Social medicine and its role in medical school curriculum

This semester is coming to an end and we are almost halfway done with first year. I say semester, but technically we use the block system. What’s the block system? Here, it refers to dividing the academic school year into single subject blocks. Instead of taking concurrent, year-long courses, we spend several weeks on one course. For instance, we started off with 5 weeks of only biochemistry, then 8 weeks of only embryology, histology and anatomy, and now, 3 weeks of only genetics. Coupled with those classes have been 2 other courses, Patient-Doctor 1 and social medicine.

Social medicine, unfortunately, is now over. As I wrote at the beginning of the school year, I think that knowledge of social medicine is integral to becoming a good doctor because it teaches you a framework for approaching your patients and for thinking about disease and suffering. The class itself provided an introduction to the various topics in social medicine and global health, with a different lecturer each week. Topics included gender and racial inequalities, humanitarian relief, and a history of global health. Although the course could’ve gotten deeper into the material (which is tough logistically given the length of the course), I think it has helped spark dialogue and interest in these issues.

After our last social medicine class, a bunch of us stayed around to talk to the course directors and we mentioned that it would be cool to make social medicine a bigger part of the medical school curriculum. From what I understand, the medical community has been hesitant about such a move. My general feeling, though, is that we actually don’t really know how to do this effectively yet. Classes like social medicine and global health have only recently started to appear in more medical schools and colleges around the country, but these classes are still faced with the challenge of packaging the incredibly complex issues underlying social medicine into a semester-long course.

Another reason that social medicine doesn’t play a bigger role in medical school curriculum is perhaps because our knowledge of the social determinants of disease and their role in medicine is limited and constantly evolving. My classmate Juliana captures this sentiment well as she reflects about her medical school interview experience last year:

During some of my first interviews, I raved on and on about my passions for social justice and asset-based community work and community empowerment etc etc – all terms and concepts that I was completely immersed in in my world of non-profit work, and all terms that, to me, had obvious connections to health and health care. So you might imagine I was rather confused when my passionate responses during interviews would be greeted by blank stares by my interviewers.

“Why couldn’t I make the connection?” I wondered, “Do they just not care about these issues.” It wasn’t until my third interview, after two such episodes, that I started to realize the error of my ways. This time, when I started to rave about community and equity, my interviewer was a bit more curious. She asked, completely straight-faced, “So, are you saying there’s a connection between social relationships and health?”

I almost fell out of my chair. “Well of course!” I was about to say back to her. But I caught myself, and during that pause I realized what I had been missing in the other interviews. I had been using the language and general understandings of the cultures I was a part of, and applying it within this incredibly different context. I had assumed that the medical community widely accepted and understood how social determinants impact health and that the language of the disciplines that I was most familiar with – sociology, political science, anthropology – was utilized in the medical world as well to describe similar concepts.

But, when confronted with my interviewer’s question, I realized that if I wanted to convey my ideas and make them have some resonance, I had to use the language and the conceptual frameworks of the medical community. So thankfully, I was able to save myself in that interview, by going back to basics and explaining some of the underlying pathways that explain the connections between social situation and health. I showed my interviewer that my thoughts and passions did have some basis in reality. Perhaps not surprising, those two first schools put me on their wait list. If it hadn’t been for my third interviewer and her genuine curiosity, maybe that would have been the case at all of them!

Like Juliana, I had a similar experience with my medical school interviews when my interviewers asked, with good reason, that given my interest why I was not applying to public health school or social work instead. It almost seemed they were implying that social medicine belonged elsewhere.

Fortunately, social medicine is an emerging field in the world of medicine that has already made great strides, and I can see social medicine making an even bigger impact in medical schools as schools better integrate the teaching of social medicine into the medical school curriculum.

Eric Lu is a medical student who blogs at Elusions.

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