‘Decolonising the Medical Curriculum‘: Humanising medicine through epistemic pluralism, cultural safety and critical consciousness

The Decolonising the Curriculum movement in higher education has been steadily gaining momentum, accelerated by recent global events calling for an appraisal of the intersecting barriers of discrimination that ethnic minorities can encounter. While the arts and humanities have been at the forefront of these efforts, medical education has been a ‘late starter’ to the initiative. In this article, we describe the pioneering efforts to decolonise the undergraduate medical curriculum at UCL Medical School (UCLMS), London, by a group of clinician educators and students, with the aim of training emerging doctors to treat diverse patient populations equitably and effectively. Throughout this process, students, faculty and members of the public acted as collaborative ‘agents of change’ in co-producing curricula, prompting the implementation of several changes in the UCLMS curriculum and rubric. Reflecting a shift from a diversity-oriented to a decolonial framework, we outline three scaffolding concepts to frame the process of decolonising the medical curriculum: epistemic pluralism, cultural safety and critical consciousness. While each of these reflect a critical area of power imbalance within medical education, the utility of this framework extends beyond this, and it may be applied to interrogate curricula in other health-related disciplines and the natural sciences. We suggest how the medical curriculum can privilege perspectives from different disciplines to challenge the hegemony of the biomedical outlook in contemporary medicine – and offer space to perspectives traditionally marginalised within a colonial framework. We anticipate that through this process of re-centring, medical students will begin to think more holistically, critically and reflexively about the intersectional inequalities within clinical settings, health systems and society at large, and contribute to humanising the practice of medicine for all parties involved

Biomedical Research and Global Sustainability: Throwing off the straitjacket of hierarchical thinking, making space for nomadic thinking

The biomedical paradigm, characterised by the separation of human from nature, of mind from body, and of ‘us’ from ‘them’, is encrusted with the jewels of western exploitation. Its legacy, one of many, has been to permit critical thinking to be infused with the domination of scientific knowledge over indigenous knowledge, of expert experience over patient experience, and of western knowledge over knowledge from other regions. Planetary sustainability has put us all into an uncomfortable liminal space where there is an urgent need to develop new ways of thinking to navigate the complexity and uncertainties of the Anthropocene. The decolonization/dismantling of the historically biased, epistemically rigid, hierarchical thinking that has led us to the brink of environmental collapse must re-centre a more ‘nomadic’ or ‘rhizomic’ type of thinking that works against the grain of traditional western categories and conventional methods, making breathing space for experiential person-centred, ecological wisdom to blossom. What might this look like for global health and academia? Practicing medicine using an ecological lens; a system with geographically diverse representation in the authorship of scientific literature; methodological diversity in the top journals, placing qualitative research, stories and art on an equal footing with Randomised Controlled Trials; and editorial boards composed in part of lay members. A more inclusive academe, through Cultural Safety, where works from patients, service users, indigenous community voices are published alongside and co-produced with expert/professional communities is a step in the right direction

Biomedical research and global sustainability: throwing off the straight jacket of hierarchical thinking, making space for nomadic thinking

The biomedical paradigm, characterised by the separation of human from nature, of mind from body, and of ‘us’ from ‘them’, is encrusted with the jewels of western exploitation. Its legacy, one of many, has been to permit critical thinking to be infused with the domination of scientific knowledge over indigenous knowledge, of expert experience over patient experience, and of western knowledge over knowledge from other regions. Planetary sustainability has put us all into an uncomfortable liminal space where there is an urgent need to develop new ways of thinking to navigate the complexity and uncertainties of the Anthropocene. The decolonization/dismantling of the historically biased, epistemically rigid, hierarchical thinking that has led us to the brink of environmental collapse must re-centre a more ‘nomadic’ or ‘rhizomic’ type of thinking that works against the grain of traditional western categories and conventional methods, making breathing space for experiential person-centred, ecological wisdom to blossom. What might this look like for global health and academia? Practicing medicine using an ecological lens; a system with geographically diverse representation in the authorship of scientific literature; methodological diversity in the top journals, placing qualitative research, stories and art on an equal footing with Randomised Controlled Trials; and editorial boards composed in part of lay members. A more inclusive academe, through Cultural Safety, where works from patients, service users, indigenous community voices are published alongside and co-produced with expert/professional communities is a step in the right direction

Decolonising ideas of healing in medical education

The legacy of colonial rule has permeated into all aspects of life and contributed to healthcare inequity. In response to the increased interest in social justice, medical educators are thinking of ways to decolonise education and produce doctors who can meet the complex needs of diverse populations. This paper aims to explore decolonising ideas of healing within medical education following recent events including the University College London Medical School’s Decolonising the Medical Curriculum public engagement event, the Wellcome Collection’s Ayurvedic Man: Encounters with Indian Medicine exhibition and its symposium on Decolonising Health, SOAS University of London’s Applying a Decolonial Lens to Research Structures, Norms and Practices in Higher Education Institutions and University College London Anthropology Department’s Flourishing Diversity Series. We investigate implications of ‘recentring’ displaced indigenous healing systems, medical pluralism and highlight the concept of cultural humility in medical training, which while challenging, may benefit patients. From a global health perspective, climate change debates and associated civil protests around the issues resonate with indigenous ideas of planetary health, which focus on the harmonious interconnection of the planet, the environment and human beings. Finally, we look further at its implications in clinical practice, addressing the background of inequality in healthcare among the BAME (Black, Asian and minority ethnic) populations, intersectionality and an increasing recognition of the role of inter-generational trauma originating from the legacy of slavery. By analysing these theories and conversations that challenge the biomedical view of health, we conclude that encouraging healthcare educators and professionals to adopt a ‘decolonising attitude’ can address the complex power imbalances in health and further improve person-centred care