Medical School Hotline

Introduction

The John A. Burns School of Medicine (JABSOM) strives to educate future physicians who are bright, driven, and most of all, dedicated to their jobs as community servants. The emphasis on community outreach and patient care is established early in the medical school curriculum, notably through the Community Health and Service Program. The major goal of this program is for first-year medical students to explore methods for promoting health and improving the quality of life for patients by working with a community organization throughout their entire first year.¹ This column will focus on the Girl Power community health program and will provide an overview of the program as well as describe the insights gained from fostering mentorship between medical students and young women during its inaugural year.

The Girl Power Program

The Girl Power program was designed and implemented in 2017 by three medical students who grew up in Hawai‘i and noticed a distinct lack of programming and mentorship targeted at girls in middle school. Girl Power is a weekly after-school breakout session for 6th–8th grade girls from local middle schools with medical student mentors through the YMCA of Honolulu. The goal of Girl Power is to develop female self-esteem and well-being through the development of interpersonal relationships and facilitating the introduction of positive female role models in the form of medical students.

The demographic subgroup of middle school girls is particularly well suited for mentorship from medical students. This is the age where most females will begin to undergo physical, emotional, and mental changes associated with puberty. The Hawai‘i Department of Education's Sexual Health Curriculum does not introduce any reproductive health education until the 7th grade,² so a proportion of middle school girls experience menarche without any formal education on the topic. Medical students are able to provide scientifically accurate information about puberty from an approachable and non-intimidating (eg, not a figure of power such as a teacher, parent, or physician) source.

Additionally, the teenage years are a pivotal transition time in interpersonal development; Real Girls, Real Pressure: A National Report on the State of Self-Esteem shows that only 67% of girls ages 13 – 17 turn to their mother as a resource when feeling badly about themselves, compared to 91% of girls ages 8 – 12.³ A similar downward trend is seen with girls turning to their fathers. As teenage girls pull away from their parents, they begin to seek external validation from their peers and society as a whole. This becomes a problem when teenagers are surrounded by fashion and beauty as a for-profit industry, which influence their standards. The same study found that a girl's self-esteem is strongly related to how she views her own body shape and weight, despite how much she actually weighs. Additionally, girls with low self-esteem are more likely to engage in negative behaviors such as disordered eating, self-harm, bullying, or substance abuse.⁴ By establishing a safe space where girls can discuss topics such as self-esteem, healthy relationships, and mental health with their peers and a knowledgeable facilitator, common ground can be found between individuals who may feel isolated, misunderstood, and deficient. Finally, through Girl Power, medical students are able to position themselves as older peers rather than adults and therefore may be able to introduce the girls to ideas such as healthy body image, self-esteem, and healthy relationships in a way that might be more relatable to the girls than the typical adult viewpoint provided through school or from their parents.

The Girl Power Curriculum

Girl Power sessions were held once per week at the YMCA of Honolulu with two JABSOM first year (MSI) students as facilitators. The sessions were divided into three blocks of eight sessions that roughly aligned to the JABSOM MSI academic schedule. Participation in Girl Power was open to all middle school girls enrolled in the Club Mid After School Program and day-to-day attendance was optional with the caveat that at the end of each block, a final wrap-up session would only be offered to those who had attended every session in the block. The number of attendees ranged from six to sixteen, with an average of eleven at each session. Since this was the inaugural year of Girl Power as a community health program, the curriculum was designed by the two MSI facilitators. Each of the three blocks followed a loose common theme: first block emphasized bullying and self-expression; the second focused on mental and emotional health; and the third contained sessions pertaining to goal-setting and the pursuit of personal passions.

Each session was planned using a similar structure. The YMCA Club Mid program has students from multiple schools in the area so some of the participants knew each other and some did not. Each session began with team building exercise to foster communication and cooperation between the girls, especially those who are not friends outside of Girl Power. Because the goal of each session is to openly and honestly discuss difficult topics, trust and willingness to share is critical for the success of the curriculum. After the team building exercise, the topic of the day was introduced using a combination of socratic dialogue, examples from social media, and hypothetical scenarios meant to mirror real-life situations the girls may encounter.

Although each session covered a different topic, the underlying objective was to challenge the thought process of the girls and get them to critically examine not only cultural norms but also their own internalized thoughts and behaviors. One downfall of modern schooling when dealing with tough topics is that students are often rewarded for a correct answer without being pushed to explain or think through the issues (eg, being taught that drugs and alcohol are dangerous without discussion about the huge number of young celebrities who glorify party culture with seemingly no negative repercussions on their physical or mental well-being). Girl Power sessions aimed to combat this using a combination of scientifically accurate facts and open dialogue. Areas of confusion were identified and addressed in engaging conversations with age-relevant, pop-culture being used as a tie in as frequently as possible.

At the end of each Girl Power session, a short and anonymous written reflection was collected from each attendant and an exit survey was administered during the final Girl Power session of the school year.

Participant Reflections

Overall, the response to Girl Power sessions was overwhelmingly positive. Because participation was voluntary and girls were allowed to opt-out at any time, most participants were interested in being there and engaging with the topics that were being discussed. This was reflected in the responses to the exit survey, with all respondents agreeing that they enjoyed Girl Power and that they felt they learned something new every session. The majority of girls also felt that the topics covered in Girl Power were topics not usually discussed in school. This highlights the value of Girl Power since the topics covered were ones that teenage girls regularly have to engage with such as self-esteem, bullying, mental health, and healthy relationships. Additionally, the girls specifically mentioned that they enjoyed our open and in-depth discussions about puberty and mensturation, especially the 6th graders who hadn't started health class in school yet.

One aspect of the program that can be improved upon was that two of the surveyed girls didn't feel that Girl Power was a safe and non-judgemental environment. This was likely due to the fact that some of the girls knew each other from school and would occasionally bring outside situations or disagreements into Girl Power, especially as situational examples. Occasionally some of the more difficult topics (eg, healthy relationships, bullying, etc) would elicit oversharing of potentially private information from various friend groups. In the future, ensuring that girls only disclose information or situations that are theirs to share, and establishing more firm boundaries between outside friendships and the Girl Power space may alleviate some of those feelings.

Finally, the girls had some insight into how the Girl Power curriculum could be improved going forward. Some of the girls were there at every Girl Power session for all three blocks, while some only attended sporadically. In an attempt to keep the curriculum fresh, topics were not repeated. The physical, mental, and emotional changes associated with puberty and menstruation as a whole was covered during one Girl Power session, however, many of the girls who missed the lesson on puberty and periods were 6th graders who would have benefitted from that lesson. The desire for more comprehensive reproductive education was evident in the reflections; a one-hour lesson from two medical students was seen as more informative than the in-school curriculum, and both 6th and 7th graders wished we had spent more time discussing puberty.

Facilitator Reflections

Kameko Karasaki

Facilitating Girl Power frequently made me feel as though I was playing an important role in helping the girls develop into young adults with confidence to make well informed and thought out decisions for themselves rather than blindly accepting the status quo. Before one Girl Power session, a group of the girls were singing lyrics to a song that came out when I was in middle school, albeit with a misogynistic twist. When I asked about why they were singing it like that, I discovered that a YouTube personality popular with teenage girls had sampled the song but drastically changed the lyrics. The original song is about the incredible potential and vast power of human beings, while the new version is sexually suggestive and filled with cliche imagery comparing women to motorcycles. The girls had absolutely no idea that the new version was sampled from anything and it led to a great discussion about the representation of women in media and how they are frequently reduced to objects.

The ability to market to kids and teenagers is endless, and also endlessly exploited, but so much can change if they're encouraged to think critically about the type of media they choose to engage with. Encouraging the girls to begin examining the messages that they're constantly bombarded with and decide if they align with their own developing values was my favorite part of Girl Power, and what I think will have the largest impact on the girls going forward.

Julie Crocker

I was excited to serve as a mentor for Girl Power and serve as a positive role model for young women. When I was young, I struggled with my identity and self esteem because most of my interests were traditionally male dominated. I had no place to discuss why certain activities were more associated with one gender than another, and that it is okay to be different. As a leader in Girl Power I wanted to provide the students a space to think critically about societal expectations of them and encourage young women to pursue their dreams no matter what they are.

One of the most powerful moments came when we were discussing how products can be marketed to men or women. We showed them an ad by a pen company that produced a line of pens “For Her.” We challenged the girls that if it was ridiculous to think of pens as gendered, why were other products like nail polish or makeup gendered? One more talkative girl became quiet during that discussion. We later learned that she had a male friend outside of Girl Power whom she and her friends often teased for having female-associated interests. This moment was powerful for me because we could see that our discussions were having a real effect on the students and led them to critically think about their actions.

Conclusion

The Girl Power curriculum fills a critically important space in the education of teenage girls. By giving the girls a space to discuss tough and sometimes “taboo” subject matters with their peers, the girls can learn to think critically, defend their ideas in a well thought out and respectful manner, and relate to each other on a deeper level. Topics that are often shunned from mainstream education can begin to be normalized, and the girls are given a great resource in the medical student mentors. In return, the medical students are able to hone their leadership skills, were given the opportunity to discuss sensitive topics in an age-appropriate manner, and were able to advocate for the mental, physical, emotional health, and wellbeing of adolescents. Although the results are specific to the Girl Power program and cannot be generalized, the reflections and feedback from the students who participated show a potential important niche Girl Power can fill in adolescent education.