Teaching Social Sciences to Medical Students; Overcoming the negative perceptions

Dr Alan Stone, Dr Sara MacBride-Stewart, Prof Kamila Hawthorne

Institute of Medical Education, Cardiff University School of Medicine and School of Social Sciences, Cardiff University

CONTEXT Social sciences teaching is an important part of the medical school curriculum (1)(2) However, the teaching of social sciences has been perceived poorly by medical students in different institutions over many years(3). Previously identified barriers include; poor integration of social sciences into medical schools, entrenched biomedical perspectives, the language used by social scientists and the hidden curriculum(4). There has been very little published to see if these barriers can be overcome METHODS A mixed methods approach was used with both quantitative and qualitative data being collected. Separate focus group discussions with both the students and their tutors were thematically analysed. A questionnaire was also sent to all students for quantitative analysis. The student written coursework was also assessed to ascertain the level and depth of learning.
If youre in a lecture youre kind of being told someones opinion on sociology whereas in the small GP groups you can listen to everyones opinions, kind of let them affect your own opinion and reflect on how they re different to yours and how some are similar to yours .
Year 3 Medical Student

OBJECTIVE The objective was to identify if the social aspects of medicine can be brought to life by applying the self-directed learning of theory to real patient cases and to identify any barriers that may have hindered implementation of the strategy. This evidence based method of teaching, used theory workbooks developed by academic social scientists as well as small group discussions led by clinical tutors, to demonstrate the practical application of the theory in clinical settings.

The workbooks gave us time to digest the information and the tutorials helped consolidate that learning and we were able to clarify anything that wasn't understood
Year 3 medical student

You can actually apply what youve been taught to the real world instead of being in a hypothetical situation in a nice cosy, warm lecture theatre
Year 3 medical student

The tutorials were really useful in bringing the workbooks to life: relating the abstract concepts to real patients helped me remember the principles better
Year 3 medical student

RESULTS Most students preferred this type of teaching to lectures and were able to relate clinical scenarios to the concepts. The majority reported being able to recognise the importance of social factors in ill health and the social effects of illness after this teaching. Students valued the clinical perspective and thought this added to their learning. Students developed a preferential hierarchy of knowledge presented by clinicians over knowledge presented by social scientists(5). The language and theoretical frameworks used by social scientists continued to be perceived as a barrier by many students. Students were able to demonstrate achievement of the learning outcomes in their reflective writing.
I was coming from the anti-camp with regard to my previous experience of sociology .. were almost a year into it and my approach has changed and thats because I dont feel threatened by it, because Ive been able to see the positive bits of making it clinically relevant
Clinical Tutor

CONCLUSIONS Social sciences can be learnt in a self-directed and integrative way, but does need both academic social science and clinical tutor support to facilitate learning. Addressing the known barriers(6) to poor integration of social sciences in UK medical schools appears to improve achievement of learning outcomes. The terminology used by social scientists is poorly understood by medical students can be addressed by close working between social scientists and clinical tutors to demystify concepts. Negative attitudes to the social sciences amongst both staff and students have to be actively addressed to ensure student engagement with the subject. Addressing the hidden curriculum of medical staff discomfort with the subject matter improves outcomes but cannot be overcome quickly or easily. Experience with this type of teaching seems to decrease tutor discomfort with the subject matter being taught. There was agreement by students, clinical tutors and social scientists that social aspects of medicine was an important part of learning which was enhanced by being resourced and integrated into the curriculum.

Tutors initially felt under qualified to teach the social sciences and appreciated the input of subject experts. Some tutors carried forward negative perceptions of their own experiences of social science teaching and allowed this to influence the way they delivered the teaching. The attitude of the individual teachers towards the social sciences correlated well with the student appreciation of the learning outcomes. Some tutors with previously negative attitudes to the subject were able to alter their perspective and became much more positive.

References
1. 2. 3. 4. Russell A, van Teijlingen E, Lambert H, Stacy R. Social and behavioural science education in UK medical schools: current practice and future directions. Med Educ. 2004; 38:409417. Tomorrows Doctors 2009 General Medical Council http://www.gmcuk.org/TomorrowsDoctors_2009.pdf_39260971.pdf (Accessed 23.1.14) Litva A, Peters S. Exploring barriers to teaching behavioural and social sciences in medical education. Medical Education 2008; Mar;42(3):309-14. Bundy C, Cordingley L, Peters S, Rock J, Hart J and Hodges L A core curriculum for psychology in undergraduate medical education; A report from the Behavioural and Social Sciences Teaching in medicine (BeSST) Psychology Steering Group. Higher Education Academy Psychology Network Report 2010 www.medev.ac.uk/static/uploads/resources/BeSST_report_LowRes.pdf (Accessed 23.12.13) (MacBride-Stewart, Hawthorne & Stone, in progress). Benbassat J, Baumal R, Borkan J, Ber R, 2003 Overcoming Barriers to Teaching the Behavioral and Social Sciences to Medical Students. Academic Medicine 78(4), April, p 372380

5. 6.

Acknowledgements; Rachel Underhill, 4th year medical student for the Wordle picture