Authors: Eva Niyibizi, MD; Susan Fraymovich, DO
Editor: Simiao Li-Sauerwine, MD, MSCR

A Case

Sarah was excited to start medical school. Her road to medical school was not the typical one. When she attended college, she majored in biology and had expected to work as a basic science researcher. She completed her master’s degree in biology and even worked in the university lab for two years. She ultimately decided her passion was in medicine and after going back to school to complete her requirements, she was finally starting medical school.  

Sarah’s first month in medical school did not live up to her expectations.  She found her physiology class boring and repetitive. Her class was held in a large auditorium with four hundred first-year medical students feverishly taking notes while the professor stood in the front of the classroom lecturing. She was disappointed that there were no engaging conversations or exchange of ideas during class time, as she had during her seminar classes during college.  

Sarah had an advanced biology degree and the material being covered in class was something she herself had already taught while being a teacher’s assistant in graduate school. Sarah felt like she didn’t have an opportunity to share her knowledge nor develop additional skills in this type of learning environment.  Sarah was frustrated. Is this what medical school was going to be like for the next four years? 

Background

Paolo Freire was a Brazilian educator, socialist, activist (1921-1997). Freire’s theory is based on a Marxist approach and his view of anti-colonialism stemming from his poor upbringing in Brazil. He believed his country’s population needed to have increased access to education.  Education, when done the right way, would empower the repressed to regain their sense of humanity and overcome their poor conditions. Freire’s Banking Model viewed educators as oppressors who teach students to conform to their way of thinking. Students are oppressed and learn their place in society through their teachers.They do not ask questions and accept what they are being taught; they are passive learners who learn by repeating facts without using critical thinking skills. The teacher deposits knowledge directly to the student and the student is expected to memorize it exactly as it is being taught. This method does not facilitate free thinking or transformative thought. Freire argues instead that the utility of education is far more than the transmission of information. Instead, he views education in the broader context of liberation of oppressed peoples, as a tool for humans to discard the tools of oppression and liberate their potential. A teacher, in Freire’s view, should foster learning without dictating content, while also being open to concurrent learning themselves. A learner is continually challenged by questions posed by the teacher, critically considers content, and is fully engaged in the creative dialogue. 

Modern takes on this Theory

The Banking Model is based on teachers recapitulating their knowledge directly to students as accepted facts. There is no thought given to the background of the student or differing levels of knowledge of those in the classroom.  Students, on the other hand, play a passive role in their own education. They do not use critical thinking or interpret the facts they are given. They are expected to memorize the content and recite it when asked. To overcome these antiquated teaching styles, Freire suggests the teacher should become a student and engage with students. Students come from different backgrounds of knowledge and skill; Students can learn from each other and educators can learn from them as well. Freire recommends problem-based learning, wherein teachers pose scenarios and allow students to formulate their own questions and answers.

In recent times, Banking Theory has been considered in the context of medical education. It is true that much of the foundational content in medical school curricula deals with a specific body of knowledge that is critical to impart. Building upon this, proponents of Freire also assert that it is critical in medical education to train students to have a deep understanding of the culture surrounding medicine as well as a commitment to supporting the humanity of all people. In Problem-Posing Education, teachers should lead by facilitating discussions and providing support, and should contribute information only after group dialogue takes place. In this way, educators empower learners and consolidate knowledge from shared experiences in order to translate and apply content to the real world. This approach lends itself in particular to medical school formats such as problem-based learning, and topics such as community health. 

Other Examples of Where this Theory Might Apply

The Banking Model of imparting foundational medical knowledge is commonly seen in the first two years of medical school curricula, where an instructor is tasked with imparting a collection of facts in a time-constrained lecture format. In a push to combat this traditional approach, many schools are now adopting more innovative techniques such as problem-based learning. 

Much knowledge and experience is also gained during residency training. Banking Model’s converse, Problem-Posing Education, is more frequently employed in the graduate medical education setting. Examples of forums allowing for lively discussion and shared knowledge include morning report, small group discussions during resident conference, bedside teaching, and on-the-fly discussions amongst residents and attending physicians.

Limitations of this Theory

Some students need the structure and may learn best in a banking model, especially those in the beginning of their students who are learning frameworks and foundations.  These students do not yet know enough to question or engage. Some concepts also lend themselves to direct instruction such as safety precautions in a laboratory or how to fill out a death certificate.  Careful and direct instruction is necessary to avoid fatal errors. 

After multiple classes in her first semester seemed to be structured the same way, Sarah had enough. She was not learning anything new and felt herself slowly disengaging from the classroom to the point where she was no longer showing up to class.  Sarah decided to do something about it.  She made an appointment and spoke to her professor. 

Returning to the case…

After multiple classes in her first semester seemed to be structured the same way, Sarah had enough. She was not learning anything new and felt herself slowly disengaging from the classroom to the point where she was no longer showing up to class.  Sarah decided to do something about it.  She made an appointment and spoke to her professor. 

At her meeting, Sarah discussed her disappointment in the classroom structure. She made it clear that she had a lot more to add than sitting and taking notes in the back of the class. Her professor listened intently and, together, they made some changes. They instituted small group learning.  Instead of the lecture- style classroom, the entire class was split into groups of 10 people. Each group was given a topic with a question to answer.  Each group was in charge of researching their idea and formulating a series of solutions to present to the class next week. Each team member was asked to contribute, engaging all players on the team.  Sarah was able to use her prior experience from her master’s program to help her team.  In return, she was able to learn from her team mates who were each able to bring something unique to the group due to their varied past experience.

References

1. Freire, P. (1970). Pedagogy of the Oppressed. New York: Continuum.
2. Drew, C. “The ‘Banking’ Model of Education – Pros & Cons (2021).” Helpful Professor, 28 Apr. 2021, helpfulprofessor.com/banking-model/. 
3. Shor, I. (1987). Freire for the Classroom: A Sourcebook for Liberatory Teaching. New Hampshire: Heinemann Educational Books. 
4. DasGupta, S., Fornari, A., Geer, K. et al. Medical Education for Social Justice: Paulo Freire Revisited. J Med Humanit 27, 245–251 (2006). https://doi.org/10.1007/s10912-006-9021-x
5. Torre D, Groce V, Gunderman R, , et al. 2017, ‘Freire’s view of a progressive and humanistic education: Implications for medical education ‘, MedEdPublish, 6, [3], 5, https://doi.org/10.15694/mep.2017.000119