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Articles Cited by Co-authors. Globalisation, societies and education 3 2 , , Therefore, articles focusing on unregulated or informal health workers e. The final extraction sheets captured demographic information author profession, country, journal, year of publication , article type e.
Importantly, the research team based these themes on their own interpretations of what the article authors presented. Thematic abstraction was conducted with each article serving as an analytic unit, and using an interpretative qualitative lens such that the main messages of the article were documented. Through an iterative process, with regular discussion amongst team members, redundant themes were collapsed into representative theme headings. During the abstraction process, the team also attended to critical pedagogy practices worth discussing.
Therefore, particularly relevant to the HPE goals of fostering compassionate and socially conscious practitioners practices of critical pedagogy, as discussed in the articles and noted during abstraction, are shared in the discussion and implications section of this article. Below, we define and articulate each theme individually, using exemplary quotations from the articles to illustrate each. In their process, questions emerged from the group leading to local level strategies to overcome social exclusion in the healthcare sector. The articles also highlight the importance of appreciating context as the communities, systems and broader relationships within which learning and practice takes place.
Central to this theme is the human context within which learning and practice takes place. Maintaining this core aspect of personhood is essential to the critically conscious learner and practitioner. Articles addressed the effects of power relations on educational and healthcare processes and aimed to make explicit the exploration of how power impacts interactions in these settings [ 13 , 16 , 17 , 19 — 21 , 23 , 29 , 32 , 33 , 38 ].
Power relations were examined in terms of the power healthcare professionals hold in patient interactions, empowerment of communities of citizens and patients, as well as the emancipation of professional groups from oppressive structures and relations. Articles recommended the explication of power relations with learners. Reid [ 33 ] argues that if we want education to be transformative for learners so that they challenge accepted norms and power structures, then we need to explicitly discuss power issues throughout their education.
Unless power is made explicit and visible, medical schools will continue to reproduce graduates with the same values and perspectives as their teachers. Although power dynamics are pervasive in the healthcare system, it is rare that conventional education systems promote their awareness, leading to unexamined perpetuation of system level exclusions.
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They argue that until this happens, they will be unable to engage in true humanistic care [ 16 ]. Similarly, Clare [ 13 ] urges nurses to challenge the taken-for-granted dominance of particular types of knowledge and values over others. Only through collective challenges, or advocacy, they argue, will professional action occur that transforms the status quo [ 13 , 16 ]. She argues that the traditional behaviourist approaches reproduce forms of learning that fail to critically analyze key social and political aspects of the health professional role.
Many echoed this assertion of how critical consciousness could help overcome the limited, instrumentally and technically focused view of our current HPE curricula, for example with respect to cultural competency. Another prominent theme in the articles reviewed is the notion of enacting reflection [ 13 , 14 , 20 , 21 , 24 , 31 , 34 , 35 ]. In the theoretical framing of critical consciousness, reflection without social action is insufficient.
Yet the imperative to act based on critical reflection ironically faces the tension of individual agency versus the constraints of structure. The themes presented in the findings section represent the ways in which critical consciousness appears in the HPE literature we reviewed. In this section we will discuss limitations, possible practices of critical pedagogy for health professions educators, and considerations for the field of HPE. Notably, few of the papers critically examine the potential limitations of adopting critical consciousness approaches.
They may be overwhelmed by the volume of new material to learn and uncertain of their position in the changing healthcare system. It can be challenging for discussions of — and challenges to — power and privilege to take place in an environment where learners and faculty may already feel their positions are precarious. We appreciate that educators will wonder how, specifically, to put critical consciousness into practice within HPE. As others have noted, the dominant epistemological positions of HPE can distort educational approaches, borrowed from other fields and thus deriving from differing epistemological bases, when these approaches are adopted into HPE [ 9 ].
We would be remiss not to briefly discuss other approaches to foster compassionate, socially conscious, person-centred health professionals. Shared decision-making aims to restore choice to individuals with regard to their own care, and has an ethical imperative as its basis [ 44 ]. Yet an examination of each, their historical and philosophical roots, and their contextualized outcomes and associated mechanisms of change would be needed in order to integrate them effectively.
Existing approaches to HPE, such as competency-based medical education that strives to guide health professions learners towards desirable attitudes and behaviours may, when applied uncritically, perpetuate existing problems. Critical consciousness, with its emancipatory history, holds the potential to transform rather than reproduce current problems.
This paper summarizes current understandings and applications of critical pedagogy in HPE. Attempting to apply critical pedagogy, however, requires nuanced and ongoing attention to how it fits and conflicts with prevailing approaches in HPE. We gratefully acknowledge the contributions of Bridget Morant for her assistance with the literature search. National Center for Biotechnology Information , U. Journal List Perspect Med Educ v. Perspect Med Educ. Published online Jan 3. Lindsay Baker 2 St. Stella Ng 2 St. Author information Copyright and License information Disclaimer. Mark Halman, Email: ac.
Corresponding author. This article has been cited by other articles in PMC. Abstract Purpose To explore how, in health professions education HPE , the concept of critical consciousness has been defined and discussed, and to consider and suggest how critical pedagogy could be applied in practice. Conclusions Critical consciousness may inform an appropriate critical pedagogy for fostering compassionate, humanistic, socially conscious health professionals who act as agents of change.
Keywords: Critical consciousness, Critical pedagogy, Health professions education, Literature review. What this paper adds Critical consciousness, an education concept originating from emancipatory work with marginalized and disadvantaged populations, holds promise if health professions education HPE aims to foster compassionate and socially responsible providers.
Introduction Fostering compassionate, socially responsible health professionals is an imperative of health professions education HPE. Critical consciousness Critical consciousness , one such critical approach, may help to fill this gap. Critical consciousness in HPE While other movements e. Open in a separate window. Table 1 Articles included in our review.
Illuminating and changing power structures Articles addressed the effects of power relations on educational and healthcare processes and aimed to make explicit the exploration of how power impacts interactions in these settings [ 13 , 16 , 17 , 19 — 21 , 23 , 29 , 32 , 33 , 38 ]. Enacting reflection Another prominent theme in the articles reviewed is the notion of enacting reflection [ 13 , 14 , 20 , 21 , 24 , 31 , 34 , 35 ]. Discussion and conclusions The themes presented in the findings section represent the ways in which critical consciousness appears in the HPE literature we reviewed.
Common practice Rationale and Description Examples Promote authentic dialogue Dialogue promotes the authentic exchange of ideas. It moves beyond discussion. The value of everyone in the room is recognized and learners are experts of their own expertise. This knowledge differs from biomedical forms and purposes of knowledge, and matters to critical consciousness.
What is Critical Digital Pedagogy?
Facilitate encounters with the unfamiliar for learners in order to stimulate the examination of their values and beliefs [ 1 , 31 ] Challenge the power hierarchy Power dynamics are inherent in health professions education and influence what is safe, and what is possible for learners to say and do. Acknowledge this power hierarchy and actively challenge it [ 1 , 23 , 29 , 39 ]. Summary Existing approaches to HPE, such as competency-based medical education that strives to guide health professions learners towards desirable attitudes and behaviours may, when applied uncritically, perpetuate existing problems.
Acknowledgements We gratefully acknowledge the contributions of Bridget Morant for her assistance with the literature search. Stella Ng is education scientist at the Centre for Ambulatory Care Education, cross-appointed scientist at The Wilson Centre, director of research at the Centre for Faculty Development and assistant professor of the University of Toronto. References 1.
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Critical Pedagogy for Social Justice (Critical Pedagogy Today)
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