updates, challenges, and successes as they feel comfortable. Additionally, co-producing terms of reference and a set of mutual expectations can help ensure that everyone contributes to creating a positive, accountable, and productive collaborative community grounded in a shared vision and shared values. In MDL, conventional team leaders (e.g., faculty, principal investigators) make space for other voices. Power is distributed among the team and sometimes requires those who are traditionally the decision-makers to step back when appropriate. Stepping back can encourage a multiplicity of perspectives to shape the work. Practicing distributive leadership by nurturing relational processes allows for member’s untapped skills, strengths, experiences, and interests to reveal new possibilities for the work.
- Approach disagreements with humility and curiosity
MDL involves the recognition that innovation happens at the intersection of diverse perspectives. When time is allocated upfront to determine the group’s shared vision and values, differences of opinion become opportunities to co-create new knowledge together. When navigating differences of opinion, approach these conversations with curiosity, humility, and an understanding that all members are invested in pursuing the same goal.
- Learn together
MDL involves learning new things together. Encourage team members to request presentations on topics they wish to explore further or invite them to share their areas of expertise that may be of interest to the group. If there is a gap in the team’s collective knowledge, consider bringing in a guest speaker or reading an article together, followed by a team discussion to reflect on the learnings. You may be surprised by the unique insights team members bring to the conversation, shaped by their diverse perspectives.
- Create a collaborative “ideas” document
As your team engages in MDL, ideas and opportunities will emerge through the collaborative process. Document these ideas! Use a collaborative platform like Google Docs or Padlet, and invite all team members to keep track of ideas and questions. These may come in handy when writing your next paper, developing presentations, planning your next CPD initiative/event, or writing your next grant.
- Co-create
MDL can also involve learning by doing together. When working with a diverse group, consider multimodal collaboration methods—supporting the different ways people learn and interact with content ensures that everyone can contribute equitably. For example, co-create an outline for written products in a collaborative platform like Google Docs or Canva. Create break-out rooms (virtual or in person) whereby members can pair up if they prefer to work that way. Once a draft is ready, the entire team can collaborate simultaneously to provide edits and feedback. Although co-creation often takes more time, the richness of the final product is significantly enhanced, as the outcome ultimately reflects a unified voice shaped by everyone’s contributions.
Conclusion
MDL can enhance all aspects of CPD development by ensuring that initiatives are informed by diverse scopes of knowledge. Learning from, with, and about each other and incorporating this knowledge into CPD initiatives increases the quality and relevance of its real-world implementation. This article highlights five practical suggestions for integrating MDL into your work. Why not pick one or two suggestions and try them out? MDL can’t tell you exactly where you will end up, but it will create new possibilities and opportunities to make CPD more relevant to the audiences it is geared toward. We can’t wait to see what you will learn and create together!
Author Acknowledgements
Holly Harris, MA is Research Coordinator, Education, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
Rowen Shier, MA is Research Analyst in Education Research at the Centre for Addiction and Mental Health (CAMH), Toronto, Canada
Gail Bellissimo is Program Engagement Co-facilitator at the Collaborative Learning College at the Centre for Addiction and Mental Health (CAMH), Toronto, Canada
Elizabeth Lin, PhD is Scientist in Education Research at the Centre for Addiction and Mental Health (CAMH), Toronto, Canada
Jordana Rovet, MSW is Coordinator at the Collaborative Learning College at the Centre for Addiction and Mental Health (CAMH), Toronto, Canada
Sam Gruszecki, CPS is Coordinator at the Collaborative Learning College at the Centre for Addiction and Mental Health (CAMH), Toronto, Canada
Georgia Black, BA is a master’s student in the Community Health Sciences program at the University of Calgary
Sophie Soklaridis, PhD is Senior Scientist, Centre for Addiction and Mental Health and Associate Professor, Departments of Psychiatry and Community and Family Medicine, University of Toronto.
