"The whole movement of life is learning" (Krishnamurti). "To be an act of knowing, then, the adult literacy process must engage the learners in the constant problematizing of their existential situations" (Freire). "Once you learn to read, you will be forever free" (Douglass). "I can learn anything I have the desire to learn" (White, S.G.).

Monday, February 10, 2014

Cannot connect

Although I like the work of Friere, and I was interested and definitely entertained by the all women English class in the Bahamas, I'm having a hard time relating these theories and techniques to the education of orthopedic surgery residents.  Practically, there isn't enough hours in the day to get the work done and learn in that type of manner (not that social and societal concerns are that important to residency training).  And maybe that is the difference between literacy "education" and "training."  Maybe I'm not educating the residents at all. I'd like to think I am teaching them valuable life lessons and giving them a "voice."  The fact of the matter is I'm more likely embedding the skills and knowledge necessary for them to take care of patients safely and to be an effective orthopedic surgeon.  Not a whole lot of liberatory education there.
Still, trying to encourage the group to be responsible for their own education and training is a nice goal to aspire to.  I think the lesson is that I have to try and create an environment that is conducive to the group educating the group. Might have to explore and shatter some basic assumptions to make that happen...


  1. Greg,

    I certainly see where you and Freire may run into some differences! In your field, liberatory education can be challenging. Ideal students (from a liberatory education stance) frequently pose questions, are active in learning and think very critically. This critical thinking challenges what educators and their school/institution/etc. should and should not do and what the aims of education and their method of delivery should or should not be. Emphasis is put on learning occurring outside of a vacuum, with the teacher being a co-learner.

    This is where I can see you, as a medical educator, having a problem. Your training (I'm assuming) needs to almost occur in a vacuum (skills need to be conveyed in a precise manner with little or no tolerances). For Freire, there is no vacuum as students' life experiences kick start education and are the basis of reflection. "A learner is not an empty vessel to be filled by the teacher or an object of education...studying is a form of re-creating, re-writing". This statement clearly goes against your role as a medical educator. Residents, while not quite "empty vessels", still present themselves as students in need specialized training- and your role is to provide this. The training you are providing, and correct me if I'm wrong- can generally be looked at as a+b should equal c, and if not, here's what we can do to make sure it does (this is about the extent of "re-creating" education). The theory and practicality of your training has more than likely been written in stone only to be changed by new and upcoming technologies/procedures- not by student interaction.

  2. Hey Greg,

    I agree that the examples/case studies presented in the reading are difficult to translate into the medical field. I'm a big Friere fan, so I'm going to try to make an analogy between my work as a high school teacher and your role as a professor in a medical school. For some types of knowledge, the teacher does possess the expertise that needs to be “given” to the student. For example, my students need to know the difference between a complete sentence and a fragment – straightforward, and it would be impractical to try to communicate this nugget of information in any elaborate way. Similarly, your students may need to know which drugs not to mix – there's nothing wrong with just telling them; it's something they need to know to do their job.

    However, there are more complex, less straightforward issues that arise in all disciplines, and they usually involve institutional structures. In the example from my posting, I wanted students to consider why their school was not as 'nice' as some others, how that came to be, and what they can do about it. Literacy, in the Frierian model, should allow students to situate themselves in the institution, identify some of its problems, and then use reading/writing/speech/gestures/all the things 'literacy' encompasses to change it for the better.

    Regarding orthopedic surgery, it's hard to pinpoint a particular issue from the outside; ideally, the issues would be generated from the students. However, I'll try to make an example. If your students observed a large number of patients coming to the hospital weeks after their injury instead of immediately, instead of just treating the injury they could also investigate why the patients waited. Did an insurance requirement such as requiring a referral delay their seeking treatment? Did they injure themselves in an embarrassing stunt and were anxious about seeking treatment? If the referral is an issue, how might the students use literacy to change that barrier? If people are embarrassed, how can the students use literacy to promote the hospital as a nonjudgmental place to seek care?

    I have no idea if that helps, but one of my main takeaways from Friere is that we all exist in systems/institutions and we have the power to change them for the better through literacy – which for him is the goal.

  3. Greg,
    I can understand your statement "I'm having a hard time relating these theories and techniques to the education of orthopedic surgery residents." At this time, these theories and techniques may not seem applicable. Nevertheless, perhaps a bit of "visioning" could help. For example, someday you might be in charge of a major public health initiative in a location or environment were the population is disenfranchised from mainstream society. As the lead of a group of medical professionals, and the person responsible for strategic planning and strategy development , your knowledge and understanding of Friereian literacy techniques could be invaluable to your team -- especially if they are not aware of Friere.

    We never know what the future holds for us.

  4. Greg - first thank you for your honest and truly generative statement. Jason's way of contextualizing your work, and Seth's suggested reach for possible application are also helping me get my head around the excellent puzzle you present. You should know that even those in the humanities are vigorously debating Freire's relevance in an time that is not revolutionary. (OF course, we the to think there are useful ways to draw on his theories and techniques. And in fact, in the nursing field there is some of the best work being done--that looks at things like "tact" in communications between medical staff and patients, etc.) But it may indeed be that in your particular context, any attempt at studying the micro-context of Discourse will be futile. But then, maybe you could use your project to take a broader, macro view: what are the historical and ideological roots of our current residence experience? Just a thought! :)

  5. The other day I was reading a chapter in Parker Palmer's Courage to Teach and there was a bit on communal learning within the medical context. It spoke to what you mention above as far as the conventional medical approaches to learning and how one hospital changed their practices to move closer to the group educating the group. I'll bring it to class and you can decide if you're interested in reading more.


Thank you for taking the time to share your thoughts on this post. Diverse opinions are welcomed.