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“It was great to break down the walls between patient and provider”: liminality in a co-produced advisory course for psychiatry residents

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Abstract

Although rhetoric abounds about the importance of patient-, person- and relationship-centered approaches to health care, little is known about how to address the problem of dehumanization through medical and health professions education. One promising but under-theorized strategy is to co-produce education in collaboration with health service users. To this end, we co-produced a longitudinal course in psychiatry that paired people with lived experience of mental health challenges as advisors to fourth-year psychiatry residents at the University of Toronto. The goal of this study was to examine this novel, relationship-based course in order to understand co-produced health professions education more broadly. Using qualitative interviews with residents and advisors after the first iteration of the course, we explored how participants made meaning of the course and of what learning, if any, occurred, for whom and how. We found that the anthropological theory of liminality allowed us to understand participants’ complex experiences and illuminated how this type of pedagogy may work to achieve its effects. Liminality also helped us understand why some participants resisted the course, and how we could more carefully think about co-produced, humanistic education and transformative learning.

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Acknowledgements

We dedicate this article to our friend, colleague and co-author Pat Capponi, who passed away as we were preparing revisions for resubmission. We gratefully acknowledge the generosity of residents and advisors who participated in this study. We also acknowledge the contributions of Jenna Lopez for conducting the interviews and the first cycle of coding, Arno Kumagai and Rachel Cooper for providing thoughtful feedback on an earlier draft of this manuscript and Hema Zbogar for copyediting the manuscript. We also thank the Associated Medical Services Inc. for supporting this project.

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Author notes

  1. Sacha Agrawal and Csilla Kalocsai are co-first authors.

Authors and Affiliations

  1. Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Sacha Agrawal, Csilla Kalocsai, Sean Kidd, David Wiljer & Sophie Soklaridis

  2. Centre for Addiction and Mental Health, Toronto, ON, Canada

    Sacha Agrawal, Sean Kidd, David Wiljer & Sophie Soklaridis

  3. Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Csilla Kalocsai

  4. The Wilson Centre for Research in Education, University Health Network/University of Toronto, Toronto, ON, Canada

    Csilla Kalocsai, David Wiljer & Sophie Soklaridis

  5. Voices from the Street, Toronto, ON, Canada

    Pat Capponi

  6. Centre for Health Sciences Education, Faculty of Health, Aarhus University, Aarhus, Denmark

    Charlotte Ringsted

  7. University Health Network, Toronto, ON, Canada

    David Wiljer

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  1. Sacha Agrawal
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Correspondence to Csilla Kalocsai.

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Agrawal, S., Kalocsai, C., Capponi, P. et al. “It was great to break down the walls between patient and provider”: liminality in a co-produced advisory course for psychiatry residents. Adv in Health Sci Educ 26, 385–403 (2021). https://doi.org/10.1007/s10459-020-09991-w

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