Critical consciousness

Tandi R. Ngwenyama Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Oregon State University, Corvallis, OR

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 DVM, DACVECC*

How can we better equip our learners to engage with the complexities and tensions of clinical interactions? How does a veterinary academic institution provide high-quality patient care and at the same time teach students and trainees to be capable clinicians, master adaptive learners, and good citizens of the world? These are the crucial questions facing our profession today. What is important is how veterinarians’ minds work, how they put things together and reflect on thinking patterns, what their relational orientation is to others and the world, and how it translates into real-world practice. A key skill is critical reflection, the process of analyzing, questioning, and reframing a personal experience to enhance learning and inform future behavior. This skill is developed over time with deliberate practice and feedback. It is used by clinicians to promote lifelong learning and improve patient outcomes.1

Clinicians need to develop an awareness of cognitive tendencies (bias) or emotional/situational factors that may influence decision-making. Critical consciousness, “an awareness of the self, others, and the world and a commitment to addressing issues of societal relevance in health care,” can be used as a guiding principle for student learning.2 We need to foster a growth mindset, ie, create a culture of learning and improving using deliberate practice (feedback, coaching, and self-assessment) and a shift of teacher roles (coach, mentor, and advisor), as opposed to a rigid mindset in which the focus is on knowing and proving.1

The alliance between OSU’s Carlson College of Veterinary Medicine (CCVM) and the Oregon Humane Society (OHS) has evolved since its inception in 2007. A novel partnership at the time, clinical students participate in this surrogate 2- to 3-week small animal primary care rotation to learn foundational clinical skills and treat shelter animals. Their experiential learning comprises a broad range of activities such as preventative care, management of common endocrinopathies, dentistry, behavior, surgical interventions, and many more ( > 41,000 medical exams and 53,000 surgeries performed according to course coordinator Dr. Kirk Miller). Clinical reasoning is a fundamental skill used by clinicians in the care of patients. Like all important skills, it can be taught, and practice is the key to developing competence.

During the COVID-19 pandemic, a new connection (partnership within a partnership) between the Portland Animal Welfare team was created. This nonprofit charity provides veterinary services for free or at low cost to pets belonging to our most vulnerable population: individuals experiencing homelessness and with significant socioeconomic hardship (those on disability or social security). Homelessness is defined as an individual or family who lacks a fixed, regular, or adequate night-time residence (US Housing and Urban Development). It is important to mention that homelessness is not a monolith or a trait; it is a state and is dynamic. There is stigma associated with homelessness and a potential for cognitive dissonance, “when one encounters an experience, idea, perspective, or identity with which one is unfamiliar.”2 It is an invaluable experience for veterinary students to learn perspective taking and reflect on social issues. This work encourages self-reflection of implicit bias and communication skills, and it enhances connections and trust building. In the fall of 2022, OHS opened the Community Teaching Hospital. The mission of this hospital is to provide access to quality, evidence-based spectrum of care for pets in the Portland area and better support the community. The goal is to also offer a Community Practice rotation.

Other learning activities offered at OSU during the pandemic to all members of the CCVM community that promote critical awareness include our student-led, faculty-supported Allyship training workshop organized by the student advocacy group PrideVMC and community of practice sessions facilitated by our Diversity, Equity, and Inclusion (DEI) committee. We also hosted the 2022 Western Regional Iverson Bell Virtual Conference, and OSU is in the first cohort of veterinary colleges that piloted the DEI program called BLEND (Build, Lead, Equity, Navigate, Diversify).

References

  • 1.

    Cutrer WB, Miller B, Pusic MV, et al. Fostering the development of Master Adaptive Learners: a conceptual model to guide skill acquisition in medical education. Acad Med. 2017;92(1):7075. doi:10.1097/ACM.0000000000001323

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  • 2.

    Kumagai AK, Lypson ML. Beyond cultural competence: critical consciousness, social justice, and multicultural education. Acad Med. 2009;84(6):782787. doi:10.1097/ACM.0b013e3181a42398

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  • 1.

    Cutrer WB, Miller B, Pusic MV, et al. Fostering the development of Master Adaptive Learners: a conceptual model to guide skill acquisition in medical education. Acad Med. 2017;92(1):7075. doi:10.1097/ACM.0000000000001323

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Kumagai AK, Lypson ML. Beyond cultural competence: critical consciousness, social justice, and multicultural education. Acad Med. 2009;84(6):782787. doi:10.1097/ACM.0b013e3181a42398

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

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