At 2:46 p.m. on March 11, the world marked the fifth anniversary of the Great East Japan Earthquake, tsunami and subsequent nuclear power plant tragedy. I traveled to Japan last week to mark this sombre anniversary – one still so raw – at Fukushima Medical University, along with the first medical responders to the crisis.
Following a disaster of such magnitude, there is a universal desire to understand what went wrong and identify lessons learned in hopes it is never repeated. However, we live in a complex world. The combination of an earthquake and tsunami was so lethal most Japanese could not bring themselves to believe it would ever happen. Yet nuclear radiation disaster specialists were well aware of ongoing potential threats, including the threat of nuclear terrorism.
Following the disaster, staff from the Division of Human Health at the International Atomic Energy Agency in Vienna worked with Fukushima Medical University. Lengthy interviews were conducted, documenting the experiences of physicians, nurses, psychologists and psychiatrists, radiation safety experts, administrators and leaders, all who formed a contingent of first responders. The nuclear accident has been discussed and written about extensively by those whose job it is to pay attention to such matters.
Many discuss topics of risk (and disaster) management, risk communication, measurement and new policies. However, this team wanted to ensure the ‘lessons learned’ found their way into their teaching to make sure the next generation of first responders would be better prepared to respond to any future disasters than they were for this one.
An early desire to build a model curriculum eventually gave way to a desire for collective interdisciplinary knowledge to be brought to bear on a process of ongoing curriculum renewal. My role was to lead this educational curriculum project.
Collaborating across disciplinary and paradigmatic boundaries is challenging work. This was further complicated by language and culture. Yet, we shared a resolve to find ways to respond to what was learned from the experiences of the brave men and women who responded to the best of their ability in the midst of a chaotic tragedy. As I collaborated with this team over the past four years, it became clear we needed to adopt a ‘social practice’ approach to curriculum renewal.
Scholars view curriculum as a flexible, dynamic and responsive way to approach a topic that involves an interplay between policies, learners, instructors and content. Yet the past two decades have seen a broad movement toward standardization of curriculum and policies aimed at raising achievement. While this movement is understandable in a context of increasing attention to accountability, a perhaps unintended effect is this ‘institutional’ and ‘programmatic’ curriculum has dominated the dialogue. What gets lost is attention to what actually takes place in classrooms – to cultural or normalized practices that may have ‘hidden’ effects; to important elements omitted from a curriculum and, finally, attention to how the application of curriculum plays out in our lives.
A social practice curriculum invites multiple stakeholders across their various discourses and roles to re-imagine, explore and test fundamental concepts within their contexts.
Collectively, our team analyzed the first responders’ experiences. We learned policies and standards for safety, training and radiation exposure had been in place. But they were insufficient. For example, several of the first responders recalled training with ‘table top’ exercises that taught them how to respond to an incoming patient, contaminated through an imagined accident at the nuclear power plant. No one imagined the real scenario they faced – one in which everything (the patient, the ambulance and the ground) was contaminated.
To prepare for a disaster is to prepare for an unknown crisis. Therefore, disaster teaching is a process that promotes learning that explicitly focuses on the unexpected.
A second important understanding was almost all physicians knew about radiology, but few understood radiation health effects on the human body. Health-care professionals were generally taught about radiology in the context of reading CT images, performing ultrasounds and looking at chest X-rays. Those who had some education about radiation health effects had long forgotten their training, as there was no call to use this knowledge in a clinical setting.
The existing curriculum did not anticipate the need for public communication. Instead, it focused on a time-honoured practice of developing medical expertise. Participants indicated little practical training, and certainly no preparation for being ambushed by an angry and frightened public or the media. Information was at first slow to come out from a government scrambling to manage three crises at once; when it did start to flow, it was at times contradictory and at best, difficult to understand. As one interviewee put it:
“There were many experts in the government. They provided various bits of information to the public. However, the public did not understand whether these experts were right because government experts said that effects of radiation were not dangerous and that 1 mSv was no problem. On the other hand, other experts were saying that 1mSv was too high. This was very confusing to the public.”
Risk management discussions, in particular, emerged as critical to this accident. Translating highly technical scientific knowledge into ‘lay’ terms was very difficult. A radiation accident induces not only physical injuries, but also psychological and social problems. People were worried about their health, especially that of young children or pregnant women. They worried about the contamination of their food and whether it was safe to be outdoors or eat vegetables from their gardens. Harmful rumours exacerbated their concerns about their economic futures. They worried about discrimination towards people from the region similar to the Hibakusha of Hiroshima – the ‘exposed people.’ They wanted clear answers, but risk is not a black-and-white issue. The responders were forced to adapt to circumstances:
The reality didn’t go as described in the manual. For example, at the screening of affected residents, the screening level of surface contamination was 13,000 CPM. With this regulation, there were too many people for us to decontaminate at the same time. Additionally, it was too cold to decontaminate them. This situation indicated that we had to keep them in cold outside for a long time, and it would exposed them to other health risks such as flu, pneumonia and hypothermia. Therefore, our team proposed to change the decontamination level. It was approved by the local government and the nuclear safety committee in Japan. So, they changed the level for the decontamination promptly.
In our collaboration, we deliberately incorporated experiences such as these into a number of curricular materials that could be adapted into a variety of courses. For example, public health nurses were rarely trained in radiation health effects, and yet they were ideally situated to speak with communicators following the accident. We produced a handbook to explain the fundamentals of a ‘science, technology and society’ curricular framework that brought their experiences into an active, engaging format focused on guiding educators to integrate and apply their learning into the health sciences curriculum they teach.
This past week, we met again in Japan to assess our progress as we marked this important anniversary. We were encouraged to see the various ways in which the ideas had been taken up by Fukushima faculty and students and demonstrated through numerous community projects, including student initiatives aimed at addressing the gaps.
The notion of ‘collective accountability’ has been challenging longstanding practices focused on individual or institutional competence as insufficient. Rather, collective accountability invites individuals, each bringing particular expertise to the curricular dialogue, to be better able to function with an awareness of the whole; the various expertise, resources, structures, contexts and so on, within and across system(s).
Collectively, it is possible to participate in curriculum inquiries from a much broader focus, including looking at systems themselves and how they function to enable or inhibit curricular goals. And, collectively, we can face our future challenges.
Education professor Kathryn Hibbert recently traveled to Japan to work in collaboration with hospitals, governments and physician educators to ensure lessons learned at Fukushima find a way into future classrooms.