Study 4: From Cases to Co-Teachers: A Freirean Analysis of Immigrant Patient Involvement in Health Professions Education

Although evidence on how immigrant patients themselves perceive their involvement in education is emerging, little is known about how students perceive immigrant patients as contributors to their education. Using Paulo Freire’s critical pedagogy as the underpinning conceptual framework, this study explored how health professions students construct the role of immigrant patients in their education, and how these constructions inform existing power relations and epistemic hierarchies.

Methods

A qualitative constructivist study was conducted using seven focus group discussions with health professions students. Participants were recruited through purposive sampling across multiple disciplines. Focus groups were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis.

Analytic rigor was supported through team-based discussion, reflexive journaling, and analytic memos. The research team brought diverse professional, disciplinary, and cultural perspectives, including lived experience as immigrants, which shaped data generation and interpretation. Findings Three interrelated themes were identified.

First, students positioned immigrant patients as epistemic contributors whose lived experience offered forms of knowledge unavailable in formal curricula, and they preferred dialogic, small-group formats that allowed reciprocal exchange. Second, encounters with immigrant patients functioned as catalysts for critical consciousness, prompting students to question taken-for-granted features of local healthcare and to recognize privilege and uneven access.

Third, students navigated bias and agency within hierarchical systems by recognizing constraints on whose voices shape the curriculum and by naming the hidden curriculum. In some cases, they moved beyond awareness to contest institutional control and engage in advocacy and action. Conclusions Immigrant patient involvement in HPE supports dialogue, critical reflection, and a reconsideration of whose knowledge counts in clinical training.

Findings point toward the need for more collaborative and transformative approaches to HPE, in which immigrant patient involvement is grounded in meaningful partnership and co-creation rather than representation alone. Practical strategies to tackle this include patient-led teaching, curriculum co-design, and immersive practice to stimulate reflection on bias and epistemic hierarchies. Attached Files Interview transcripts (anonymized ) ORCID id orcid.org/0000-0003-1508-1395