Medical students and patient-centred clinical practice: the case for more critical work in medical schools

In the last two decades, undergraduate medical education in the United Kingdom has undergone several important changes. Many of these have revolved around a paradigmatic shift from 'paternalistic' to 'patient-centred' approaches to healthcare. Adopting a Foucauldian understanding of power and borrowing from Freire's critical pedagogy, in this paper I draw upon ethnographic data from one UK medical school to illustrate the recurrence among medical students of narrow and uncritical understandings of patient-centred practices. These understandings highlight a tension between the ideals and frameworks of medical education policy and students' conceptualisations of professional learning and practice. I explore this tension by tracing some possible links between students' views of patient-centredness and the teaching practices at the medical school. I argue that more critical approaches to medical learning are sorely needed and suggest some directions for medical education that would help support the personal and professional development of more critically aware practitioners.