A critical approach on the impact of student initiatives
This article is a more explicit written version of a speech given at the SHOUT2013 event, hosted by the Strategic Planning Community Initiative committee of the Medical Student’s Society of McGill University.
---------
Over the past three years, I have worked hard with many of my colleagues from medical school in the audience to build a stronger sense of community at the McGill level and particularly in global health. This article is an attempt to express why I failed to do so and why the same story happens to all of us every year.
There are four reasons I can think of:
The high turnover of students
The preconception that motivates students to get involve
The incapacity for us to stay involved at 50% leading to frequent abandon
The modular and punctual funding available
-- 1 --
We all know that the window during which medical students can get involved is really short. There tends to be more students with extracurricular involvement during the preclinical years mostly since the material presented is dry and is often used as a compensatory mechanism to have a contact with patients or more with the population served. That small window actually pressures us to have quick results and have everything done for tomorrow. Then add to this the fact that there is a high turnover of coordinator and often times an improper transition period, you end up with student projects who are changing vision year after year, hence losing all credibility and institutional memory. Every year we risk of repeating the same mistakes again and again.
-- 2 --
A second argument that could be brought to the table to explain our failure is the fact that students are getting involved at the beginning of their medical school, when they are still naive and optimistic about their impact in the community. Over the years, I have developed a theory that when someone participates to an activity with a preconception, they will carry on that preconception through their involvement regardless of the various factors that could make them change their mind. For example, someone goes to Tanzania thinking that the population there is really poor and sad and needs any help possible to fix the situation. Even though that tourist will be exposed to different social classes, different environment and perhaps a lot of locals who have accepted what life had to offer them, that person will still remember the one and only kid who came to her asking for chewing gums and crying for it. There is going to be subconsciously a skew or a bias of the real situation, almost discriminating the elements that would refute her opinion before leaving. I sometimes feel like this theory can be applied pretty much to a lot of student initiatives in the sense that a project will be focusing its work with a community trying to improve or provide education about a specific topic, regardless of the actual situation that is not as bad as described. We are seeking for a utopian society and are often OCD[1] in medical school. We will then focus on the injustice we find worth fighting for that the local population has accepted or learned to deal with long time ago.
It is perhaps due to the fact that most of the time, a medical student is not going to gain anything from the outcomes of a project as they will never be reached, so it will focus its attention on promoting the project and showing the world he doing something while it clearly is not helping out. Medical students will then carry the preconceptions that were present before getting involved with a vulnerable community and be happy to discuss the fact that this problematic is still present and he did something about it.
There is also a whole different class of “reasons why to get involved” and those are formal recognition and CV building. I will not spend more time talking about those, as they are unfortunately non-genuine and self-explanatory. These will again, most of time, not force the student to see on the long-term and do the extra work behind the scenes to bring a project to completion or elevate the project to a new level.
-- 3 --
Now knowing that the window is small and that it is hard to get people who want to get involve for genuine reasons, why don’t we keep our members longer just as advisors?
The truth is that if a Student A has started a project, put in a lot of effort to bring it to life and had a vision of what it could become in the future, it is going to be hard for A to let Student B take over the project and witness every actions he would have taken differently. At this point, the Student A will be demotivated about the project and will prefer to quit the implication to 0% instead of just being involved at 50% and feeling powerless about the loss of potential. In medical school, we also deal with strong leaders that want to take on full charge and have sometimes difficulties sharing the work and decisions. This is a gray zone that any project will face and where the new coordinator will impose his choice and where the previous coordinator will feel less and less stimulated to continue the leadership of the project.
The easy abandon of projects by simply fading away and the facility for new projects to be created often leave the stage for similar projects created over and over from scratch at every five-year interval.
-- 4 --
Lastly, most of the funding available to student organization is given following an application process that is relatively simple. Filling in couple of forms, stating a quick budget and the targeted population and voilà. Often times, it will be presented in a contest or competition framework where only the innovative, fresh and impressive idea will win. So the funding we receive from corporations and non-profit is not taking into consideration the long-term development of a project. Whichever funding body will favor a new unproven project over a recurrent sustainable one, since it is all about marketing and the image that are projected from this funding body to the general public. Strong applications often get selected because the end-goal is needed by society or is sensitive to current issues and not because they have started work and prove their project was working. However nobody has ever thought of the fact that because a project, who claims to do X, is given a 1000$ once, it does not mean that the project will reach its objective. It often takes years before seeing any impact in the community. In most cases, a project that has been running for 2-3 years will have a hard time getting funding, as it will look “recurrent”. I have seen ideas of a project getting funding over a recurrent successful event. That is a problem.
One would be tempted to say that having corporations and non-profit supporting the students and getting some popularity on the other side is a win-win situation. I don’t think so. I think the donator for sure gets a lot of attention from the population when funding a social or community initiatives. As costumers, we feel like the company is “taking care of us”. In another perspective, funding organizations don’t even have to hire a comedian for their next advertisement. It is as effective to give your project 500$ and get you to be featured in the next TV add. In exchange, your project gets this sporadic, non-renewable funding and does not get you anywhere near the “said” mission featured in the TV ad.
There is a well-known event and award night in Québec that is called Forces Avenir. This event is held annually and is funded by some private companies and a lot of university funds for community involvement. Don’t get me wrong, the idea of having a platform for students’ projects to compete is great, however I sometimes feel like this is too much of a brainwash in wanting to promote new projects and new personalities, without reinforcing the projects that are up and running already and that are struggling. We want to look open and interested into innovation, but we are not even supporting projects enough to see them come to life.
This failure is not only affecting us, it is everywhere in all non-profit organizations and a lot of community groups. I am thinking of Engineers Without Border who published for the third time earlier this year their Failure Report[2], stating what has not worked and the improvements to be made.
Now how do we move forward and deal with those two problems. Since we cannot really lengthen medical school, we have to implement a change in our funding system.
For me, the perfect sponsorship package would be a guaranteed amount every trimester for a 5-year period during which the students would give continuous feedback and follow up report about how they are progressing on their 5-year vision development. Regulating income would make it more likely to retain students in the project. It would potentially also attract new students since the project would be stable, more focused on the future and consistent with its mission.
Universities have always been good at setting new trends and starting new movements. I believe this is the time for us to raise the bar and structure our funding so that it promotes the long-term perspective, taking into accounts the factors above. Eventually, corporations and foundations will copy those funding strategies since they will prove themselves to be effective with projects finally coming to maturity.
It took me three years to get at that point of criticism and I am already fading away from student politics. I hope that this was enough to get some students to think and reflect about how we want to structure ourselves for future generations to benefit from it.
