Harvard Macy Community Blog

Fostering the ongoing connectedness of health professions educators committed to transforming health care delivery and education.

Calling all Content Crackerjacks and Pedagogical Pros!

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!

 

 

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Comments 5

 
Peter V Chin-Hong on Thursday, 11 August 2016 13:24
5 Suggestions for Social Medicine

5 Suggestions for Social Medicine:

1. Instead of bringing the community to the classroom, make the community the social medicine classroom. Have social medicine live-and thrive- beyond the one-month course. Classic Billett workplace learning-http://tinyurl.com/jt4a8s9

2. Workplace learning for social medicine can occur in a variety of settings -longitudinal ambulatory clerkships (best), clinical clerkships, electives. Perhaps have a way to make sure each student gets at least one social medicine workplace learning site before graduation. This will require recruitment of new sites and faculty development.

3. Touch all students by having social and behavioral medicine or social medicine as a domain of science in a school-wide inquiry based curriculum.

4. Any curriculum in social medicine should be spiraled for maximum effect. Touch students at various points in their educational life and deliberately build on pre-existing knowledge.

5. A “deep-dive” in social medicine as a legacy product will affect the most-interested students the most, but all students can benefit in structured multidisciplinary works-in-progress, bringing different lenses of inquiry to the group.

5 Suggestions for Social Medicine: 1. Instead of bringing the community to the classroom, make the community the social medicine classroom. Have social medicine live-and thrive- beyond the one-month course. Classic Billett workplace learning-http://tinyurl.com/jt4a8s9 2. Workplace learning for social medicine can occur in a variety of settings -longitudinal ambulatory clerkships (best), clinical clerkships, electives. Perhaps have a way to make sure each student gets at least one social medicine workplace learning site before graduation. This will require recruitment of new sites and faculty development. 3. Touch all students by having social and behavioral medicine or social medicine as a domain of science in a school-wide inquiry based curriculum. 4. Any curriculum in social medicine should be spiraled for maximum effect. Touch students at various points in their educational life and deliberately build on pre-existing knowledge. 5. A “deep-dive” in social medicine as a legacy product will affect the most-interested students the most, but all students can benefit in structured multidisciplinary works-in-progress, bringing different lenses of inquiry to the group.
Jennifer Kasper on Tuesday, 16 August 2016 14:35
RE: 5 suggestions for social medicine

Thank you Dr Chin-Hong for your thoughtful response and suggestions. With the launch of the new curriculum in 2015, we will work on integrating with other course and clinical experiences. The students are invested in helping us create a longitudinal curriculum, so they will hold us accountable. And thank you for the article by Billet. One take home message I gleaned from it is the distinction between mastery (superficial acceptance of knowledge coupled with the ability to satisfy requirements for public performance) and appropriation (the desire to incorporate, in an engaged and effortful way, what was learned into one's understanding).

Thank you Dr Chin-Hong for your thoughtful response and suggestions. With the launch of the new curriculum in 2015, we will work on integrating with other course and clinical experiences. The students are invested in helping us create a longitudinal curriculum, so they will hold us accountable. And thank you for the article by Billet. One take home message I gleaned from it is the distinction between mastery (superficial acceptance of knowledge coupled with the ability to satisfy requirements for public performance) and appropriation (the desire to incorporate, in an engaged and effortful way, what was learned into one's understanding).
Admin User on Thursday, 25 August 2016 12:20
Best practices

Dr. Kasper - Thank you for giving such an eloquent summary of the critical importance of teaching a social medicine curriculum while acknowledging the numerous challenges!

At the Feinberg School of Medicine, we have been grappling with similar issues. I look forward to our upcoming phone call where we can share our experiences with teaching and assessing students given the current structure of medical education.

Best wishes,
Mita Sanghavi Goel, MD MPH

Dr. Kasper - Thank you for giving such an eloquent summary of the critical importance of teaching a social medicine curriculum while acknowledging the numerous challenges! At the Feinberg School of Medicine, we have been grappling with similar issues. I look forward to our upcoming phone call where we can share our experiences with teaching and assessing students given the current structure of medical education. Best wishes, Mita Sanghavi Goel, MD MPH
Jennifer Kasper on Thursday, 25 August 2016 12:33
Best practices

Dear Dr Goel,
Thank you for your support. I too look forward to our upcoming conversation. I am confident that sharing experiences and lessons learned can only help enhance our courses and provide students a robust education.

Dear Dr Goel, Thank you for your support. I too look forward to our upcoming conversation. I am confident that sharing experiences and lessons learned can only help enhance our courses and provide students a robust education.
Karen Sheehan on Thursday, 25 August 2016 16:54
Thanks for your thoughtful blog

Dear Dr. Kasper
I enjoyed reading your thoughtful blog about teaching social medicine. I found it comforting to learn that others face the same challenges in trying to deliver a meaningful social medicine curriculum in a limited period of time. Even though we have a ways to go in perfecting how and when to teach social medicine, I am encouraged that these conversations are occurring. Thanks for providing a forum.

Dear Dr. Kasper I enjoyed reading your thoughtful blog about teaching social medicine. I found it comforting to learn that others face the same challenges in trying to deliver a meaningful social medicine curriculum in a limited period of time. Even though we have a ways to go in perfecting how and when to teach social medicine, I am encouraged that these conversations are occurring. Thanks for providing a forum.
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