My students tell me I foster their ability to bring course content to social problems with views of social justice in their work. As a first generation student myself, I believe my own past instills this social justice perspective in teaching and learning: the hallmarks of social justice teaching are the experience of cumulative small discoveries; linking teaching processes to teaching goals; and discovering that learning confers agency.
I tell my students that in all the social justice work we do, we need to know the context so we can build effective partnerships. How and why are some groups marginalized in society through stigma? What is the history of doing research in a particular community or with a certain group?
Even if a particular health service or resource is available, does everyone have the same access? We need to learn to read the footprints of inequity. We come to see that ill-health travels along lines of social disadvantage. We need the best knowledge, skills and tools available and so we all must work hard together. It is for this reason that we have high expectations of ourselves and each other, rather than for a particular grade or for an award. Our rewards are knowing we are striving to make a difference and sometimes we actually succeed.
I am very lucky as I get to teach about the practice of research, about clinical practice and about research that is about improving practice and that helps me to better get to know my students. I like to hear their stories about who they are and how they got to where they are. I find each one so interesting, so full of life and potential. I learn a lot from my students and they often challenge my assumptions. From here, I can then begin to have conversations about how to work with others, in practice and research that begins with listening and embracing a stance of mutual respect, in all the settings in which I teach: the classroom, the clinic and in our community-focused research settings. In the classroom, I tend to teach graduate seminars with 10-20 students from nursing and other disciplines across campus. I also give lectures to much larger groups, but that is not my preferred mode of teaching, precisely because I cannot possibly get to know them all. I individually mentor students at all levels and I also precept students in a primary care clinical setting.
I try to foster openness to new perspectives through repeated exposure to different views in readings and in class discussions and encourage engagement incrementally. In one of my PhD courses, I address the foundations of the nursing discipline by focusing on how and why it emerged. Students encounter current and past dilemmas people face about their health, many of which relate to a variety of social injustices. For example, we read about Tuskegee, Alabama within its historical context and from the vantage point of Nurse Rivers. We read the story of Henrietta Lacks. For some students the material we are covering is new and very challenging, for other students the type of material is not so new, but we broaden and deepen the context. I try to move each student beyond where they were before and for some, I have been told, “The learning curve is very steep.” The process I use to foster discussion moves from their individual interaction with the material by preparing written notes prior to discussion. Then they get a chance to talk about some of their ideas with a few people and get feedback before they present in the larger seminar setting. In this way, I can usually get everyone in the seminar talking at some point during each class, including those who are less comfortable speaking up. More importantly, it helps all the students engage with the material. There are often differing views and I encourage students to challenge each other respectfully. I weigh in from time to time, but try hard not to impose my views on them as this course is about the students exploring and developing their views. As such, there are no right or wrong answers. The students’ areas of inquiry demand a deep understanding of the philosophical assumptions that undergird their work as they examine such important topics as: end-of-life issues in the pediatric intensive care unit; adolescent prescription substance abuse; and pain and post-traumatic stress disorder in combat veterans.
If the goal is to teach justice, then it is important that also be reflected in the process by which we teach, conduct research and practice. Although we cannot ignore the hierarchies of power that exist, we can work to mitigate the barriers they impose on our interactions. In my course focused on global women’s health, the students have say over what topical areas of inquiry are selected for several class sessions. In my graduate course focused on developing health promotion interventions to reduce health disparities, social justice issues are front and center. As the students develop new interventions, I emphasize the importance of process and the need to solicit input from the people we are working with and then to use their feedback in a meaningful way. It is also equally important to conduct self- evaluative research so we can collect the evidence to not only determine if our interventions are really making a difference to those we are trying to reach, but if the content is relevant and relatable. I encourage students to use a similar process when we see patients in clinic. There too, we work together to find out what barriers may exist for them to carry out their health recommendations so we can problem solve together.
Learning can foster agency in our students and in turn students feel more capable of speaking up for themselves and the people they work with. For example, in the free student-run clinic where I currently practice, students come to see firsthand the ravages of disease and inequality. Together, we ask questions and discuss the reasons why and what can be done now for the short term to solve an immediate problem (e.g., in clinic) and what solutions may be needed for more durable change. In one of my graduate seminars, each student builds a prototype intervention to address issues such as depression among African-American youth, diabetes prevention among Filipino-Americans, or medication adherence among HIV+ new mothers in Nigeria. We need to be brave and have passion for our work in order to sustain these efforts. In my graduate course on global women’s health research, students come to see that fostering equity is one of the basic analytical principles that will allow us interventions to reduce female genital cutting in western Africa, the impact of stigmatization on the health of female sex workers comparing Brazil and Canada or women’s health among Syrian refugees.
A social justice perspective can be fostered in students by understand- ing and working with others who have fewer resources while understanding the role of underlying inequalities; being open to new perspectives while also being able to express one’s own views; and knowing our history and context as providers or policymakers while insuring this work is done in partnership with those we work with in the context of mutual respect. In this way, we can be effective caregivers, advocates and research to advance health equity.
For me, teaching and being a health care provider has offered a way to advance social justice by fostering opportunities to experience incremental discoveries, linking teaching processes with goals and offering tools so others may develop mastery and gain more control over their work and their lives. I hope my students have benefited from these opportunities and will pass that along to others.
Anne M. Teitelman is associate professor in the department of family and community health in the School of Nursing. She won the Dean’s Award for Exemplary Teaching in the School of Nursing in 2017.
This essay continues the series that began in the fall of 1994 as the joint creation of the College of Arts and Sciences, the Center for Teaching and Learning and the Lindback Society for Distinguished Teaching. See https://almanac.upenn.edu/talk-about-teaching-and-learning-archive for previous essays.