The ‘Pedagogy of discomfort’: A qualitative exploration of non-indigenous student learning in a First Peoples health course

Abstract

To improve healthcare practices and increase cultural safety when working with First Peoples, it is essential that students engage with challenging discourses that critically engage their social, political, personal, professional and historical positioning. Such engagement may provoke emotional responses in students. However, little is known about the nature of non-indigenous students’ emotional engagement when learning First Peoples health content that integrates cultural safety principles. The pedagogy of discomfort is a process of self-examination that requires students to critically engage their ideological assumptions and may be useful in examining the emotional dimension that occurs when learning this content. Eighty-two non-indigenous health students gave permission for their critical reflective essays, submitted as an assessment requirement of a First Peoples health course to be analysed. Elements of the pedagogy of discomfort informed the analytical and theoretical framework. The emotional engagement by students was captured in the following overarching themes: Acknowledging preconceived ideas; Uncomfortable emotions; Fragile identities; Spectating and Witnessing. Findings highlight how students' emotional engagement may contribute to changes in perspective and frames of reference, transpiring to a ‘call to action’ that challenges systems of differential privilege. While many students expressed discomfort when learning about key cultural safety concepts, the extent of transformative potential varied.

Exploring Tertiary Health Science Student Willingness or Resistance to Cultural Competency and Safety Pedagogy

“…This literature is supported by study findings of students expressing resistance through challenging course content and walking out of teaching sessions. Study findings also support existing literature that shows that there are discernible patterns of resistant student behavior, ranging from negative emotions, defensive coping mechanisms and students appraising teaching topics as harmful [32,46]. Resistance can be the result of feeling confronted by values and concepts that are different to those students have been brought up with.…”

Cultural respect in midwifery service provision for Aboriginal women: longitudinal follow-up reveals the enduring legacy of targeted program initiatives

“…Critical self-reflection involving a willingness to question deeply held assumptions and consideration of the views and perspectives of others can be precursors to shifts in attitudes according to Mezirow's transformational learning theory [12,21]. Mills and Creedy noted however, that "research that measures learning in this space" is not widespread and much remains unknown about the emotional responses of both students and staff with uncomfortable content [13]. Furthermore, Isaacs and colleagues, who explored the concept of 'cultural desire' among nursing students upon completion of an Indigenous health unit, found no evidence of an increased desire to practise in a culturally competent manner; they noted that enhanced knowledge and skills "might all be in vain if there is no desire to be culturally competent" [26].…”

“…Informed, culturally competent graduates were considered essential to efforts to reduce socio-economic and health disparities experienced by Aboriginal Australians; medical and health sciences accreditation bodies responded by mandating compulsory Aboriginal content in programs. Numerous initiatives across the country have provided evidence of a range of transformative impacts on students from classroom content and cultural immersion experiences [12][13][14][15][16][17]. Despite some encouraging findings, doubt has been expressed about a link between educational initiatives and improved outcomes for Aboriginal people due, in part, to embedded culture within organisations and barriers with implementation of knowledge [18][19][20].…”

“…Mills and Creedy usefully employ a 'pedagogy of discomfort' framework to explore non-Indigenous students' emotional responses to content and the process of critical reflection [13]. Despite discomfort, students can move from 'spectating' to 'witnessing'; the former being a passive, comfort-zone position which maintains distance and absolves one of responsibility, while the latter involves a deeper engagement and includes an ethical and active dimension that can lead to transformational changes [13]. These changes can also be understood in the context of transformational learning theory [12,21].…”

“…A number of theories have been posited to explain the experience of learning about Aboriginal history and cultures, the shift in attitudes that can occur and the positive impact of cultural immersion experiences. Mills and Creedy usefully employ a ‘pedagogy of discomfort’ framework to explore non-Indigenous students’ emotional responses to content and the process of critical reflection [ 13 ]. Despite discomfort, students can move from ‘spectating’ to ‘witnessing’; the former being a passive, comfort-zone position which maintains distance and absolves one of responsibility, while the latter involves a deeper engagement and includes an ethical and active dimension that can lead to transformational changes [ 13 ].…”