In my previous blog, I introduced you to the HMS course, “Essentials of the Profession” that integrates social medicine with medical ethics, clinical epidemiology and population health and health policy into a required one-month intensive course for first year students and another one-month required course to be taken sometime during years 3 and 4. We face a number of dilemmas in the teaching and learning of social medicine; I will highlight three of the most salient ones here.
One challenge is creating a course that teaches to students with a diversity of experience and exposure to social medicine prior to entering medical school. All courses — not just the social sciences — deal with this diversity of prior experience and knowledge. But it is a particular challenge for us because it is less clear what counts as advanced prior experience. Some students have taken courses (e.g. anthropology) and/or worked with government, public health, global health, or community-based organizations to address social problems (e.g. housing, immigrants rights). Anyone who majored in biochemistry or molecular biology can be expected to know a lot about those subjects. But sociology majors might or might not know about social medicine; their work experience may be relevant, but may amount to idiosyncratic expertise. Other students have had a purely STEM education and are not familiar with social medicine concepts.
Another challenge is how to bring the community into the classroom. I recently participated in a Social Medicine Consortium sponsored by Partners in Health and the Josiah Macy Foundation and a Summit on Race and Equity where numerous people from all walks of life discussed and debated why and how to do this. We know the majority of a person’s health and well-being, or to put it another way, their morbidity and mortality, is mitigated or exacerbated by forces outside the traditional clinical setting. Hence, we want to expose students to studies, programs, and agencies that address these social forces. This has the potential to make learning more active, engaged and service oriented; teach about interprofessional and collaborative teamwork and community engagement; and highlight examples of physician-advocates/activists, which can contribute to the students’ career development. Thus far, we have tried three approaches: 1) sent the students on a self-guided community walk, but students felt voyeuristic and didn’t get the depth of a community experience; 2) brought representatives from community agencies into the classroom, which the students enjoyed, but felt was too brief; and 3) sent students to meet community members in their community agencies, but this was a time-intensive activity.
A final challenge has to do with time and ongoing exposure to social medicine. How can we move from working to get a social medicine sensibility out of our two months of intensive, siloed coursework to a longitudinal social medicine experience that is infused into the entire curriculum across fours years of study? One of our goals is to have social medicine inform students’ thinking and be the key way students approach health and illness. How do we respond to faculty who say “but we have so little time to teach biochemistry or anatomy already!” Or faculty who say they are uncomfortable addressing topics such as racial bias in their pathophysiology course. Social medicine can’t be an isolated learning module. It must be an attitude that affects the curriculum, such that when other courses talk about race, they do so in a way that’s informed by social medicine. The challenge of creating themes or threads that run throughout the curriculum has existed for decades; our course is no exception.
I am fortunate to have participated in the Harvard Macy Program for Educators in the Health Professions. Through it I was exposed to a vibrant, diverse, community of people committed to education. So, in the spirit of collaborative learning, I reach out to you, my community. I pose the following questions to you and look forward to your responses.
CHALLENGE #1: What benchmarks demonstrate proficiency, fluency, and advanced understanding of social medicine? What materials and in what format should we provide to those who are new to social medicine themes? What content and pedagogical ideas do you recommend to teach across this spectrum of knowledge and experience?
CHALLENGE #2: How can we make the adage, “our health is affected by where we live, learn, work and play” come alive for students? How do we bring the community into the classroom?
CHALLENGE #3: For those of you creating longitudinal curricula, what advice do you have to help us provide ongoing exposure to social medicine themes for the duration of a medical student’s education?
Thank you for taking the time to read this and offer your wisdom and guidance!
Jennifer Kasper, MD, MPH, received a combined BA/MD with honors from Boston University and Boston University School of Medicine and an MPH from Boston University School of Public Health. Dr. Kasper is a faculty member of the Division of Global Health, Department of Pediatrics at Massachusetts General Hospital for Children; Assistant Professor and Chair of the Faculty Advisory Committee on Global Health at Harvard Medical School; Contributing Instructor of the HMS course, “Essentials of the Profession” and faculty member of the HMS course, “Practice of Medicine;” Pediatrician at MGH Chelsea HealthCare Center; and Presidents’ Council and Board Member of Doctors for Global Health (DGH).