Principles and Frameworks Guiding Anti-Oppressive Efforts in Medical Education

• In Event: Building Antiracist, Anti-Oppressive Educational Spaces in the Health Professions: Frameworks, Tools, and the Way Forward

Abstract

This presentation will discuss principles and frameworks that guide anti-oppressive efforts in education and how we are applying them through an Anti-Oppression Curriculum Initiative (AOCI) at the UCSF School of Medicine (SOM).

Anti-oppressive efforts in medical education are in an early stage of development.1,2 Given this early stage, anti-oppressive transformation must draw on work both inside and outside of academic medicine. Robust approaches are needed to avoid unintentionally perpetuating harm or making change at a superficial level. Our understandings are continuously evolving as new and modified frameworks emerge and as more stakeholders join us.

We will describe principles and frameworks guiding anti-oppressive work in education, particularly those we have found helpful in our AOCI, which can be clustered into the following areas:

1.Grounding Principles:
a. Cultural humility3,4 and radically inclusive listening require truthful acknowledgement of medical education’s early stage of change (resisting an ‘ahistorical’ stance) and encourage us to flatten hierarchies, engage, and learn from all stakeholders.5
b. Explicitly naming and intentionally working against racism and all forms of oppression anchors our efforts and involves recognizing and dismantling the harmful ways of being, knowing, and doing that constitute white supremacy culture.6,7

2.Pedagogical Principles:
a. Anti-oppressive pedagogy—introduced by Paulo Freire—emphasizes respecting the expertise of learners, shifting the learner/teacher hierarchy, and avoiding an educational model that simply deposits knowledge.2,8-12
b. Trauma informed medical education,13,14 an outgrowth of trauma informed care/healing centered engagement,15-17 focuses on tenets of safety; trustworthiness/transparency; peer support; collaboration/mutuality/co-production; empowerment/voice/choice; and cultural/historical/identity.

3. Critical theories:
a. Critical race theory, gender/queer theory, and disability theory, among others, provide an analytic lens to engage with the “problem-posing” principles of anti-oppressive pedagogy (i.e., by understanding race, ethnicity, gender, and sexuality as social constructs).18-21

4. Structural frameworks:
a. A structural competency lens shifts the focus away from individual-level behaviors and interventions towards system-level changes and perspectives needed to address the social, institutional, legal, political, environmental, and economic forces that create and sustain oppression.22,23

5. Anti-deficit frameworks:
a. Uplifting the expertise and resilience of individuals and communities who experience oppression is critical to re-imagining student support.24

Translating these principles and frameworks into processes and practices, we follow Dr. Camara Jones’ campaign against racism framework, extending these lessons to all forms of oppression: 1) naming racism [oppression]; 2) asking “how is racism [oppression] operating here?” and 3) “organizing and strategizing to act.”6 Aligning with the principle of radically inclusive listening, we engaged a wide range of stakeholders (e.g., internal/external experts in anti-oppression, students, community members) intentionally drawn from all 3 of our missions—education, research, clinical care—to encourage collaboration. Challenges to embodying anti-oppressive principles and frameworks include inadequate institutional support for community involvement, high burn-out amongst faculty/staff, an entrenched scarcity model, and passive resistance to anti-oppressive efforts.

Solutions needed to transform medical education are complex and can only be accomplished with deeply inclusive involvement and longitudinal institutional commitment. Connecting change in medical education with other pillars of medicine, which themselves contribute to oppression (e.g., research, clinical care), is a future goal.

Authors

• Denise Conner, University of California - San Francisco

• Allison Gomez, University of California - San Francisco

• John Davis, University of California - San Francisco