Medical students’ views of power in doctor–patient interactions: the value of teacher–learner relationships

Medical Education 2010: 44 : 187–196 Context This paper aims to contribute to the important, and relatively underexplored, area of medical education research that seeks to illuminate the value and meaning of relationships in the undergraduate education of doctors. Here I present new empirical material in which I ground my reflections on some ways in which teacher–learner relationships can help address medical students’ often uncritical views of professional practice. The views I illustrate are of particular significance as they contrast sharply with the participative models of practice promoted by current policy, professional and educational discourses. Methods My reflections stem from the analysis of data I generated for a larger, broadly ethnographic study exploring students’ approaches to their future role as practitioners in one UK medical school. I draw upon this larger body of data and focus here on two examples in particular of the more general uncritical readings of medical professionalism I encountered at Sundown Medical School (an invented name), namely: students’ often reductive views of medical power, and their simplistic formulations of patient education. Discussion I argue for the need to foster richer and more critical understandings of professional power and knowledge among students and educators, and suggest here that teacher–learner interactions could have an important role in fostering such richer understandings. I argue that teacher–learner relationships can model some of the dynamics of the practitioner–patient interaction and thus provide useful opportunities for closer and more critical analysis of power, education and knowledge in the medical school classroom as well as in the consultation room. Conclusions I suggest that effective integration of participative and critical pedagogical strategies in medical curricula and more structured involvement of patients in the role of teachers may represent valuable strategies for the development of learning relationships that better promote reflexive and collaborative forms of professionalism.