Teaching Sociology to Undergraduate Medical Students: AMEE Guide Education Management 122
Abstract
Understanding the social basis of health and medicine and the contexts of clinical care are essential components of good medical practice. This includes the ways in which social factors such as class, ethnicity and gender influence health outcomes and how people experience health, illness and health care.
In our Guide we describe what sociology is and what it brings to medicine, beginning with the nature of the “sociological imagination”. Sociological theory and methods are reviewed in order to explain and illustrate the role of sociology in the context of undergraduate medical education. Reference is made to the 2016 report ‘A Core Curriculum for Sociology in UK Undergraduate Medical Education’ by Collett and colleagues. Teaching and student learning are discussed in terms of organisation and delivery, with an emphasis on practice. Sections are included on assessment, feedback to students, evaluating teaching, faculty development, challenges for teaching sociology, and the value of a “community of practice” for sociology teachers in medical education.
... I sensed that the responses were representative of a range of perspectives that centred on the suffering endured by lecturers, as well as students, when trying to integrate a social science subject into a biomedical course. Far from this being an empowering situation for all those concerned (Ellsworth, 1992), there is evidence of a great deal of suffering when trying to teach social determinants of health and infuse notions of social justice into seemingly privileged locations (Kendall et al, 2018;Bleakley, 2017;Kumagai, Jackson, & Razak, 2017). To me, this very awkward situation runs the risk of polarising even further the two fields of social science and biomedicine unless approached with compassion. ...
... Using the complementarity of disciplines to move beyond culture or psychology means moving beyond individualising of responsibility for social determinants of health. Creating an awareness or social action on the effect of cultural systems of values on health outcomes Kendall et al., 2018) only reinforces the ontological divide that caused the problem in the first place with the concomitant need for translation between epistemic and ontological domains (Kristeva et al., 2018;Cerea, 2018). Decentering the causal problematic means developing a curriculum based on principles of complementarity and dual awareness of both cultural and psychological functioning as an act of compassion. ...
This reflective piece of writing explores the experience of gaining medical student feedback that is negative in the context of teaching social sciences in a medical school. There are a number of different ways in which an educator can explore negative feedback and respond. Some ways may be less helpful than others even though they reflect prevailing dominant thinking within higher education and how students are perceived. Compassionate pedagogy provides an avenue for allowance of challenging feedback and situations, as well as an unpacking of assumptions made about teaching and medical students, in a way that is respectful of the teacher, student and ultimately the patient. Since the way students are treated can be seen as an exemplar for how they will then go on to view and treat the patient, the compassion gap within universities (that train health professionals to then work with patients) is astonishing as noted by Waddington (2016). Drawing on theory from the social sciences as well as medical humanities, this paper uses reflective practice (Foley, 2002), critical pedagogy (Freire, 2000) as well as intelligent kindness (Ballett & Campling, 2011) to analyse a student feedback experience within medical education and asks the question of how can compassion be integrated in a biomedical field where the emphasis is on science, with all the implications that has for the learner? This question centres on the relative valuing of objective facts over subjectivity of experience. Using compassionate pedagogy, some suggestions or, food for thought, are made on how to re-interpret negative student feedback that negotiates the tricky area between social science and medicine, whilst not negating either.
... I sensed that the responses were representative of a range of perspectives that centred on the suffering endured by lecturers, as well as students, when trying to integrate a social science subject into a biomedical course. Far from this being an empowering situation for all those concerned (Ellsworth, 1992), there is evidence of a great deal of suffering when trying to teach social determinants of health and infuse notions of social justice into seemingly privileged locations (Kendall et al, 2018;Bleakley, 2017;Kumagai, Jackson, & Razak, 2017). To me, this very awkward situation runs the risk of polarising even further the two fields of social science and biomedicine unless approached with compassion. ...
... Using the complementarity of disciplines to move beyond culture or psychology means moving beyond individualising of responsibility for social determinants of health. Creating an awareness or social action on the effect of cultural systems of values on health outcomes Kendall et al., 2018) only reinforces the ontological divide that caused the problem in the first place with the concomitant need for translation between epistemic and ontological domains (Kristeva et al., 2018;Cerea, 2018). Decentering the causal problematic means developing a curriculum based on principles of complementarity and dual awareness of both cultural and psychological functioning as an act of compassion. ...
This reflective piece of writing explores the experience of gaining medical student feedback that is negative in the context of teaching social sciences in a medical school. There are a number of different ways in which an educator can explore negative feedback and respond. Some ways may be less helpful than others even though they reflect prevailing dominant thinking within higher education and how students are perceived. Compassionate pedagogy provides an avenue for allowance of challenging feedback and situations, as well as an unpacking of assumptions made about teaching and medical students, in a way that is respectful of the teacher, student and ultimately the patient. Since the way students are treated can be seen as an exemplar for how they will then go on to view and treat the patient, the compassion gap within universities (that train health professionals to then work with patients) is astonishing as noted by Waddington (2016). Drawing on theory from the social sciences as well as medical humanities, this paper uses reflective practice (Foley, 2002), critical pedagogy (Freire, 2000) as well as intelligent kindness (Ballett & Campling, 2011) to analyse a student feedback experience within medical education and asks the question of how can compassion be integrated in a biomedical field where the emphasis is on science, with all the implications that has for the learner? This question centres on the relative valuing of objective facts over subjectivity of experience. Using compassionate pedagogy, some suggestions or, food for thought, are made on how to re-interpret negative student feedback that negotiates the tricky area between social science and medicine, whilst not negating either.
This article was migrated. The article was marked as recommended. Based on a review of the literature pertaining to sociology teaching in medical education, this paper asks why does the problem of relevance with regards to sociology teaching in medical education still persist? And is there any change in sight?The literature suggests that epistemological understandings of medicine as represented by the biomedical model are deeply entrenched with far reaching consequences for sociology teaching. Notions of the social components of medicine as 'irrelevant' or 'common sense' have over time been reinforced by students' expectations of medicine on entering medical education; by the attitudes of clinical and biomedical staff members who can act as negative role models and by institutional barriers including the organization of curricula content, decisions about 'who teaches what', timetabling and assessment.Changing such deeply ingrained practices may be an insurmountable task for educators working alone in individual medical schools. However, pedagogical changes emphasizing 'integration' and a growing understanding within medicine and higher education of alternative epistemologies predicated on social paradigms, means that increasingly, persons from different disciplinary and professional backgrounds share similar understandings about the complexities of medical care.As associated ideas filter into medical education new opportunities are arising to challenge collectively the structural forces at play which in turn could lead to a major shift in medical students' thinking. If sociologists are to have a role in guiding the transmission of sociological ideas about health and illness it is crucial to understand and take part in these developments.
Despite the obvious triumph of a medical theory and practice grounded in the hospital, a new medicine based on the surveillance of normal populations can be identified as emerging in the twentieth century. This new Surveillance Medicine involves a fundamental remapping of the spaces of illness. This includes the problematisation of normality, the redrawing of the relationship between symptom, sign and illness, and the localisation of illness outside the corporal space of the body. It is argued that this new medicine has important implications for the constitution of identity in the late twentieth century.
The paper is based on semi-structured interviews with a series of rheumatoid arthritis patients. Chronic illness is conceptualised as a particular type of disruptive event. This disruption highlights the resources (cognitive and material) available to individuals, modes of explanation for pain and suffering, continuities and discontinuities between professional and lay thought, and sources of variation in experience.
Smoking prevalence is declining in industrial capitalist countries. The downward trend has resulted in a narrowing of gender differences and a widening of class differences. The shrinking population of cigarette smokers is increasingly drawn from those occupying subordinate positions in gender and class hierarchies: from women and from those in lower socio-economic groups. The paper reports on a UK survey which suggests that cigarette smoking follows the contours of disadvantage within as well as between groups.
In this paper I focus on two arenas of student resistance that have come under closer sociological analysis. I do this to illustrate that teaching will always be difficult, but that we have more opportunities and challenges in these interesting times. One of those challenges just might be to expand our definitions of student resistance in order to further develop our own thinking about teaching and learning. The first form of student resistance I consider to be the “classic” form in which teachers focus on classroom disruptions and why their educational messages are not absorbed by students; the second is a more contemporary consideration of student resistance as a form of building social capital for learners and teachers alike.
Classic student resistance is taken as an affront to the authority of college professors and the meaning of the liberal arts degree (Perry 1970; Becker et al, 1985). The shared assumption is that most students are either unprepared or unwilling to learn what is presented in the traditional college classroom. Forms of student resistance might reflect cognitive deficits (dualistic thinking in Perry’s scheme) or a subculture of student resistance to the values of the academy (Becker et al.). Learning takes place in environments fraught with individual and group resistance, especially resistant to the dominant patterns of teaching and learning in the social structure of higher education.
The second more contemporary form of student resistance I bring to the discussion draws from critical perspectives on learning with classroom resistance serving as a form of social capital. These perspectives are often radical, critical or liberatory pedagogies that engage distinctive forms of resistance as a potential learning tool, or as a challenge to our mainstream sociological teaching strategies (Sweet 1998, Yasso 2005).
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Programmatic assessment is a notion that implies that the strength of the assessment process results from a careful combination of various assessment instruments. Accordingly, no single instrument is superior to another, but each has its own strengths, weaknesses and purpose in a programme. Yet, in terms of psychometric methods, a one-size-fits-all approach is often used. Kane's views on validity as represented by a series of arguments provide a useful framework from which to highlight the value of different widely used approaches to improve the quality and validity of assessment procedures.
In this paper we discuss four inferences which form part of Kane's validity theory: from observations to scores; from scores to universe scores; from universe scores to target domain, and from target domain to construct. For each of these inferences, we provide examples and descriptions of approaches and arguments that may help to support the validity inference.
As well as standard psychometric methods, a programme of assessment makes use of various other arguments, such as: item review and quality control, structuring and examiner training; probabilistic methods, saturation approaches and judgement processes, and epidemiological methods, collation, triangulation and member-checking procedures. In an assessment programme each of these can be used.
As medical students, we were taught to ask three questions to elicit the social history: “Do you work?,” ”Are you single or married?,” and “Do you smoke or drink?” But patients' lives are complex, and knowing their social history can be key to good care.
Estudio que describe por un lado la etnografía de la arterioesclorosis, a través de observaciones cotidianas y entrevistas tanto con las personas que acuden con este padecimiento al hospital de la Universidad de Dutch como con los médicos de dicha institución; y por otro, elabora un análisis de la representación social de la enfermedad desde la antropología médica y la filosofía.
100 years ago, a series of studies about the education of health professionals sparked groundbreaking reforms. The challenges of the 21st century demand a new redesign of professional health education. The Commission on Education of Health Professionals for the 21st Century came together to develop a shared vision and a common strategy for postsecondary education in medicine, nursing, and public health. The Commission provides a vision that calls for a new era of professional education that advances transformative learning and harnesses the power of interdependence in education. Just as reforms in the early 20th century were advanced by the germ theory and the establishment of the modern medical sciences, so too the Commission believes that the future will be shaped by adaptation of competencies to specific contexts drawing on the power of global flows of information and knowledge. Undertaking of this vision requires a series of instructional and institutional reforms, which are guided by the two expected outcomes, transformative learning and interdependence in education. On the basis of these core notions, the Commission offers 10 specific recommendations. The implementation of these recommendations require a series of enabling actions, including the mobilization of leadership, the enhancement of investments in health education, the alignment of the accreditation processes, and the strengthening of global learning. These recommendations also demand the support of a global movement engaging all stakeholders as part of a concerted effort to strengthen health systems.
Undergraduate medical education programmes universally struggle with overfull curricula that make curricular changes quite challenging. Final content decisions are often influenced by available faculty staff, vocal champions or institutional culture. We present a multi-modal process for identifying 'need-to-know' content while leveraging curricular change, using the social and behavioural sciences (SBS) as an exemplar.
Several multi-modal approaches were used to identify and triangulate core SBS curricula, including: a national survey of 204 faculty members who ranked the content importance of each of the SBS content areas; a comprehensive review of leading medical SBS textbooks; development of an algorithm to assess the strength of evidence for and potential clinical impact of each SBS construct; solicitation of student input, and review of guidelines from national advocacy organisations. To leverage curricular change, curriculum mapping was used to compare the school's 'actual' SBS curriculum with an 'ideal' SBS curriculum to highlight educational needs and areas for revision. Clinical clerkship directors assisted in translating core SBS content into relevant clinical competencies.
Essential SBS content areas were identified along with more effective and efficient ways of teaching SBS within a medical setting. The triangulation of several methods to identify content raised confidence in the resulting content list. Mapping actual versus ideal SBS curricula highlighted both current strengths and weaknesses and identified opportunities for change.
This multi-modal, several-stage process of generating need-to-know curricular content and comparing it with current practices helped promote curricular changes in SBS, a content area that has been traditionally difficult to teach and is often under-represented. It is likely that this process can be generalised to other emerging or under-represented topic areas.
This paper briefly reviews the development of the teaching of sociology in UK medical schools, and then discusses some of the problems associated with such teaching.
The issue of compliance with prescribed medication has traditionally been dominated by the perspective of the health professional although increasingly sociologists, using qualitative methods, have begun to present the patients' point of view. However, little has been published on asthma, despite the numbers of people suffering from this chronic condition and the amount of medication regularly prescribed. This paper focuses on the perspective of a sample of S. Wales (U.K.) asthma patients who have all been prescribed prophylactic medication in the last 12 months and explores their attitudes to medication in the context of their everyday lives, using inductive qualitative research methods. Two main groups were identified: the deniers and the accepters. They differed fundamentally in their readiness to accept the identity of asthma sufferer which, in turn, was associated with very different beliefs about the nature of their problem and the meaning of the medication prescribed for it. There was also marked differences in their strategies of self-presentation and disclosure and their pattern of medication use, particularly for prophylactic medication. A third group, the pragmatists, were also identified as a possible sub-group of the accepter category who are less open within self-presentation and less consistent in their beliefs about asthma but do not reject the label entirely. Identity work, i.e. the way the respondents interpreted the social identity of asthma sufferers and managed to reconcile it with other social identities, is proposed as the most useful way of understanding the observed variation in the way people diagnosed as asthmatic conceptualise and use their medication.
Most U.S. medical schools offer courses in the behavioral and social sciences (BSS), but their implementation is frequently impeded by problems. First, medical students often fail to perceive the relevance of the BSS for clinical practice. Second, the BSS are vaguely defined and the multiplicity of the topics that they include creates confusion about teaching priorities. Third, there is a lack of qualified teachers, because physicians may have received little or no instruction in the BSS, while behavioral and social scientists lack experience in clinical medicine. The authors propose an approach that may be useful in overcoming these problems and in shaping a BSS curriculum according to the institutional values of various medical schools. This approach originates from insights gathered during their attempts to teach various BSS topics at four Israeli medical schools. They suggest that medical faculties (1) adopt an integrative approach to learning the biomedical, behavioral, and social sciences using Engel's "biopsychosocial model" as a link between the BSS and clinical practice, (2) define a hierarchy of learning objectives and assign the highest priority to acquisition of clinically relevant skills, and (3) develop clinical role models through teacher training programs. This approach emphasizes the clinical relevance of the BSS, defines learning priorities, and promotes cooperation between clinical faculty and behavioral scientists.
The increasing importance accorded the social and behavioural sciences in medical education presents opportunities for developing new and innovative forms of teaching and learning in this field. Yet social and behavioural scientists often feel isolated and marginalized. This research was designed to build a network of such practitioners to share and compare current practice, and to develop better models and resources.
Questionnaire survey and workshop discussions describe current practice among social and behavioural scientists in UK medical education, and identify current and future issues.
Most UK medical curricula feature a significant social and behavioural science component, often in multidisciplinary contexts. Questions of core content, and how this relates to desired learning outcomes, particularly in the attitudinal sphere, remain unresolved. Identity problems result from differing perspectives of medics and social and behavioural scientists, staffing constraints, assessment regimes, and relationships with external examiners.
This project identified barriers and opportunities for providing adequate training in the social and behavioural sciences in medical schools. Some of the barriers are common to higher education generally. Through our network, a database of core cases and assessments can be developed that would be available to all for teaching purposes.
Social and behavioural scientists involved in medical education show commonality and difference in the extent and scope of their input. While they have made great progress, there remains much to achieve.
Personal beliefs about what knowledge is and how we understand, integrate and apply knowledge (known as personal epistemologies) are entrenched in the process of decision-making. Evidence-based medicine in all its forms brings with it the need for an ever more sophisticated appreciation of individual patients' perspectives and 'scientific' perspectives within the clinical encounter. However, current theoretical perspectives on personal epistemology focus more on scientific ways of knowing where knowledge is abstracted and logical. We conducted semi-structured interviews to investigate medical students' personal epistemological thinking towards the end of their second year of training at a new medical school in the South West of England. Whilst responses were varied, students appeared to express predominantly simplistic levels of epistemological thinking according to current developmental models of personal epistemology. However, the process of professional identity formation together with epistemological thinking brought together both scientific and experiential ways of knowing in a way that has largely been ignored by current theorists in the domain of personal epistemology.
Tomorrow's Doctors provides guidance about what is considered core knowledge for medical graduates. One core area of knowledge identified is the individual in society: graduates are required to understand the social and cultural environments in which medicine is practised in the UK. Yet, despite the presence of the behavioural and social sciences (B&SS) in medical curricula in the UK for the past 30 years, barriers to their implementation in medical education remain.
This study sought to discover medical educators' perceptions of the barriers to the implementation of B&SS.
Medical educationalists in all UK medical schools were asked to complete a survey identifying what they felt were the barriers they had experienced to the implementation of B&SS teaching in medical education.
A comparison of our findings with the literature revealed that these barriers have not changed since the implementation of B&SS in medical education. Moreover, the barriers remain similar across medical schools with differing ethos and strategies.
Various agendas within the hidden curricula create barriers to effective B&SS learning in medical education and thus need further exploration and attention.
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