Nov 24, 2021
At the end of the violent dictatorship of Augusto Pinochet in 1990, Chileans united for a newfound democracy. The short interview you are about to hear picks up at this historic time, when primary care doctors at Chile’s leading medical school called for a revolutionary approach to their own learning, and that of the communities they served. Stay tuned for a conversation with a leader of that movement, Dr. Joaquín Montero.
This short exchange with Dr. Jane Vella, GLP Senior Partner Valerie Uccellani, and Dr. Joaquín Montero offers a glimpse of the bold history of dialogue-based learning at the Pontificia Universidad Católica de Chile – Escuela de Medicina (School of Medicine). We encourage you to take a peak at this timeline of the revolutionary approach that’s taken hold at the medical school. This story is a beautiful illustration of GLP’s tagline: “revolutionize your learning, transform your world.”
Listen on Apple Podcasts, Spotify or virtually anywhere podcasts are found!
This show is produced by Global Learning Partners and Greg Tilton Jr.
Theme music: ‘Pretty Face’ by Una Walkenhorst.
Read transcripts for the episode below.
MEG
[INTRO MUSIC] Hello, and welcome to Shift the Power: A Learning-Centered Podcast, where we talk about the revolutionary power of a learning-centered approach. Through this podcast, we hope to inspire creative thinking and provide practical tools and techniques to deepen learning through dialogue.
VALERIE
I’m your host for today’s episode, Valerie Uccellani. I’m a Co-Owner of Global Learning Partners, a proud co-owner of Global Learning Partners and happy to be with you all here today. We’re joined by Jane, who you all know well, and her longtime friend and a friend of Global Learning Partners. Dr. Montero, welcome to our podcast today. I know that in addition to a medical degree that you earned many years ago, you also received a Master’s in Public Health. And you’ve been honored for decades of commitment as a faculty member of the School of Medicine in the Pontificia Universidad Católica de Chile. So, we’re really delighted that you’ve joined us from Chile this morning-
JANE
Me too!
VALERIE
-and know that there will be really too little time to talk to you both today and to hear about your visionary work there at the University of Chile, Dr. Montero. But, but we look forward to the time that we have. Welcome and welcome Jane as always. So, Joaquin, tell us a bit about yourself and how you came to know Jane or Global Learning Partners.
DR. MONTERO
Before I answer your question, I – I feel very honored to be invited to tell with Jane and with you, Val. I never imagined that will happen some time. So, it’s like a surprise, a big surprise, there are people in the world that are interested in this little story, but thank you, thank you very much. Going to your question, when I decided to go to UNC Chapel Hill in 1988, my motivation was to learn the basics – the basics of behavior change, to apply it to clinical prevention with regular patient. I am an MD Professor at the University, I realized that I didn’t have any competence to help my patients to change behavior. It was very necessary to help them to change. I consider in that moment, that it was necessary to me and to my work at the University and to change the curriculum of the School of Medicine. And so, I went to UNC. In 1889, after some months there, I was invited to a special meeting, an encounter with Jane Vella. An atypical teacher, she shared with us some of her several educational experiences in Africa. I didn’t understand much and I – it was a bit confusing for me, it was a little bit crazy.
JANE
It still is.
DR. MONTERO
It was highly unexpected. But the following term, I participated in her Dialogue Education seminar once a week, Wednesday afternoon, and I was captivated by her and her model. The content were very interested in itself, but more interesting than that, were the sessions and the way they were developed. At first, sometimes I found things out of place, but little by little, I realized that the medium was the message.–
JANE
Oh.
DR. MONTERO
–The importance she attached to the staging of the session was unique. The attention to detail when she conducted the session. All of which made us feel welcome and respected. Through love for educational tasks and respect for us, for students.-
JANE
Wow.
VALERIE
Yeah.
JANE
30 year remembrance.
DR. MONTERO
That’s true.
JANE
I know. I know.
DR. MONTERO
Well, when I go back to Chile, I brought my knew knowledge, skills and attitudes along with my MPH and a project: “Basis to Change Medical Curriculum,” you know, oh-hoh! But the great treasure that I brought with me, was Jane’s participatory education model. And then shortly after arriving, the Dean commissioned me to take care of a proposal of young doctors who wanted to train to be a specialist in Primary Care, it was crazy. No one in Chile were doing that – what they were seeing were a new model to work in Primary Care. That was something strange and unusual, but we share a common topic with them. Because I was interested in clinical prevention and health promotion, and to work in Primary Care they also want to be trained in those areas. Along with accepting the challenge, I made some demands to the Dean, such as putting Dialogue Education as central to the training process. I’m sure he didn’t understand anything. I said we’re sad of this condition. When – when this new program began in 1993, Jane was invited as the honored guest at the inauguration and she lead the first academic activity.–
JANE
Incredible.
DR. MONTERO
–Today, the program has trained around 300 specialties and is one of the most prominent programs in Family Medicine in Chile, not only because of the number of graduates, but also because it is a leading group in the development of Primary Care in Chile, the working in partnership with other academic and non-academic groups.
VALERIE
Joaquin, thank you for that history and we will make sure to make the visual accompanying that history, available to our listeners. So, Joaquin, you explained how when you returned from the University of North Carolina, Chapel Hill emboldened, I might say, by your experience there, you actually made a demand of the Dean that a program–
JANE
I love it!
VALERIE
–of Dialogue Education, become a central part of the training for Primary Care Physicians, which is quite bold of you. So, I wonder if you could tell us just a little bit more about how you made that happen, because many of our listeners are, like you were, really jazzed about the power of Dialogue Education, and yet a bit stuck about how to bring that into institutions and networks. So, tell us a bit how you were able to make that happen.
DR. MONTERO
Hahaha – no, no, no, because Chile was initiating a new historical period at that time, you know, after Pinochet, and democracy was regained.–
JANE
Wow.
DR. MONTERO
-So, there were many people interested to change things. To generate changes, and learning is a form of change, we need energy. It is necessary to connect people to a continuous source of energy. It is necessary to know what are the needs and what are the generative themes of people are and work with them, because those will be the source of energy to achieve the transformation. There were happening a lot of new things around- in health. And one of that was that – this, there were a group of students that received their MD, the year before I came back to Chile. And they presented to the Dean a paper – and they presented what they wanted to do, and they want to stay at the Primary Care. But they – they realize that they – they weren’t prepared to work there. So – and they asked, “why don’t we create a program to stay just working in Primary Care in – in community clinics,” very-
JANE
Amazing!
DR. MONTERO
-and learned how to talk with people, and how we can prepare to – to work together with people in order to get better health. And so they were, as the Dean was very disconcerted and the students – some of them were very, very high rank students and they were absolutely committed to that. You have to have the end in your mind – where are you wanting to go? You know? So they were absolutely clear that they want to be an expert in Primary Care, specialists and to be known as specialists.–
JANE
Yes.
DR. MONTERO
–You know, so it’s- so an – and – and this document I still have with me, it’s fantastic. So the Dean was very – a little bit upset about that and he was, he was sure that he had to do something. So for that, I asked, if you want I – I will work with them and also, I invited another student that knew Jane, and was Rosa Walker. She also returned back – came back to Chile and so together, we- we began to work about that – how we can introduce this. Because we – when we saw it’s very important to – in the middle of this residency, student program, insert this – this way of learning.
VALERIE
Thank you so much for adding that bit of history. It sounds to me like the conditions in Chile were ripe for Dialogue Education, that there was – that there was a movement to democratize everything. Dialogue Education was something of a response to that call to democratize what was happening at the School of Medicine.
JANE
Valerie, may I, the question was perfect. Thank you, Val. We needed that, we need – I didn’t know all these details.
DR. MONTERO
We were so afraid, you know,-
JANE
Of course! But now, no fear, no fear you know it works!
DR. MONTERO
But at that time, we were very, very fear about that.-
JANE
Of course.
DR. MONTERO
-You know, at my home when we were imagining why we were doing this, it’s because we are creating a new way to do things, the residents were…
[SPANISH] Toda la facultad nos iba a juzgar comparando con las otras especialidades y residentes que se empezaban a formar en las otras especialidades, que eran 300, 400 que entraban ese año a medicina interna, pediatría, cirugía, en fin todas las especialidades que se dan. Y ellos tenían un programa muy distinto, ya que entraban directamente a trabajar con los pacientes, trabajando junto con sus profesores y nosotros partíamos en una semana dedicada a la educación de ellos, de cómo deberían aprender para que a su vez cuando ellos salieran a trabajar a la atención primaria, ellos iban a tener una experiencia de aprendizaje distinto y por lo tanto podrían aplicar esa experiencia a sus futuros pacientes, familias y comunidades. Eso era una cosa que éramos responsables, Jane, Rosita y yo estábamos allí dando la cara y asegurando que esto iba a funcionar. Y funciono y eso es lo más importante. Mira. Si yo miro 300 médicos formados del curso, el seminario de Educación Dialogantes, se sigue dando igual todos los anos indicados, ellos siguen apreciándolo mucho. Todos los anos. Es algo impresionante porque no lo hemos modificado prácticamente nada. Y todos los anos al terminar, les preguntamos que nos evalúen y nos siguen llegando unas alabanzas al programa que son emocionantes.
[ENGLISH TRANSLATION] The entire faculty was going to judge us by comparing with the other specialties and residents who were beginning to be trained in other specialties, which were 300, 400 who were entering internal medicine, pediatrics, and surgery that year, in short, all the specialties that we had. And they had a very different program, since they went directly to work with patients, working together with their teachers and we started a week dedicated to educating them, how they should learn so that when they go out to work in primary care, they were going to have a different learning experience and therefore could apply that experience to their future patients, families and communities. That was one thing we were responsible for, Jane, Rosita and I were there showing our faces and ensuring that this was going to work. And it worked! and that’s the most important thing. If I look at 300 doctors trained from the course, through the Dialogue Education seminar, it continues to be the same every year, they continue to appreciate it very much, every year. It is something impressive because we have hardly modified it at all. And every year after we finish, we ask them to rate us and we keep getting some exciting praises.
[SPANISH] Fíjate que me llego uno, se los voy a leer en inglés para que no sufran tanto. Esto fue del año pasado de una estudiante que estaba comenzando entonces escribió todo lo que nosotros hacíamos al inicio de la residencia antes hacíamos una semana de educación dialogante, pero ahora es un mes de inducción antes de comenzar la beca, esto es un invento nuestro, del espíritu de prepararlos para estos 3 anos de aprendizaje intensivo, pero ingresa muchas otras cosas.
[ENGLISH TRANSLATION] One note that I received, I’m going to read it to you in English so you all don’t suffer too much. This was from last year of a student who was just starting and she wrote everything that we did at the beginning of the residency before we did a week of Dialogue Education, but now it is a month of induction before starting the scholarship, this is an invention of ours with the spirit of preparing them for these 3 years of intensive learning, but enters many other things.
“I want to focus my attention on the adult education course, as there were contents such as the lead learning approach, the relevance of the safe environment, positive feedback, real and attentive listening, among others, that challenge me to reflect and review some personal and professional issues. For example, in my school, I have been characterized as not very participatory, since I have limited myself to asking questions or interviewing- intervening for fear of not being heard, or ‘making a fool of myself’.”
JANE
Oh, yes.
DR. MONTERO
“However, in this course, I felt so much trust with the teacher and my classmates, and the content made sense to me, that I allowed myself to express my opinion and raise my hand without fear.” And then, it’s fantastic.
VALERIE
Joaquin, the more I listen, the more fascinated I am with this history. And for our listeners, I just want to recap that what you and your colleagues did was you established within the residency program, the multi-year program, an initiation into Dialogue Education, at the very start of that program, so that they were already thinking about learning in a different way–
JANE
Right.
VALERIE
–so that they could apply that to the work that they’re doing in that- what they would be doing in the community, but also so that they could apply it to their own learning as medical residents.
DR. MONTERO
[SPANISH] Por supuesto. Porque ellos no podían ayudar a aprender a los otros sino habían ellos tenido ellos la experiencia de aprendizaje, ósea el modelo tenía que ser vivido y ellos así lo podían transmitir. Eso fue lo que Jane nos enseno, sin decirlo, pero lo hizo así.
[ENGLISH TRANSLATION] Of course! Because they could not help others learn if they had not had their own learning experience, that is the model that had to be lived so they could transmit it. That’s what Jane taught us, without saying it, but she did.
VALERIE
Thank you so much. So this has been such a rich conversation and obviously, we’ve gotten just a snippet of the decades of history, from which we can all learn so much. So we will have available on our website, for all of you listeners a bit more about the history of the work with the University of Chile Medical School, the timeline and some testimonials from Dr. Montero and his colleagues. So visit us there at GlobalLearningPartners.com for more. So, thank you so much, Dr. Joaquin Montero and Dr. Jane Vella for today’s conversation. You know, as someone who’s been practicing Dialogue Education for some time, I must say that I’ve – I’ve – I’ve learned a lot about the – the boldness that it takes sometimes to bring a truly revolutionary approach to learning into a system and the incredible growth that can come from that. So, thank you so much for all you’ve done and for sharing that with us today. Have a wonderful afternoon.
JANE
Thank you, Val. Thank you Joaquin, gracias mi amigo.
DR. MONTERO
Thank you, Val. Thank you Jane. Muchas gracias, una braso.
MEG
[OUTRO MUSIC] Thank you for tuning into another episode of Shift the Power: A Learning-Centered Podcast. This podcast is produced by Global Learning Partners and Greg Tilton with music by Una Walkenhorst. To find out more about Global Learning Partners, whether it be our course offerings, consulting services, free resources or blogs, go to www.globallearningpartners.com. We invite you to sign up for our mailing list, subscribe to our podcast and find us on social media to continue the dialogue. If you enjoy the show, please consider leaving us a review on Apple Podcasts or your preferred podcast player. [OUTRO MUSIC FADES]