Health and 'I': an analysis of curricular phenomena in health professional training through the focus of critical pedagogy

The education of health professionals is based on a series of discourses of professionalism that privilege notions of control and choice (Riggs, 2004a; Titchen and Higgs, 2001). These discourses are expressed through both explicit and implicit curricula, which encourage the enactment of a particular construction of the „self‟ of both health professionals and clients or patients. This thesis adopts a feminist poststructural analysis of relations of power to explore some of the effects of the enactment of these curricula, drawing on three case studies of education in rural health settings and interviews with 17 health workers. The results indicate that the enactment of these curricula seems to produce a particular sense of self for health workers – one that is bound up with notions of control and choice, and one that may require struggle on an inner level with the self-regulation and self-policing (O‟Grady, 2005) required to fit this norm. The struggle for female health workers to link the abstract theorizing with the actualities of their lives (Williams, 2002)seems to produce a paradoxical type of relationship with themselves and their clients. On one hand there is a discourse of conformity, compliance and obedience, which suggests more of a slippage of self while at the same time the expert-novice relationship characterizing the health professionals interaction with clients emphasizes autonomy, control and empowerment of self. Further, while health workers see themselves as having high levels of internal locus of control this is in direct contrast to the helplessness and powerlessness they experience at work, and revealed through the research.

The curriculum reform taking place within all health professional education at the moment emphasizes evidence-based practice and scientific content, and thus reinforces the dominant norm of the neo-liberal individual capable of self-regulation and self-policing. This research suggests the limitations of this approach, given the practices of power that continue to disadvantage women in general and patients in particular in relation to their health and the institution.