“The journals may be where the students do their deepest work, as they are asked to reflect at several points in the course regarding what they have read or watched and how it has impacted them. The journal entries are private between each participant and the instructors, and an instructor responds to each journal to offer insights and encouragement. The lengthy duration of the course has allowed white students to take more time to understand current manifestations
of racism and privilege. Many white students are learning these concepts for the first time and have a
predictable course of emotions that come with a deep examination of racism in their own lives, including denial, defensiveness, rationalization, guilt/shame, distancing from other white individuals, and, finally, acceptance and readiness for action as allies.” - 
Gordon, McCarter, Myers p. 722-723.

“Because of these unique midwives, we learned how the backdrop of racial/ethnic and gender diversity influenced their personal entry and socialization as a midwife, as well as their practice. Because none of the three investigators matched the participants' diversity, it became our own lesson in cultural humility to hear from our colleagues about barriers far greater than we had ever experienced in our own professional struggles in midwifery.” - Kennedy et al, 2006, p. 89

 

Critical Consciousness

 


 

  • "The authors critically analyze the concept of cultural competency and propose that multicultural education must go beyond the traditional notions of “competency” (i.e., knowledge, skills, and attitudes). It must involve the fostering of a critical awareness—a critical consciousness—of the self, others, and the world and a commitment to addressing issues of societal relevance in health care." p. 782
     

  • "The development of critical consciousness involves a reflective awareness of the differences in power and privilege and the inequities that are embedded in social relationships—an act that Freire calls 'reading the world'—and the fostering of a reorientation of perspective towards a commitment to social justice. The development of this type of consciousness...is both cognitive and affective and leads to engaged discourse, collaborative problem-solving, and a “rehumanization” of human relationships." p.783
     

  • It "requires critical self-reflection and discourse and anchors a reflective self with others in social and societal interactions. By 'critical self-reflection,' we do not mean a singular focus on the self, but a stepping back to understand one’s own assumptions, biases, and values, and a shifting of one’s gaze from self to others and conditions of injustice in the world. This process, coupled with resultant action, is at the core of the idea of critical consciousness." p.783

 

- Kumagai & Lypson, 2009


 

  • "Central to the fostering of critical consciousness are engaging dialogue in a safe environment, a change in the traditional relationship between teachers and students, faculty development, and critical assessment of individual development and programmatic goals." p.782
     

  • "The object of knowledge is not just a series of lists of cultural attributes (which can quickly degrade into dehumanizing stereotypes), nor is it a skill set of questions and demeanors we should assume when encountering a patient who is not like us." p. 783
     

- Kumagai & Lypson, 2009

 

  • "Instructors are specifically trained to pose questions to stimulate reflection and engaged discussion. The types of questions are designed to present the group with an ill-defined problem or paradoxical situation. The point of this approach is not to get the 'right' answer but to personalize the situation to stimulate reflection on the impact of culture on patient and physician preferences, the nature of patientcentered care, the potential emotional impact of being the target of prejudice, and the different types of prejudice (e.g., individual, institutional) that may arise in health care settings. Instead of an abstract discussion, the focus is on answering the questions, “How would you feel or what would you do if you encountered such a situation?” or “Who benefits from labeling a patient as ‘noncompliant’ or looking at him/her in this way?” - Kumagai & Lypson, 2009, p. 786
     

  • Specific Approaches and Techniques incorporated into the multicultural curriculum at the University of Michigan Medical School to assist in fostering critical consciousness in students:

    • Stories

    • Cognitive disequilibrium

    • “Keeping it current”

    • Evaluation

      For details, see Kumagai & Lypson, 2009, p. 785-786

"At Emory, I teach a master’s level course for midwives and other nurse practitioner students on developing cultural humility.

 

What began years ago as a course on cultural competence has transformed to a course that examines both one’s own biases, as well as the structural patterns in healthcare that have perpetuated social inequality and health disparities.

 

Students are asked to explore compassionate and thoughtful leadership-for-change to promote genuine health equity for all."  

 

- Jenny Foster, CNM, MPH, PhD, FACNM​

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