A Q&A with Diane Finegood about The Future of Healthcare

If you’ve watched or scrolled through any news lately, you’ve likely encountered at least one healthcare issue in the headlines. Pandemic aside, the province faces a family doctor shortage, a drug overdose epidemic, impacts from climate events, and more.

How can a semester-long, cohort-based course even begin to tackle these complex, but pressing, problems? Diane Finegood, a professor and fellow at Morris J. Wosk Centre for Dialogue, will take students on an immersive journey through these topics in this fall’s Semester in Dialogue (SID): The Future of Healthcare. As a recent recipient of SFU’s Awards for Excellence in Teaching, Diane is known for her inclusive, innovative and experiential learning approach to teaching. She will engage students in practicing dialogue, relationship building, self-reflection and orientation towards social accountability during the course.

As a researcher, Diane has a deep passion for investigating complex (unpredictable, self-organizing and emergent) versus complicated (predictable, controllable and designable) problems. “The starting place for anyone who wants to become a systems thinker is to understand that complex is not the same as complicated,” she explains.

“So, if I apply this to the building of SFU’s new medical school, I’d say there are many complicated things, others that are complex. In complexity, we need to become less transactional and more relational. Standard methods of assessing applicants and students are highly transactional, relying on the use of grades and MCAT scores to determine admission eligibility. To become more relational, it would help to get to know these students before they apply and look for those with the qualities we would like to see in our care providers.”

Here are more of Diane’s thoughts on the course, topics and her approach to teaching.

Some topics students may explore as part of SID include planetary health, toxic drugs, the healthcare workforce, chronic disease and technology. As a researcher, which of these do you think will prove most disruptive to future primary care providers like family doctors?

I love this question, especially in the context of what makes a challenge complex. My first thought was that some of these challenges are wicked seemingly intractable problems in healthcare. We have been making the planet ill for a very long time and are now facing the predictable impacts of climate change. Despite having predictable impacts, we struggle because the challenges are complex and many years in the making. The solutions depend on recognizing this complexity and changing the way we problem solve.

As for acute disruptions, the rapid growth of artificial intelligence (AI) combined with other technologies like robotics and genomics will really challenge our ways of thinking and modes of practice in healthcare. It feels like we are at the extremes of uncertainty and disagreement about the way forward and this can lead to chaos.

I doubt many have thought much about how we can influence in a good way what emerges from this next phase of technology development. With my researcher hat on, I am collaborating with a national health charity and an AI researcher on how we can use AI to help identify stigma and develop tools to help change the conversation.

Social accountability, access and equity are increasingly important in healthcare education. Tell us a little about how the learning experiences in SID highlight the importance of community and social accountability.

We start by trying to “walk the talk” of access and accountability by meeting with each student interested in the Semester in Dialogue and discussing what supports they might need to succeed. I do my best to recognize the power I hold as an instructor and position myself as a learner. Doing this allows me to help make the course accessible to all types of learners and to support students through their varied learning journeys. While our practices are important, students will also do a deep dive into a complex challenge, and inevitably, issues of access, equity and accountability will arise.

For students who might be interested in a career path in healthcare or medicine, how could your teaching and learning approach in this course help students develop skills applicable to working in complex, patient-centred, community-based healthcare environments?

While I can’t speak to what is possible within the current expectations of those who control accreditation, I do imagine the practice of medicine and our thinking about the future of medical education needs to change. If I prioritize what I want my doctor to know, it will be how to listen, how to be supportive and how to ask questions rather than be able to name each muscle and bone in the hand or the chemical bonds that create the mechanisms of action of specific drugs. They will be able to get the known information they need at their fingertips.

Instead, I want my doctor to know how to question the information their AI system will give them and how best to apply it to the patient in front of them. These are also complex challenges and will require understanding the technology and what it is and isn’t good at.