Meaghan Ruddy, MA, PhD has cultivated a path into the world of medical education that many may regard as non-traditional. However, amidst the ever-evolving climate of graduate physician training, it is exactly Dr. Ruddy’s non-traditional views for the future of MedEd that have set her apart and established her as a leader amongst medical educators. Her progressive thinking landed her the position as Vice President of Graduate Medical Education at The Wright Center in Scranton, Pennsylvania a graduate medical education organization known for its innovative and collaborative approach to graduate physician training.
While Dr. Ruddy was working on obtaining her PhD in Human Development, she taught bioethics at the undergrad liberal arts level. During this time, her PhD advisor introduced her to the Associate Dean for Curriculum at the recently opened Commonwealth Medical College. This relationship proved to be mutually beneficial as it fostered collaboration between Dr. Ruddy and the newly established school allowing her to utilize her expertise to integrate both ethics, and the adult learning theory of transformative learning, into the pre-clinical curriculum at Commonwealth.
What exactly is Transformative Learning?
Transformative Learning is an adult learning theory developed by Jack Mezirow. The theory centers on the idea that when learners are put into an unfamiliar situation, their views of the world may be challenged or possibly no longer viable. In order to succeed in this new environment they must undergo a “premise transformation” where these beliefs and views must change. This idea of premise transformation is very relevant to MedEd as a medical student transitions to a practitioner. During our discussion, Dr. Ruddy described the three ways transformation tends to occur in learners: content, process and premise. In its current state, medical education focuses primarily on content transformation or learning the course material, and process transformation such as learning procedures. The third form of transformation that can occur is known as premise transformation, which results in a lasting change to the learner’s identity. Dr. Ruddy feels that medicine as a whole is presently going through a premise change and we are seeing evidence of this throughout MedEd with changes in standardized testing and physician training. On the individual practitioner level, an example of premise transformation is the transition that a physician must make from an independent practitioner to their role of team leader. The integration of transformative learning theory into graduate medical education will help foster this shift as medical students enter the world as transformed and transformative practitioners. Dr. Ruddy is helping The Wright Center to lead the way in this regard.
Can you discuss your roles at The Wright Center (TWC) as well as The Commonwealth Medical College (TCMC)?
“I’m now on a volunteer basis with TCMC, and I’m hoping to be able to continue to contribute to the integration of transformative learning methodologies into their courses, as well as help to guide MS experiences in their 3rd and 4th year experiences with TWC. As far as my role as VP of GME, I am working to help create more connections between the various GME programs at TWC as well as increase the sense of nurturance in the organization – nurturance of everyone as a learner – nurturance of the values of a learning organization whose mission is steeped in true primary care access.”
What are 2-3 changes you would like to see in the current medical education system? Healthcare system?
“I know this is naive, but I’d love to see the Step 1 blown up completely. It is so antithetical to the development of future physicians; it’s emphasis on single-best-answer thinking is polluting the talent pool before its members even have a chance to engage in real clinical care. There is also way too much needless information in medical school. I know, I know – I’m not a clinician so what do I know about it really – but just from a learning and development standpoint, the volume of information is detrimental. There has been a consistent adding on of information rather than a parsing out of what is crucial. Of course every discipline thinks it’s content is crucial but really, unless you’re going to be a neuropathologist, how much neuroscience do you really need? Unless you’re after an MD/ PhD in microbiology, how much of that do you NEED?
As for the healthcare system, my biggest concerns are ethical. The focus on value is an important issue. Is healthcare a right or not? If it is, should it be a profit-driven conversation? If it is not, how should we value care at various levels of accessibility? Quality is important, access is important, but access to what, when, and at what level? I also think EHRs should be mandated to be compatible and that proprietary nonsense should be outlawed. It’s the same idea, right? Are we talking about what is best for health or as we talking about what is better for someone’s investment account? It is frustrating, the conflation of financial value with human value. But it’s part of US culture; medicine is a subculture in which the outcomes are writ more obviously.”
How does your work with The Wright Center/The Commonwealth Medical College help to foster some of those changes for the future?
“All I can do is work with people who make themselves available to the conversations. The conversations are about personal, professional, and organizational development and how in medicine it is all linked to health and wellness of practitioners and patients, of people generally. Our outcomes may be differences in curricula, policies, procedures, processes, allocations… but without the whole-hearted buy-in of agents at all levels, we’re bound to chase our tails a bit. Keep beating the drum, that’s what I tell myself. Keep the beat and eventually toes will tap.”
Do you have any final thoughts regarding the medical profession as a whole?
“Medicine is a culture fraught with anxiety, stress, and fear. It is a challenging matrix of axiology, epistemology, and ontology because the values, perceptions, and assumptions about what exists are defined so much by a version of strength that denies the truth and power of vulnerability, of accepting that so much is NOT known and that sometimes all we can hope to do is discover something helpful as we journey with one another. But medicine is also a culture of hope, expectation, helpfulness, compassion, perseverance – so much greatness that there is potential in every care team member, every patient encounter, every administrator, potential to do immeasurable good for humanity. I count myself lucky everyday that I’m allowed to remain a part of what is possible.”