1. CRICOS Provider No 00025B
Working with Student Partners to Establish Understanding of the Social Determinants of Health as a Threshold Concept CAPHIA, Auckland, Lisa Fitzgerald, Allyson Mutch and Charlotte Young School of Public Health, University of Qld

2. Threshold Concepts?
“Concepts that bind a subject together, being fundamental to ways of thinking and practising in a discipline” (Land et al 2005, 54)
Characteristics of the conceptual gateway:
Troublesome - challenge the learner to let go of previously held positions to discover unfamiliar and often disconcerting new terrain
Transformative - involve a shift in understanding,
Integrative - highlight interrelatedness of the topic or discipline
Irreversible - cannot be unlearned or forgotten,
(Land et al. 2005).

3. Why are the Social Determinants of Health a Threshold Concept?
Troublesome:
Challenges students ontological and epistemological positioning.
Understanding ‘wicked problems’, derived from complex, multiple social causes fundamentally challenging for biomedically trained students
Transformative: the individualised view of health is fundamentally challenged, as students acknowledge the social and structural foundations of health inequalities.
Integrative: Integrates the social and cultural with the psychological and biomedical. Provides a framework for understanding the transdisciplinary nature of complex PH problems.
Irreversible: Once they have incorporated an understanding of the social, it is unlikely that this way of knowing will be reversed.
Meyer and Land (2005; 2003)

4. Working with Student as Partners to examine the SDH
The student voice is a notable omission from research in this field.
Felton (2016) argues:
The emotional terrain of threshold knowledge as the most challenging
Tensions between the liminality and uncertainty experienced through learning ‘troublesome knowledge’ and classrooms that privilege correct answers and competencies.

5. What is Student as Partners?
A collaborative, reciprocal process through which all participants have the opportunity to contribute equally, although not necessarily in the same way, to curricula or pedagocial conceptulisations, decision making, implementation, and investigation or analysis (Cook-Sather et al, 2014, 67)

6. Research Questions
What is the role of Students as Partners in facilitating the learning of social determinants of health as a threshold concept?
How does this learning differ for postgraduates and undergraduates?
How can we facilitate the teaching and learning of threshold concepts such as the SDH in a multidisciplinary curriculum?

7. Methods
Phase 1 - Conceptual Mapping with colleagues and Focus Groups with past students
Phase 2 - Baseline Survey at start of semester identifying student’s assumptions about health inequalities
Phase 3 - Engaging Student Partners
– Journaling and fortnightly meetings
Phase 4 - Follow-up Survey
Phase 5 – revisiting and revising curriculum

8. Our Students
First year Health Systems and Policy (250 students) and postgraduate Social Perspectives (120 internal and external students)
5 Undergraduate and 5 postgraduate students
Aged 18 to 30+
8 women and 2 men
3 international students
1 Indigenous student
1 external student
1 part-time student
Across the spectrum of academic performance

9. Students as Partners: Working through the Liminal State
For us:
Challenging for us to see the challenges they identified. Constant questioning of who we are and what we’re doing. Some loss of confidence
“I keep questioning what we’re doing”
Supported through collaborative teaching
For the students:
Moving beyond consumer satisfaction towards an ontological reflection of their learning
Showed the ‘stuck’ places where the learning was most troublesome and where they became unstuck
Supporting students to deal with uncertainty
“I realise I’m having to sit a little uncomfortably for a bit as we engage with the reality that ‘wicked problems aren’t just an easy/straightforward apply the formula fix”

10. The process of Curriculum Review and Revision
Opening the ‘black box’ of teaching and learning
Expanding the living classroom
Ongoing curriculum review and change
Reinvigorating the active classroom to also support practice

11. Opening the black box of teaching and learning
SAP opened the ‘black box’ of teaching and learning” for us and the students
Being open and honest about the curriculum development to empower students and ourselves
Continuing the conversation with students, engaging them in curriculum design and development
SAP opened the ‘black box of teaching”
Our focus is on an active learning community, which includes the teaching team and students as co-producers of learning who will play an active role in ameliorating the social determinants of health.
Being open and honest about the curriculum and seeing the course as a living changing entity - not set in stone/ no ‘correct’ answers.
Slow down, pare back and provide space for students to engage in emotional content - and support them as they struggle with their positioning and question their ability to facilitate change
We model the learning of complexity actively debating among the team and with students – emphasis on critical thinking, praxis and what can be achieved (strengths approach)

12. Establishing a living classroom
Seeing the course as a living, changing entity.
Adaptive and responsive to students’ learning
Adaptive and responsive to the external environment – eg., SDH facebook page to map current events, debates and writing.
Bringing the real world into the classroom and going into the real world
“Outside the class I’m more aware of public health issues and I’m able to understand current affairs with a deeper understanding, which is really cool!”
Using authentic assessment and feedback, to scaffold learning and gain feedback from students that directly informs teaching
SAP opened the ‘black box of teaching”
Our focus is on an active learning community, which includes the teaching team and students as co-producers of learning who will play an active role in ameliorating the social determinants of health.
Being open and honest about the curriculum and seeing the course as a living changing entity - not set in stone/ no ‘correct’ answers.
Slow down, pare back and provide space for students to engage in emotional content - and support them as they struggle with their positioning and question their ability to facilitate change
We model the learning of complexity actively debating among the team and with students – emphasis on critical thinking, praxis and what can be achieved (strengths approach)

13. Reinvigorating active learning to incorporate practice
Reinvigorating an active learning community - the teaching team and students as co-producers of learning.
Slow down, pare back and provide space for students to engage in emotional content.
Modelling the learning of complexity, active debate and discussion
Recognition of students’ future roles in PH – they want to play a role in ameliorating the SDH. Fostering a strengths approach.
Engaging students in the applicability to practice, particularly for postgrads, who are seeking ways to deal with complexity and uncertainty.
“It provides the opportunity for us to learn to be comfortable with the uncertainties”
SAP opened the ‘black box of teaching”
Our focus is on an active learning community, which includes the teaching team and students as co-producers of learning who will play an active role in ameliorating the social determinants of health.
Being open and honest about the curriculum and seeing the course as a living changing entity - not set in stone/ no ‘correct’ answers.
Slow down, pare back and provide space for students to engage in emotional content - and support them as they struggle with their positioning and question their ability to facilitate change
We model the learning of complexity actively debating among the team and with students – emphasis on critical thinking, praxis and what can be achieved (strengths approach)

14. Thank you to our student partners
Tony, Gillian, Christina, Zoe, Maisie, Brenna, Matt, Nicole, Dishka, Yinling.