‘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 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

Royal College of Obstetricians and Gynaecologists guidelines: How evidence-based are they?

Evidence-based medicine aims to translate scientific research into good medical practice. The Royal College of Obstetricians and Gynaecologists publishes recommendations and guidelines to guide clinicians in decision-making. In this study, the evidence base underlying the ‘Green-top Guidelines’ has been analysed in order to establish the quality of research underlying recommendations. During this descriptive study of 1,682 individual recommendations, the authors found that only 9–12% of the guidelines were based on the best quality (Grade A) evidence. The authors believe that this type of analysis serves to provide greater clarity for clinicians and patients using guidelines and recommendations in the field of obstetrics and gynaecology to make collaborative clinical decisions

The psychobiological revival of the ‘three P’s’ in an integrated antenatal education model

Achieving two main objectives of antenatal education, namely optimising normal birth outcomes for low risk pregnant women and improving the quality of birth experience for all new mothers (Ogden et al., 1997/2014), is linked with a cascade of health benefits indicated in research converging on the concept of ‘primal health’ (see www.primalhealth.org). Mothers’ mental wellbeing is paramount to thriving families and lightens the burden and cost of health care in the short, medium and long terms (Brixval et al., 2014; Gamble et al., 2002

Translating Cultural Safety to the UK

Disproportional morbidity and mortality experienced by ethnic minorities in the UK have been highlighted by the COVID-19 pandemic. The ‘Black Lives Matter’ movement has exposed structural racism’s contribution to these health inequities. ‘Cultural Safety’, an antiracist, decolonising and educational innovation originating in New Zealand, has been adopted in Australia. Cultural Safety aims to dismantle barriers faced by colonised Indigenous peoples in mainstream healthcare by addressing systemic racism. This paper explores what it means to be ‘culturally safe’. The ways in which New Zealand and Australia are incorporating Cultural Safety into educating healthcare professionals and in day-to-day practice in medicine are highlighted. We consider the ‘nuts and bolts’ of translating Cultural Safety into the UK to reduce racism within healthcare. Listening to the voices of black, Asian and minority ethnic National Health Service (NHS) consumers, education in reflexivity, both personal and organisational within the NHS are key. By listening to Indigenous colonised peoples, the ex-Empire may find solutions to health inequity. A decolonising feedback loop is required; however, we should take care not to culturally appropriate this valuable reverse innovation

Long COVID in children: the perspectives of parents and children need to be heard.

Parents have been struggling to obtain help and support, watching their children with persistent symptoms following acute infection with COVID-19. Early on in the pandemic, parents and children felt they were disbelieved by their GPs. As ‘long COVID’ came to be recognised in adults and named as such by patients there came to be a growing acceptance that it can also occur in children as evidence emerged. Indeed, ONS data suggest that 12%–15% of children may have symptoms lasting 5 weeks after an acute infection with COVID-19