when i say When I say . . . reflexivity Petra Verdonk
As my husband and I climbed towards a mountaintop in the Bieszczady of southeast Poland, a Polish couple passed us. The man recognised our language and checked to find out whether we were indeed Dutch. He then confronted us with questions about our feelings on Dutch legislation for euthanasia, same sex marriage and abortion! We had already found ourselves confronted just by being in the high mountains, which imposed a recognition of our Dutch Otherness, given that we are used to a flat, two-dimensional landscape, but other than trying to orient to the three-dimensionality of the Polish hills, we had not necessarily felt our Dutchness that day until we were challenged to defend Dutch practices that are strongly embedded in atheist, individualist, liberal values, which are quite different from those of the person with whom we were speaking. We managed to avoid further debate about soft drugs legislation and prostitution. People are not necessarily aware of their cultural identity on a daily basis. Living in a Western country and not having to regularly reflect on our cultural background is mostly a privilege. We begin to reflect when our values and norms, as they are expressed in how we do things and the conviction with which we do them, are questioned. The event made me reflect and consider in depth what happened and why, and how not only I but also the others involved experienced, thought and felt about the event. According to Gillie Bolton, ‘. . .reflexivity is finding strategies to question our own attitudes, thought processes, values, assumptions, prejudices and habitual actions, to strive to understand our complex roles in relations to others ‘.1 Reflexive Department of Medical Humanities, EMGO Institute for Health and Care Research, School of Medical Sciences, VU Medical Centre, Amsterdam, The Netherlands
Medical Education 2015
thinkers make aspects of the self strange by standing back from their beliefs, values and professional identities, and focusing on how they are embedded in cultural structures.1 In many Western countries, populations are becoming increasingly diverse. This growing diversity challenges dominant practices and the values that underpin them. An important reason for addressing differences in medical education is to ensure access to high-quality health care for a diverse patient population. A health care professional’s ability to respond to diverse understandings, needs and practices requires knowledge, skills and the self-awareness that the norms and assumptions he or she takes for granted are just that. The notion that physicians must reflect on their values, norms and power in the physician–patient relationship is widely held as an objective for medical education. Reflexive teaching in education encourages selfawareness, fosters critical thinking and helps to challenge the preconceived ideas embedded in the practices we take for granted.2 Showing examples of unequal treatment, and addressing differences and inequalities in access to health care and skills training are important. However, supporting medical students in developing critical thinking is difficult. How do we foster critical thinking? What does that mean for us, the teachers, and our own awareness? Students and teachers alike must gain insight into how assumptions about groups affect health, health care and teaching. We must gain an understanding of group differences while we recognise differences even within groups and between individuals. To avoid essentialism, such as the idea that all Dutch people are atheists, an intersectional perspecCorrespondence: Petra Verdonk, Department of Medical Humanities, EMGO Institute for Health and Care Research, School of Medical Sciences, VU Medical Centre, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands. Tel: 00 31 610 905805; E-mail: [email protected], [email protected]
doi: 10.1111/medu.12534
ª 2015 John Wiley & Sons Ltd. MEDICAL EDUCATION 2015; 49: 147–148
147
P Verdonk tive is useful. People do identify with and are ascribed to multiple and changing social identities. These can be based on gender, cultural or religious background, sexual orientation, class, age and ability. Creating an awareness means incorporating dynamic variations rather than static differences into our thinking.3 This helps us to avoid treating patients, and students, like flat stereotypes based on our own perceptions of their identities. Shortly after my Polish trip, I reviewed Adrienne Rich’s essay ‘Notes towards a politics of location’4 in a gender studies course. I was asked to locate myself on the map of social identities. I had clearly understood that my gender and class status inform my outlook on life and my values. Other locations, particularly cultural background and race, had hardly been within my sight. I was so unaware of the colour of my skin that it seemed as if only other people had such a thing. Gradually, it trickled through to me that I too have a race, a culture and, more recently, an age. The locations I was unaware of had been hidden from me because they were normative: they gave me power and advantages in a secularised environment that favours rationality, Whiteness, Western liberalism and individual autonomy. When we include the social and political dimensions, reflexivity stretches reflection beyond simply thinking about ourselves and events in order to solve problems and do better the next time.1
148
Understanding our complex roles in relation to others implies understanding how we are involved in structures of power. Now that I have begun to recognise this, I can perform my research and teaching with more intention. I try to make room for the needs of students who are not like me and are not going to be like me. I have ended up advocating for the incorporation of gender and diversity in medical education. So when I say reflexivity, I think of how I appeared to myself to be relatively flat – or two-dimensional – that day on the mountain in Poland.
REFERENCES 1 Bolton G. Reflective practice: an introduction. In: Reflective Practice. Writing & Professional Development, 3rd edn. London: Sage Publications 2010. 2 Fook J, Askeland GA. Challenges of critical reflection: ‘nothing ventured, nothing gained’. Soc Work Educ Int J 2007;26 (5):520–33. 3 Verdonk P, Abma T. Intersectionality and reflexivity in medical education research. Med Educ 2013;47:754–6. 4 Rich A. Notes towards a politics of location. In: Blood, Bread and Poetry: Selected Prose 1979–1985. London: Virago Press 1987;210–31. Received 2 May 2014; editorial comments to author 5 May 2014, 4 June 2014; accepted for publication 11 June 2014
ª 2015 John Wiley & Sons Ltd. MEDICAL EDUCATION 2015; 49: 147–148
As my husband and I climbed towards a mountaintop in the Bieszczady of southeast Poland, a Polish couple passed us. The man recognised our language and checked to find out whether we were indeed Dutch. He then confronted us with questions about our feelings on Dutch legislation for euthanasia, same sex marriage and abortion! We had already found ourselves confronted just by being in the high mountains, which imposed a recognition of our Dutch Otherness, given that we are used to a flat, two-dimensional landscape, but other than trying to orient to the three-dimensionality of the Polish hills, we had not necessarily felt our Dutchness that day until we were challenged to defend Dutch practices that are strongly embedded in atheist, individualist, liberal values, which are quite different from those of the person with whom we were speaking. We managed to avoid further debate about soft drugs legislation and prostitution. People are not necessarily aware of their cultural identity on a daily basis. Living in a Western country and not having to regularly reflect on our cultural background is mostly a privilege. We begin to reflect when our values and norms, as they are expressed in how we do things and the conviction with which we do them, are questioned. The event made me reflect and consider in depth what happened and why, and how not only I but also the others involved experienced, thought and felt about the event. According to Gillie Bolton, ‘. . .reflexivity is finding strategies to question our own attitudes, thought processes, values, assumptions, prejudices and habitual actions, to strive to understand our complex roles in relations to others ‘.1 Reflexive Department of Medical Humanities, EMGO Institute for Health and Care Research, School of Medical Sciences, VU Medical Centre, Amsterdam, The Netherlands
Medical Education 2015
thinkers make aspects of the self strange by standing back from their beliefs, values and professional identities, and focusing on how they are embedded in cultural structures.1 In many Western countries, populations are becoming increasingly diverse. This growing diversity challenges dominant practices and the values that underpin them. An important reason for addressing differences in medical education is to ensure access to high-quality health care for a diverse patient population. A health care professional’s ability to respond to diverse understandings, needs and practices requires knowledge, skills and the self-awareness that the norms and assumptions he or she takes for granted are just that. The notion that physicians must reflect on their values, norms and power in the physician–patient relationship is widely held as an objective for medical education. Reflexive teaching in education encourages selfawareness, fosters critical thinking and helps to challenge the preconceived ideas embedded in the practices we take for granted.2 Showing examples of unequal treatment, and addressing differences and inequalities in access to health care and skills training are important. However, supporting medical students in developing critical thinking is difficult. How do we foster critical thinking? What does that mean for us, the teachers, and our own awareness? Students and teachers alike must gain insight into how assumptions about groups affect health, health care and teaching. We must gain an understanding of group differences while we recognise differences even within groups and between individuals. To avoid essentialism, such as the idea that all Dutch people are atheists, an intersectional perspecCorrespondence: Petra Verdonk, Department of Medical Humanities, EMGO Institute for Health and Care Research, School of Medical Sciences, VU Medical Centre, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands. Tel: 00 31 610 905805; E-mail: [email protected], [email protected]
doi: 10.1111/medu.12534
ª 2015 John Wiley & Sons Ltd. MEDICAL EDUCATION 2015; 49: 147–148
147
P Verdonk tive is useful. People do identify with and are ascribed to multiple and changing social identities. These can be based on gender, cultural or religious background, sexual orientation, class, age and ability. Creating an awareness means incorporating dynamic variations rather than static differences into our thinking.3 This helps us to avoid treating patients, and students, like flat stereotypes based on our own perceptions of their identities. Shortly after my Polish trip, I reviewed Adrienne Rich’s essay ‘Notes towards a politics of location’4 in a gender studies course. I was asked to locate myself on the map of social identities. I had clearly understood that my gender and class status inform my outlook on life and my values. Other locations, particularly cultural background and race, had hardly been within my sight. I was so unaware of the colour of my skin that it seemed as if only other people had such a thing. Gradually, it trickled through to me that I too have a race, a culture and, more recently, an age. The locations I was unaware of had been hidden from me because they were normative: they gave me power and advantages in a secularised environment that favours rationality, Whiteness, Western liberalism and individual autonomy. When we include the social and political dimensions, reflexivity stretches reflection beyond simply thinking about ourselves and events in order to solve problems and do better the next time.1
148
Understanding our complex roles in relation to others implies understanding how we are involved in structures of power. Now that I have begun to recognise this, I can perform my research and teaching with more intention. I try to make room for the needs of students who are not like me and are not going to be like me. I have ended up advocating for the incorporation of gender and diversity in medical education. So when I say reflexivity, I think of how I appeared to myself to be relatively flat – or two-dimensional – that day on the mountain in Poland.
REFERENCES 1 Bolton G. Reflective practice: an introduction. In: Reflective Practice. Writing & Professional Development, 3rd edn. London: Sage Publications 2010. 2 Fook J, Askeland GA. Challenges of critical reflection: ‘nothing ventured, nothing gained’. Soc Work Educ Int J 2007;26 (5):520–33. 3 Verdonk P, Abma T. Intersectionality and reflexivity in medical education research. Med Educ 2013;47:754–6. 4 Rich A. Notes towards a politics of location. In: Blood, Bread and Poetry: Selected Prose 1979–1985. London: Virago Press 1987;210–31. Received 2 May 2014; editorial comments to author 5 May 2014, 4 June 2014; accepted for publication 11 June 2014
ª 2015 John Wiley & Sons Ltd. MEDICAL EDUCATION 2015; 49: 147–148
