Learner Types: Social Roles Encountered in Multicultural Clinical Education in Psychiatry

To the Editor:

In recent years, there have been numerous calls to action to increase attention to the cultural aspects of clinical education in academic psychiatry. Despite recognition that specialized culturally informed education represents a critical need, providing instruction in this area may be challenging. We also lack a conceptual framework to optimally engage trainees in order to foster learning and change [1].

In this letter, we outline our novel conceptualization of “learner types,” which are social roles that learners inhabit in the classroom. In presenting this view, we integrate concepts from academic literature on human small-group dynamics with our experiences as instructors of cultural courses in psychiatry [2, 3]. Our experiences in this type of education range from didactic to experiential and include lectures, multicultural supervision/consultation, and cultural immersion experiences. Complex group dynamics occur even when the group is formed with a clear task or set of goals [4]. As instructors, we noticed a pattern of recurrent behaviors in the classroom that we classified into learner types. This conceptualization was created through complex interactions including individual personal learning history and psychodynamics, the specific group’s dynamics, and interactions with instructor(s).

The six learner types we identified are:

  1. 1.

    The Uninterested Learner who communicates—explicitly or implicitly—that they do not have interest in the subject matter.

  2. 2.

    The Overinvested Learner who may have the intention of being extremely engaged with the material, yet their enthusiasm may not match their level of knowledge about the content presented.

  3. 3.

    The Hostile/Aggressive Learner may display verbal (e.g., appearing overtly argumentative in group discussions, openly questioning the authority or experience of the instructor, voicing their discontent to program administrators) and/or non-verbal indicators of discontentment (e.g., being distracted by phones or computers). Their aggression is more palpable to the group and to the instructor than that of the Uninterested Learner.

  4. 4.

    The Questioning Learner may be aware that they have limitations in their understanding of cultural issues specifically as it relates to their field of practice. They are usually open to the fact that they have “blind spots.” This learner may request specific answers, or an algorithm related to behavior that is “culturally competent.”

  5. 5.

    The Tokenized Learner may be clearly seen as “different” or a “minority” in the group. In learning environments, these learners may have been repeatedly, most times inappropriately, called upon to represent their group.

  6. 6.

    The Experienced Learner may enter the learning process with a robust set of experiences (personal and/or professional) such that the material being presented in these courses may not be altogether novel (e.g., formal education, multiple marginalized identities with a lived experience of oppression, significant research experience in health care disparities).

The Uninterested and Hostile/Aggressive Learner roles may contribute negatively to the learning process; however, these roles can also serve to enhance meaningful discussion by compelling all learners to address aspects of their experiences that are reflected in these roles. Other learner roles (e.g., Overinvested, Questioning, Tokenized) serve to bring balance to the group.

The roles we have operationalized serve distinct functions and arise under specific circumstances (i.e., when something important is being communicated). For example, the Overinvested Learner may highlight for other learners the importance of this work. The Questioning Learner may query the group and instructor in ways that can increase the depth of the conversation. The Tokenized Learner may provide an alternative viewpoint not considered by the rest of the learners. Thus, these roles identify specific needs and skills that individuals in the group or the group as a whole needs to acquire. It is important to note that residents may get stuck in one role or they may shift into different roles at different times. The role of the Experienced Learner is often a boon to the whole group. This role can broaden the overall skill set of the group in a much more organic fashion. The Experienced Learner helps the group to understand that a peer at their level can have expertise in the area of multicultural education but that there may still be room to grow and more that the learning process can offer even to an expert. For the instructor, this role can serve as a challenge to heighten their skills to teach the subject matter while also incorporating the expertise offered.

Culturally informed clinical education is an essential part of training for the newest generation of physicians. There is a gap in the literature and limited guidance for instructors on how to implement successful and useful culturally informed didactics. There is no standardized method of assessment for skills, knowledge, or attitudes. By identifying, categorizing, and describing these learner types, we hope to contribute to the conversation on how best to inform and train the next generation of psychiatrists.

We recommend that instructors remember that social roles are co-constructed. Their emergence yields information about individuals and the group as a whole. It is useful to consider the following questions: what is it about this particular group of people at this particular time in life that is pulling for hostility, an experienced hand, or tokenizing? Are there larger forces in the program or the institution that are playing out in the classroom?

In summary, an appreciation of the impact of learner types on the learning process can help programs design more effective trainings. No “gold standard” curricula or methodology exists for how to transform residents into well-trained physicians who are able to integrate concepts relevant to cultural issues in the delivery of mental health care. By understanding how different learner types can affect the learning process, training programs may now consider these factors in the design of a new educational initiative. We understand there are limitations in this conceptual framework as it is based on the authors’ individual experiences and observations. We hope that by describing our observations, we can help learners move out of one strict learner type to begin to engage more fully in the learning process. This knowledge allows learners and instructors to benefit and can enrich the overall experience for all participants.

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Correspondence to Anique Forrester.

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Forrester, A., Nagy, G.A. & Bhatt-Mackin, S. Learner Types: Social Roles Encountered in Multicultural Clinical Education in Psychiatry. Acad Psychiatry 45, 130–131 (2021). https://doi.org/10.1007/s40596-020-01387-7

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