Awakening Critical Consciousness in Medical Education: Insights for a Critical Pedagogy in General Practice Teaching

Problem

As medicine’s social contract evolves, medical schools have a growing obligation to foster doctors who are conscious of social dynamics and inequality in health care, and willing to affect societal change. This approach can be nurtured via the development of a “critical consciousness” (i.e., awareness and questioning) of power and privilege (Freire, 1972  2017). Although this discourse is increasing in medical education (Manca et al., 2019), applying a critical pedagogy within curricula in which competency-based orientations are dominant, is not straightforward because of their different philosophical and theoretical underpinnings. It requires courage towards change from medical educators, and a profound awareness of how context influences educational practices and dynamics. This presentation outlines the affordances of an undergraduate general practice educational context, to provide essential elements, for medical educators to adopt in their teaching, to awaken critical consciousness in their students.

Approach

This qualitative educational research adopted an overarching (post) critical ethnographic approach, informed by social constructivist theory, postmodern themes and critical theory. The researcher observed a GP undergraduate course writing extensive fieldnotes, and interviewed and collected audio-diaries to elicit participants’ viewpoints. Discourse analysis was used to analyse the data in order to answer the question: “How are the affordances for the development of critical consciousness enacted, in an undergraduate general practice learning environment?”

Findings

The GP teachers, while mitigating hierarchical relations with students, “directed” them by imparting a certain degree of instruction. They cultivated students’ understanding of general practice through their educational practices and through their teaching of values, rather than the teaching of skills for immediate practical purposes. Their educational approach acknowledged students’ “spontaneity”, while pursuing “conscious direction” (Gramsci, 1992). The educational practices guided students into “reading the world” (Freire & Macedo, 1987) of general practice and medicine in general. This involved the observation of the practical social context and the recognition of social issues, an exercise that entails an orientation to action. Both students and teachers used their own voice to “speak” their reading of the world. Speaking the world (ibid.) appeared as a foundation for practical action towards transformation (personal, educational, social): an act of power.

Consequences

The educational practices and relations embedded in the GP course foregrounded an implicit critical approach to education and an orientation to praxis. Crucially, once these spontaneous, implicit pedagogies were manifest, it was seen that they were epistemologically developed, fostered and intentionally adopted to support the development of desired attitudes, motive dispositions, and values. The attention to establishing pedagogically sound educational practices and environments is important not only for general practice education, but to improve future doctors’ attitude to care in all settings, primary and secondary.