The world is facing an unprecedented health crisis. With that, comes the urgent need for effective education about this health crisis.
If you’re a health professional, educating patients or the public, this is for you.
I’m going to tell you one thing you can do—one important change you can make right now—that will improve how you educate.
To do this, we’re going to the bank.
Paolo Freire & the banking model
The work of Paolo Freire has informed health care research for nearly 40 years. It’s gaining in popularity – you may have heard of critical pedagogy. Freire is a Brazilian social theorist and educator who came to international prominence in the 1980s. He is perhaps best known for his theories of critical consciousness, emancipatory pedagogy, and dialogic learning. In the health sector, Freire’s work has been used in public health, community health, digital health, & health literacy interventions.
One of his best known concepts regarding education is what he calls the “banking” model.
In the banking model, Freire describes what may sound familiar to many people. He observed that education, in typical classrooms, looked and sounded more like banking than actual teaching and learning:
“Education thus becomes an act of depositing, in which the students are the depositories and the teacher is the depositor. Instead of communicating, the teacher issues communiques and makes deposits which the students patiently receive, memorize, and repeat. This is the ‘banking’ concept of education, in which the scope of action allowed to the students extends only as far as receiving, filing, and storing the deposits.”
Not a pretty picture. Education-as-transfer from those who have something of value, to those who don’t. The banking model is a popular concept in part because it’s so accurate–and widespread. You may know how it feels to be on the passive-learner side. Many of us were educated at least partly in this kind of ‘banking’ way.
Flawed assumptions
Banking-model-teaching has many side effects. One is that we’ve become accustomed to seeing the teacher as the holder. The one with all the money. All the power. All of whatever’s worth having.
Expertise certainly has value. You, as health professionals, have worked for years to acquire important information, and to develop professional insights–explicitly to share them and apply them. And the health professionals I speak with all have a desire to share and apply their expertise with their patients or the public.
The problems come from banking-style education. It makes the education process less effective for everyone, as it operates on flawed assumptions. Here are three of these flawed assumptions.
1. experts are the only ones holding something of value
2. everyday people are empty receptacles
3. everyday people should passively absorb what is of value from the experts.
As Freire says about the banking model,
“Worse yet, it turns [students] into ‘containers,’ into receptacles’ to be ‘filled’ by the teacher.”
Passive recipients. Not people with lives, thoughts, histories, or resources.
It can be easy to see patients or the public this way. There are many pressures toward doing so. Let’s say your patient just took some sort of assessment. Or maybe they answered some questions. These often show what the patient doesn’t know, and focus your attention on what they don’t do, what they don’t have. It’s important to know these needs.
But the needs, or areas of deficit, can easily become the focus. Banking style education positions the patient as an empty vessel needing filling—rather than a person with a full life and rich cultural and linguistic resources. And, who right now, is doing their best in a crisis.
An example
I was talking with a wound care clinician. Describing a common scene in her practice, she said,
“We tell patients, ‘It’s important, you should get out of your [wheel]chair for 3 minutes a day!’ And the patient nods, and everyone goes away, and that’s it.” She laughed a little as she told me this. It had almost become a joke. No one took it seriously, it seemed, and she saw it as a lost opportunity to do some patient education.
There’s no wonder that ‘education’ was not taken seriously. That statement is based on at least 3 deficit assumptions:
- that the patients are not getting out of their chair (or not for 3 minutes a day),
- that patients do not already know that they should get out of their chairs for at least 3 minutes a day
- that patients are able to get out of their chairs for at least 3 minutes a day.
So, banking model education comes in to fill the empty vessel! Et voila, no one takes it seriously. To be clear, no one is disputing that there’s science behind the 3 minute rule; it’s the banking model style educating that’s getting in the way.
1 important change you can make now
How do you resist the banking model? What can you do to combat a deficit perspective on your patients? I promised I would tell you one change you can make, and here it is:
When educating someone–an individual patient, or a whole population–assume they are already doing the best they know how at the thing you want them to do.
That is, go in with the assumption they ARE doing something related to what you’re about to teach. Rather than with the assumption they are NOT doing anything about it at all.
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What about the problem? Their needs? You’re still going to address them. You’re just not starting with the needs.
Instead, start with the assumption that people are already doing the best they know how.
Then, show how you’re going to help them along in that direction.
Changing your starting point can be as simple as a shift in language. Let’s go back to the wound care clinician. She knew that telling patients to get out of their chairs for 3 minutes a day wasn’t adequate.
At best, it was a banking transfer of information–and nothing more.
A small shift in language
I talked to her about shifting her language. About starting her patient education by seeing patients not as empty containers to be filled, but as people are already doing their best. I suggested her language could reflect this.
She turned and looked at me and said, “So instead of telling patients ‘You should get out of your chair for 3 minutes,’ we could ask them, ‘How long do you get out of your chair?’”
We smiled. It could be that easy.
That subtle shift in language was an important change. The first phrase ‘You should get out of your chair for 3 minutes’ presumes what patients don’t know and don’t do. The second phrase ‘How long do you get out of your chair’ focuses on what the patient does know and does do.
We quickly brainstormed some more.
‘When you get out of your chair, how do you do it? for how long?’
‘What do you do to relieve pressure on your wounds?’
These phrases put more emphasis on the patient as capable, active, and involved. A person with a life. Not the empty container of the banking model, waiting passively to be filled.
I thought the clinician could ask follow-up questions. ‘Do you feel like you get out of your chair enough?’ and if they didn’t, ‘what would help you do it more?’ or ‘let’s come up with something that will work for you.’
More benefits
These subtle but important changes in language also have the potential to reveal more information about the patient, her surroundings, and her background knowledge and assumptions about her condition. All of these are helpful building blocks for patient education, for real learning that lasts.
Shifting your language to reflect the assumption that people are doing their best also helps you catch where things might be going wrong.
Patients may have misconceptions. It may be that some wound care patients did not, in fact, know they should get out of their chairs for 3 minutes a day. Questions we brainstormed would have allowed the patient to admit this, safely, and then you get to do more educating.
The banking model way? Well, no such chance.
I’ve been explaining a bit about the banking model. Freire’s language is strong as he takes critical aim at the taken-for-granted ways of educating many of us experienced. I hope you’ll check out his most famous work, Pedagogy of the Oppressed, as well as some of the important critiques and extensions of his work.
In this time of upheaval and uncertainty, we’re all doing the best we can. Keep that in mind when communicating with individuals or groups. Want help? Contact me.
