The theoretical foundations of the framework trace back to two distinct intellectual traditions. Constructivism has roots in the German philosopher Immanuel Kant, whose ideas were later developed by the Swiss clinical psychologist Jean Piaget. Piaget grappled with a central philosophical puzzle: if a priori knowledge is both universal and necessary, as Kant proposed, why do young children perceive and structure the world so differently from adults? His response was that adult reasoning represents a late-developing set of cognitive structures that actively impose order on experience, a process he described as the biological vision of the functional a priori. Critical pedagogy, by contrast, is most profoundly shaped by the Brazilian educator Paulo Freire, whose emphasis on dialogue, empowerment, and social justice established a foundation for incorporating critical social theory into educational practice. When combined, these two traditions form the theoretical core of critical constructivism, encouraging learners not only to construct knowledge actively but also to examine the forces that influence what counts as knowledge.

According to Piaget, constructivist learning unfolds through three sequential processes: assimilation, accommodation, and equilibrium. Assimilation involves incorporating new experiences into pre-existing cognitive frameworks, or assimilatory schemata, relying on the interaction between new information and prior knowledge. Learning occurs only when new information can be integrated into existing mental structures, highlighting the importance of continuity in cognitive development. Accommodation refers to the process by which understanding evolves in response to novel experiences that challenge existing frameworks, eventually causing them to crack and reorganize. The authors offer a vivid metaphor: assimilatory schemata can be understood as mental pinboards, where assimilation involves attaching new information to existing structures, while accommodation requires reconfiguring those pinboards, moving, modifying, or even removing prior pins to make space for what is newly encountered. Equilibrium represents the cognitive balance between these two processes, and intellectual growth depends on maintaining this dynamic tension.

Critical constructivism extends these cognitive principles by embracing the assumptions of critical theory as developed by the Frankfurt School, emphasizing social justice in education through critical examination of the power dynamics that shape educational practices at all levels. With its embrace of epistemological pluralism and its rejection of dominant or grand narratives, the framework aligns with postmodernism while fostering a more inclusive approach to knowledge construction. Freire’s model of dialogical action is central here: for genuine dialogue to occur, teachers must step back from their traditional authoritative roles and share epistemic authority with students in the collaborative creation of new knowledge. Freire identified love, humility, faith in humanity, hope, and critical thinking as the five essential prerequisites for genuine dialogue, and he urged educators to view students as co-creators of knowledge rather than passive recipients of a fixed reality dictated by an expert.

Importantly, the authors are explicit that critical constructivism in medical education should not be misunderstood as epistemic relativism or as implying that all knowledge claims are equally valid. Scientific and clinical knowledge remains grounded in empirical evidence, disciplinary expertise, and established processes of validation. Critical examination of how scientific knowledge is produced and validated does not require rejecting empirical evidence; rather, it encourages learners to understand both the evidence supporting accepted knowledge and the social, historical, and institutional processes through which knowledge is produced, validated, and sometimes revised. In this framing, critical examination and respect for scientific evidence operate as complementary rather than opposing commitments, a distinction the authors argue is essential for educators wary of frameworks that appear to challenge scientific authority.

The practical implications for medical education are considerable. The authors note that students participating in constructivist learning environments exhibit enhanced critical thinking skills on assessments compared with peers in more traditional settings, even after accounting for variables such as GPA, gender, and ethnicity, and qualitative research suggests these learners engage with their studies more positively and with heightened interest. Student-centered methods such as flipped classrooms, problem-based learning, team-based learning, case-based learning, and large group discussions are increasingly common, but the authors stress that these strategies are not inherently critical constructivist. They become aligned with the framework only when they intentionally foster dialogue, encourage learners to question assumptions, incorporate diverse perspectives, promote reflexivity, and create environments in which learners’ voices are valued and shared epistemic authority is encouraged.

Team-Based Learning offers a concrete example of these principles in action. Freire contrasted problem-posing education with the traditional banking model, in which teaching is seen as a process of depositing knowledge into students regarded as empty vessels who are expected to passively receive, memorize, and repeat information. In a problem-posing model like TBL, students become critical co-investigators in dialogue with the teacher, bouncing ideas off each other and observing how peers process information differently. This collaborative environment fosters additional connections between new material and prior knowledge, including insights students may not have reached working independently. The authors argue that when implemented correctly, such approaches differ markedly from the passive lecture-based formats that still dominate many biomedical basic science courses.

These principles extend directly into clinical practice, where effective patient care depends on communication, collaboration, and shared understanding among team members. During multidisciplinary rounds, learners must actively engage with input from physicians, nurses, and other healthcare professionals, integrating multiple perspectives to arrive at clinical decisions. The authors point out that communication failures between healthcare professionals remain a leading contributor to adverse events, and recent evidence suggests miscommunication contributes to a substantial proportion of patient safety events. By fostering habits of collaborative reasoning, open dialogue, and shared responsibility, constructivist approaches can support safer and more effective team-based care. The framework also has implications for assessment, encouraging holistic strategies that incorporate self-, peer-, and team-based evaluation alongside traditional measures, with formative feedback viewed as a dialogic process rather than a purely summative judgment. The authors caution, however, that such approaches should not be assumed to be inherently emancipatory; without careful attention to power and group dynamics, they may reproduce rather than challenge existing hierarchies.

Power dynamics play a significant role in the construction and validation of knowledge, often serving to privilege certain groups while marginalizing others. The authors observe that while medical schools have increasingly recognized the importance of diversity in their student bodies, there appears to be a lag in fully emphasizing the inclusion of diverse student populations. On ward rounds, hierarchical structures may discourage medical students or junior trainees from questioning diagnostic decisions or voicing patient concerns. A critical constructivist approach encourages educators to cultivate psychologically safe learning environments in which learners are invited to question assumptions, contribute diverse perspectives, and consider the patient’s voice as an essential component of clinical reasoning. In this way, ward rounds become opportunities not only to acquire clinical knowledge but also to co-construct understanding through dialogue and shared clinical reasoning.

The framework is particularly relevant as healthcare systems integrate digital technologies and artificial intelligence into clinical practice. From a critical constructivist perspective, these technologies should be viewed not simply as tools for information delivery but as participants in learning environments that can support collaborative knowledge construction, reflection, and critical evaluation when thoughtfully integrated. The authors suggest learners could use an AI-generated response to a clinical case as a starting point for group discussion, critically examining its assumptions, comparing it with their own reasoning and other sources of knowledge, and reflecting on whose perspectives may be represented or overlooked. In this way, AI can serve not only as a source of information but also as an object of critical inquiry through which learners examine how knowledge is produced, represented, and evaluated. Ultimately, the authors conclude that a teaching strategy becomes critical constructivist not simply because it is learner-centered, active, or collaborative, but when it intentionally creates opportunities for dialogue, critical reflection, questioning of assumptions, and examination of the contexts and power dynamics that shape knowledge and practice, preparing physicians who are adaptive, reflective, and responsive to the complex social and clinical environments of modern healthcare.

Subject of Research: Medical Education

Article Title: A primer on critical constructivism and its relevance to medical education

Article References: Azim, H. M., Lee, R. Y., Sprague, A. V., & Near, C. P. (2026). A primer on critical constructivism and its relevance to medical education. Discover Education, 5(1), Article 873. https://doi.org/10.1007/s44217-026-02141-1

Image Credits: AI Generated

DOI: 10.1007/s44217-026-02141-1

Keywords: critical constructivism, medical education, constructivism, critical pedagogy, Paulo Freire, Jean Piaget, clinical reasoning, team-based learning, artificial intelligence, professional identity, primer, critical