Awakening Critical Consciousness? Opportunities seized and missed in General Practice teaching.

Problem

There are increasing calls in the field of Medical Education to become more socially accountable, by adopting critical approaches to curriculum development. Critical Pedagogy theory was developed by Paulo Freire with reference to ‘disempowered populations’, but it also refers to all educational experiences promoting empowerment and transformation among learners. Central to Critical Pedagogy is ‘Critical Consciousness’, a process through which individuals identify elements of a socio-cultural environment that contribute to the reality of a particular context. So, Critical Consciousness is the basis of social accountability and transformation.A way for Medical schools to become truly socially accountable, could be to embed critical pedagogy constructs in their curricula in a way that it stimulates both educators and students to identify where power imbalances might compromise the mission of medical education and to develop attitudes to rectify those imbalances. This research seeks to identify areas of the GP curriculum where the opportunities to cultivate critical consciousness in our future doctors are seized and those where they are missed. Can we design GP teaching experiences in undergraduate medical curricula as opportunities to develop ‘grounded and rounded doctors’?

Approach

We conducted a Critical Ethnography (CE) of a 4th year GP teaching attachment in a UK Medical School in order to understand the dynamics in which critical consciousness develops and is conceptualised by teachers, tutors and students within the educational practices. CE can help suggest ‘what can be done about’ a particular situation, challenging the status quo in society, and promoting emancipation. We argue that this character of CE makes it suitable for Medical Education research, particularly for exposing hidden dynamics of power, hegemony of certain practices over others, and how these affect the learning experience for students and educators alike, in furtherance of transformative practices, both clinical and educational. We also interviewed a sample of students, GP tutors and teachers, and collected students’ audio-diaries during their GP clinical attachment. Discourse Analysis was used to analyse interview and audio-diaries transcripts and observe the ways in which language portrays critical consciousness. Grounded Theory was used to analyse the fieldnotes and understand how the GP teaching cultivates learners’ critical attitude.

Findings

A preliminary analysis of the collected data suggests that teaching and learning practices within the GP curriculum we observed, are based on premises which facilitate students’ understanding of the forces influencing healthcare and of the impact of socio-political inequities on the health of disadvantaged populations.

Consequences

GP Educators’ and curriculum planners’ critical attitude in the design and delivery of educational interventions is key to ensuring that students themselves develop skills to foster social transformation through self-reflection, critical analysis of socio-cultural issues, and social action. The findings of this research will potentially influence GP curriculum design and pedagogical practices.