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The 2022-23 Inner City Health portfolio is focusing on the ongoing drug poisoning and overdose crisis. By narrowing in on a single, critical health issue from a systems-level perspective, we aim to provide knowledge and experiences to better understand this issue; but also, a model framework to help future physicians conceptualize how to consider their own (inner city) health advocacy.

Systems-thinking, in a social innovation context, is an approach to problem solving that is centered on first understanding the roles and relationships of entities within the system. In his book about systems-thinking, David Peter Stroh describes how understanding a systems story first requires three shifts (2015):

1. From seeing just their part of the system to seeing more of the whole system - including why and how it currently operates as well as what is being done to change it.

2. From hoping that others will change to seeing how they can first change themselves.

3. From focusing on individual events (crises, fires) to understanding and redesigning the deeper system structures that give rise to these events.

Broader systems-thinking in medicine is a new idea. In the book Inflamed: Deep Medicine and the Anatomy of Injustice, Marya & Patel discuss the critical need to shift our perspectives (2021):

"Studying the ways in which systems interact to create health or illness is the leading edge of a revolution of understanding in medicine. The reductionist understanding of disease in singular terms, such as one gene encoding one faulty protein or one drug targeting one receptor, can get us only so far. We evolved as systems within systems."

This elective is a rare opportunity for medical students to learn about a complex social problem as a system, and to build an approach of looking at problems through a systems-level lens.

The Inner City Health Community Engagement elective seeks to inform pre-clerkship medical students about the ongoing drug poisoning and overdose crisis from an applied systems-level perspective. The following stated learning objectives have been tiered using Bloom’s taxonomy:

Level 1: Knowledge and Comprehension. Students should be able to…

1. Better identify who is involved in this crisis at the individual, care team, organizational, and environmental/community levels, from a healthcare perspective

2. Be able to explain the complexity of this crisis, and the inadequacy of reductionist, linear thinking to define and collaboratively generate appropriate solutions to the problem

3. Appreciate the different forces at play and the many determinants of drug poisoning and overdose during substance use, especially for the inner city community

Level 2: Analysis and Application. Students should be able to…

1. Analyze the interactions, patterns, processes, and underlying structures (i.e. mental models) that are involved when we consider this crisis as a complex problem.

Level 3: Synthesis and Evaluation. Students should be able to…

1. Use an inclusive systems approach toward knowledge acquisition and advocacy within the elective as a model to build a sense of advocacy and responsibility toward the inner city community among medical learners

2. Adapt the use of the applied systems-thinking approach within and beyond the context of this crisis

3. Anticipate the role, responsibilities, and appropriate actions of medical learners, physicians, community experts, allied health professionals, researchers, government, and others who work to address complex health problems in future practice

If you are interested in completing the Inner City Health elective, pre-clerkship Year 1 MED 517/518 and Year 2 MED 527 must be recorded in assess.med before attending the elective. HOWEVER, if you do not want to use the Inner City Health elective to complete your required 12 hours, but you want to attend our events anyway, then you do not need to complete this process. To claim the elective:

• Go to assess.med.ualberta and select the tab for “First Year Elective” or “Second Year Elective”

• Select “Evaluations” and click on the form to begin.

• Please choose Dr. Katherine Smith (kesmith@ualberta.ca) as the preceptor

• Elective Name: "Inner City Health (Community Engagement)" OR "Community Engagement Mix & Match"

• Use the date that you are submitting the form

• Indicate all 12 hours.

• At the end of the year, Dr. Smith will review our attendance lists & input/confirm your hours for the elective sessions you attended. You'll just need to submit this one form :) It is also best for you to track this for yourself so that you know you will reach the hours you need. You can always reach out and confirm with us which events we acknowledge your attendance for

• After you complete your portion of this form click the “Save for Later” button. This will email your preceptor the form who can complete it after the shadowing/elective experience is completed.

For any questions about this process email Norma Maloney at electives@ualberta.ca