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This week I’ve been watching adult educational theory come to life in a most enchanting way. I have been witness to the mutual introduction of Ethiopian Family Medicine trainees and Canadian Family Medicine trainees. The picture is poignant. I always had a hunch this would be a magical moment. I’m convinced that one of the best justifications for international collaboration in medical education is the magic that happens when people from diverse backgrounds but common educational goals are given the opportunity to learn together.

About five years ago, I co-wrote a paper called “Learning best together: social constructivism and global partnerships in medical education” which was later published in the journal Medical Education. In that article I noted that “Considering all the ways in which adults learn, there is no technique as appealing as the fact that when human beings interact, learning takes place. This process is known as ‘social constructivism’.”

Just after writing that paper, I visited Ethiopia for the first time. I was invited to participate in an International Workshop on Postgraduate Programs hosted by Addis Ababa University (AAU). That led to a journey shared by colleagues at the University of Toronto in which we had the privilege of consulting with leaders at AAU as they launched the first Family Medicine training program in Ethiopia. The program started in February.

Throughout that journey I imagined the day that Family Medicine trainees from Canada and Ethiopia could meet and study together. That day happened this week. It has turned out to be as splendid as I’d hoped it would be. It has fully affirmed some of the theory I described in that paper from years ago.

Family Medicine residents Netsehet, Sari, Dana, Meseret

The residents from Canada have been learning alongside their Ethiopian peers at the Tikur Anbessa teaching hospital in Addis Ababa as well as the Arada Health Centre. They’ve been comparing experiences and asking one another about alternative approaches to health care. Every conversation builds both medical knowledge and mutual understanding. I’m watching it happen just as I envisioned it in my paper:

“Social interaction increases the likelihood that one can begin to perceive the perspective of another person or another culture. The learner will be required to reflect on those interactions to see a bigger picture. In the best use of global partnerships for medical education, learners move beyond self-reflection to collaborative reflection. Learners from different cultures can explore differing attitudes on a topic. Although constructivism involves critique and evaluation, the goal of such interaction is not the destruction of the notions of one group, but the construction of innovative ways of thinking: a synergy of wisdom.”

I’ve always felt that one of the best results of learning together is how it teaches humility.  British psychologist Vivien Burr is an expert in social constructivism. She notes how this learning theory rejects “an implicit or explicit imperialism and colonialism in which western ways of seeing the world are automatically assumed to be the right ways, which it then attempts to impose on others.” This has definitely been the case when I watch these Family Medicine residents interact. They compare the approaches to similar health problems in very different contexts. This triggers a courteous but critical reflection about the wisest approach. Mutual respect grows in the process.

Tikur Anbessa Hospital, Addis Ababa, Ethiopia

Some might assume that when Canadian health care professionals work in international settings, it’s about what knowledge we can impart or what resources we can share. But it’s so much richer than that. The beauty of social constructivism means that when we human beings interact in the face of common questions, we build knowledge together. This week in Ethiopia, I’ve seen how effective this can be. When we ask good questions, challenge assumptions and explore solutions together, everybody teaches and everybody learns.

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