Department of Continuing Professional Development and Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada.
Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Melbourne, Victoria, Australia.
Med Educ. 2024 Nov;58(11):1286-1295. doi: 10.1111/medu.15410. Epub 2024 Apr 27.
Epistemic injustice refers to a wrong done to someone in their capacity as a knower. While philosophers have detailed the pervasiveness of this issue within healthcare, it is only beginning to be discussed by medical educators. The purpose of this article is to expand the field's understanding of this concept and to demonstrate how it can be used to reframe complex problems in medical education.
After outlining the basic features of epistemic injustice, we clarify its intended (and unintended) meaning and detail what is required for a perceived harm to be named an epistemic injustice. Using an example from our own work on introversion in undergraduate medical education, we illustrate what epistemic injustice might look like from the perspectives of both educators and students and show how the concept can reorient our perspective on academic underperformance.
Epistemic injustice results from two things: (1) social power dynamics that give some individuals control over others, and (2) identity prejudice that is associated with discriminatory stereotypes. This can lead to one, or both, forms of epistemic injustice: testimonial and hermeneutical. Our worked example demonstrates how medical educators can be unaware of when and how epistemic injustice is happening, yet the effects on students' well-being and sense of selves can be profound. Thinking about academic underperformance with epistemic injustice in mind can reveal an emphasis within current educational practices on diagnosing learning deficiencies, to the detriment of holistically representing its socially constructed and structural nature.
This article builds upon recent calls to recognise epistemic injustice in medical education by clarifying its terminology and intended use and providing in-depth application and analysis to a particular case: underperformance and the introverted medical student. Equipped with a more sophisticated understanding of the term, medical educators may be able to re-conceptualise long-standing issues including, but also beyond, underperformance.
认知不公正指的是作为认知者的某人在其能力范围内所遭受的不公正对待。虽然哲学家已经详细阐述了这个问题在医疗保健领域的普遍性，但医学教育者才刚刚开始讨论这个问题。本文的目的是扩展该领域对这一概念的理解，并展示如何将其用于重新构建医学教育中的复杂问题。
在概述认知不公正的基本特征之后，我们澄清了其意图（和非意图）含义，并详细说明了要将感知到的伤害命名为认知不公正需要什么。我们使用自己在本科医学教育内向性研究中的一个例子来说明，从教育者和学生的角度来看，认知不公正可能是什么样子，并展示了这一概念如何重新调整我们对学业表现不佳的看法。
认知不公正源于两件事：（1）赋予某些人控制他人的社会权力动态，以及（2）与歧视性刻板印象相关的身份偏见。这可能导致一种或两种形式的认知不公正：证词和解释学。我们的案例研究表明，医学教育者可能没有意识到何时以及如何发生认知不公正，但对学生的幸福感和自我意识的影响可能是深远的。从认知不公正的角度思考学业表现不佳，可以揭示当前教育实践中对诊断学习缺陷的重视，而忽略了其社会构建和结构性本质的全面表现。
本文通过澄清术语及其预期用途，并对特定案例（表现不佳和内向的医学生）进行深入的应用和分析，进一步探讨了医学教育中的认知不公正问题。有了对该术语更深入的理解，医学教育者或许能够重新概念化包括但不限于表现不佳等长期存在的问题。
