when i say When I say . . . critical theory Brian D Hodges

One of the newspapers I enjoy features a restaurant critic who is just as well known for her sharp, biting commentary as she is for her culinary expertise. Whether she is critiquing a five-dollar Vietnamese pho or a fifty-dollar boeuf bourguignon, she considers the meal from a variety of perspectives and often declares the experience lacking. Critics of all stripes – of theatre, literature, art and cuisine – hold a valued place in society. Voraciously read and vigorously debated, critics play important roles because they do not reflexively accept whatever dish (painting, play or polonaise) is paraded in front of them. Although university scholars might be surprised by this allusion to restaurant critique, the latter does share common roots with the academic branch known as critical theory. The notion of critique can be traced, in the West at least, to Socrates and his practice of relentlessly questioning received wisdom, and later to the work of philosopher Immanuel Kant.1 Foucault called critique a ‘general cultural form, both a political and moral attitude, a way of thinking’, but also ‘the art of not being governed quite so much’.2 Academic forms of critique have been useful across the centuries in the challenging of officially legitimised ‘truths’ such as the flat earth hypothesis, the humeral model of disease, phrenology and eugenics. And although it seems unlikely that a restaurant critic would be put to death for publicly exposing a charred fillet, scholars who have challenged accepted notions and official wisdom certainly have been. ‘Truth’, it seems, even when arbitrary, speculative or plain wrong, can nonetheless be

Toronto, Ontario, Canada Medical Education 2014 doi: 10.1111/medu.12474

held firmly in place by political, legal and academic institutional power. The value of a critical approach was particularly apparent prior to the Second World War when the so-called Frankfurt School shone a critical light on dangerous ‘truths’ propagated in domains ranging from literature and linguistics to politics and history. In his primer Critical Theory: A Very Short Introduction, Stephen Eric Bronner traces the contributions of Theodor Adorno, Herbert Marcuse, Max Horkheimer, Walter Benjamin, Erich Fromm and others to a movement that has challenged contemporary academic thinking since it rolled through universities in a crashing, frothy wave during the mid-20th century.3 Through two world wars, the Nazi atrocities, the 1968 student riots and the Vietnam war, critical scholars were motivated by profound distrust of institutions that were supposed to advance ‘civilised’ societies. Although referred to as critical theory, the work of the Frankfurt School and its descendants is best understood as a family of approaches rather than as a theory per se. Critical approaches have in common the intent to understand and to disrupt notions of truth and the structures of power that come to be taken for granted. Adopting a critical approach in medical education research means exploring the roles played by medical schools and educators in constructing power and privilege in our societies. It means asking whether they sustain a status quo or work toward greater equity. Adherents of critical theory make a commitment to participate in change rather than to content themselves with pure academic analysis.

Correspondence: Brian D Hodges, Wilson Centre for Research in Education, University of Toronto, Toronto General Hospital, 200 Elizabeth Street Suite 1ES565, Toronto, Ontario M5G 2C4, Canada. Tel: 00 1 416 340 3079; E-mail: [email protected]

ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 1043–1044

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B D Hodges Critical scholars in medical education study the socio-economic, gender, racial, sexual, cultural and linguistic correlates of persistent or growing inequities. They shed light on how medical schools and organisations function as social actors that can either foster diversity or further privilege an elite group through practices of admission, teaching, assessment and research. Current topics include: the struggle of aboriginals and peoples of colour to access medical schools in Euro-America; persistent gender imbalances among the higher professorial ranks; and the over-representation of students from wealthy and urban families in medical schools. Others explore the ethical implications of a stampede of medical school applicants and elective students to low-income African and Asian countries where they seek a reference or an ‘experience’ but provide little in exchange to overloaded teachers, and the aggressive recruiting of international students to the West for ‘training’, only to hire them, thereby creating a ‘brain drain’ from countries with huge shortages of health care professionals. Kuper and Hodges4 have described a variety of critical perspectives useful in asking such research questions, using Foucauldian, Bourdieuvian, neo-Marxist, feminist, anti-racist and anti-colonial approaches. If a newspaper columnist writes about a disappointing casserole, he or she may annoy the chef who cooked it, but a critical journal article about the

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practices of medical schools will trigger sharper dissonance among faculty and students. Most of us medical educators, who are trying to do our best, will be pained to think that our cherished institutions and practices sometimes can produce adverse effects. Yet timely, incisive critique of any kind draws our attention to important things that are otherwise muted or obscured. Critique can lead us to be more reflective, to expect better of our institutions and of ourselves. And when critique exposes inequity, oppression or even the roots of violence, some of us will hear a call to action.

REFERENCES 1 Chaves E. The art of not being quite so governed: an examination of the work of the ‘critical’ journal. New Politic Sci 2013;35 (3):507–21. 2 Foucault M. Qu’est-ce que la critique? (Critique et Aufkl€arung). Bulletin de la Soci e t e Francßaise de Philosophie 1990; 84 (2):47–8. 3 Bronner SE. Critical Theory: A Very Short Introduction. Oxford, New York, NY: Oxford University Press 2011. 4 Kuper A, Hodges BD. Medical education in societies. In: Dornan T, Scherpbier A, Spencer J, eds. Medical Education: Theory and Practice. London: Elsevier 2010;39–49. Received 23 December 2013; editorial comments to author 17 January 2014; accepted for publication 17 February 2014

ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 1043–1044

When I say … critical theory.

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