Razack Saleem, Richardson Lisa, Pillay Suntosh R
Division of Critical Care, Department of Pediatrics, Faculty of Medicine, University of British Columbia; Centre for Health Education Scholarship, BC Children's Hospital, Vancouver, British Columbia, Canada.
Temerty School of Medicine, University of Toronto, Toronto, Canada.
Med Educ. 2025 Jan;59(1):114-123. doi: 10.1111/medu.15470. Epub 2024 Jul 11.
Epistemic violence is enacted in medical curricula in mundane ways all the time, negatively impacting learners, teachers and patients. In this article, we address three forms of such violence: White supremacy, indigenous erasure and heteronormativity.
In this article, we examine the knowledge systems of medicine as a global phenomenon, impacted by Western and European ideologies of race and colonisation, both produced by them, helping to reproduce them through authoritative and hegemonic ideologies. We seek not only to problematise but also to propose alternative teaching approaches rooted in the Global South and in Indigenous ways of knowing. Taking inspiration from Paulo Freire, we advocate for the development of critical consciousness through the integration of critical pedagogies of love, emancipation and shared humanity. Drawing on Irihapeti Ramsden, we advocate for cultural safety, which emphasises power relations and historical trauma in the clinical encounter and calls for a rights-based approach in medical education. Deliberately holding space for our own vulnerabilities and that of our students requires what Megan Boler calls a pedagogy of discomfort.
Our perspectives converge on the importance of critical consciousness development for culturally safe practice in medical education, acknowledging the need to emphasise a curriculum of shared humanity, introducing the concept of Ubuntu from Southern Africa. Ubuntu can be encapsulated in the phrase 'I am because we are', and it promotes a collective approach to medical education in which there is active solidarity between the profession and the diverse populations which it serves.
认知暴力一直在医学课程中以平凡的方式上演,对学习者、教师和患者产生负面影响。在本文中,我们探讨这种暴力的三种形式:白人至上、本土知识的抹杀和异性恋规范。
在本文中,我们将医学知识体系视为一种全球现象进行研究,它受到西方和欧洲种族及殖民意识形态的影响,由这些意识形态产生,并通过权威和霸权意识形态帮助其不断再现。我们不仅试图对其进行质疑,还提出源自全球南方和本土认知方式的替代教学方法。从保罗·弗莱雷那里获得灵感,我们主张通过融合爱的批判性教学法、解放和共享人性来培养批判性意识。借鉴伊里哈佩蒂·拉姆齐登的观点,我们倡导文化安全,它强调临床接触中的权力关系和历史创伤,并呼吁在医学教育中采取基于权利的方法。有意识地为我们自己和学生的脆弱性留出空间需要梅根·博勒所说的一种不适教学法。
我们的观点都聚焦于培养批判性意识对于医学教育中文化安全实践的重要性,承认需要强调共享人性的课程,引入来自非洲南部的乌班图概念。乌班图可以用“我因我们而存在”这句话来概括,它促进一种医学教育的集体方法,即在专业人员与其所服务的不同人群之间存在积极的团结。