From Awareness to Agency: A Freirean Analysis of Critical Consciousness and Social Justice Among International Medical Students in the UK

Abstract

Social justice is increasingly emphasised in medical education, yet students often struggle to translate awareness of inequity into meaningful action. Drawing on Paulo Freire's critical pedagogy, this study explores how international medical students conceptualise social justice, encounter inequity within clinical and educational environments, and perceive their capacity to act as agents of change. Given the growing internationalisation of UK medical schools, understanding how international learners develop critical consciousness and experience inequity is essential. A qualitative study was conducted using three online focus group studies with 11 Year 2 international medical students at a UK medical school. Data was thematically analysed using a Freirean framework. Analysis focused on students' expression of critical consciousness, experiences of structural inequity and the hidden curriculum, sense of belonging and perception of agency and praxis. Four interconnected themes were identified. (1) Emerging critical consciousness: students demonstrated awareness of social injustice, recognising how poverty, racism, disability, immigration status and biased curricular representations shaped health outcomes. (2) Witnessing inequities in clinical practice: clinical placements in General Practice (GP) settings exposed students to structural constraints such as language barriers, limited resources, inaccessible services reinforcing their understanding of health inequity as systemic rather than individual. (3) The hidden curriculum, inequity and belonging: while students identified financial and representational inequities within medical education, they also described a strong sense of belonging fostered through stable Team-Based Learning (TBL) groups, supportive peers and approachable staff. For international students this relational inclusion provided psychological safety and enabled engagement with justice-focused reflection. (4) Awareness without agency: despite growing critical consciousness, students reported limited power to enact change, citing hierarchical norms, lack of authority and resource-constrained systems, reflecting a predominantly banking model of education. Conclusion International medical students demonstrated emerging critical consciousness and strong relational and institutional belonging, yet faced systemic barriers that constrained their ability to translate awareness into action. Medical education must move beyond awareness‑raising to intentionally create opportunities for praxis, address the hidden curriculum, and support faculty to foster action-oriented, socially just learning environments. Integrating belonging with structured opportunities for participation and change is essential to developing critically conscious, socially responsive future practitioners.