photo: Lecture Hall from Luke Jones flickr photo stream

The stirring of medical students’ sociological imagination in 2020

Teaching sociology to medical students is challenging in the best of times. Marked by the global pandemic, last year was certainly the worst of times. Yet, as members of Behavioural and Social Sciences Teaching (BeSST) in Medicine, we will remember 2020 not only for the tragedies Covid-19 has left in its wake, but also, for the window of opportunity it has provided for our students to discover and to develop their sociological imaginations.

Katarina Wegar observes that in the U.S.A. during the late 1960s, events converged which momentarily raised the profile and perceived relevance of sociology to medical curricula. The civil rights movement contributed to more liberal political views among many doctors and students who insisted that medicine had a social responsibility to all members of the community. Furthermore, there was a growing awareness that society made people ill and that it did so unequally. Since sociology addressed structures, institutions, hierarchy and power, and the relationships of individuals to and through these, it was identified as the discipline best suited to help medicine fulfil its social responsibilities. The inclusion of sociology in medical schools was therefore regarded as a sign of medicine’s social conscience and commitment to distributive justice. Unfortunately, doctors returned to a medical ethics focused more on the individual, pushing sociology back to the margins.

Wright Mills argues that we are typically unaware that our personal problems are often rooted in wider social structural forces. Within medicine, this is reflected in the focus of medical intervention on individuals’ biology and psychology and neglect of social forces including racism, sexism, heterosexism and poverty. The promise of sociology, Mills suggests, is to help shift perspective from our immediate personal situation to wider society, and to make the connection between them. To acquire the sociological imagination, he felt it necessary to be able to move away from our everyday routines. In disrupting our taken-for-granted daily lives, has Covid-19 created a space within our medical schools for the sociological imagination to flourish?

We believe that we are at another opportune juncture which may see the profile of sociology rise and its value within medical education recognised once again. During the last decade, the discipline has moved from being ‘nice to know’ to ‘need to know’, as illustrated by the fact that many medical regulatory and accreditation bodies now require undergraduate content and assessment to include sociology.

Social movements, including Black Lives Matter and MeToo, along with the Covid-19 pandemic, appear to have stirred the sociological imagination of our students here in the UK. In far greater numbers than we typically observe, our students are recognising how social problems are socially created and in particular, how social structures constrain their own lives and the lives of others. They tell us how decisions made by governments and universities to manage the pandemic have harmed them and others and illustrate this assertion with numerous examples including: the school exams debacle, the lack of PPE on the wards, hypocrisy in how guidelines are enforced, and university accommodation fees. By its very nature, sociology attends to issues that are pertinent and meaningful to society and therefore to the individuals within it. Its theories and concepts are principally abstract representations of actual complex social realities. Nonetheless, our discipline can sometimes feel too removed from and irrelevant to medical students. As we move into 2021, this impression appears to be shifting. In recognising a personal connection to the kinds of social problems we teach, and using the critical frameworks we promote as means of understanding and addressing them, the significance and value of sociology has become more apparent to them.

Whether online or face-to-face, learners appear much more willing to acknowledge that illness is socially patterned and that the most vulnerable populations in society experience the worst health and healthcare. Until now, students have generally been reluctant to speak up during teaching sessions about institutional and systemic racism, sexism, classism, heterosexism, disablism, and ageism. Not only is this changing, they appear to be more politicised, as demonstrated by their participation in various protests on and off campus and their demands for more inclusive, even decolonising, curricula. For example, last summer students led on petitions calling for the GMC to introduce a requirement ensuring that all medical schools include BAME representation in clinical teaching and a student-staff partnership created a freely-available handbook of clinical signs and symptoms in black and brown skin.

A key part of such activism is a recognition by students of their own role and agency in creating, challenging and changing social problems. We aim to foster such reflexivity and critical thinking through what and how we teach. For example, we ask students to explore critically dominant and marginalised epistemologies within medicine and to consider how these are reflected in their own assumptions, beliefs and practices. Learners struggle with the notion that science is not value-free or objective. However, their recent observations of highly respected scientists promoting competing views on Covid-19 and the recognition by many of white normativity in medical curricula, has helped them to see this more clearly and to question their own epistemic positions.

Our sense that students are becoming increasingly politicised is further reflected in a National Union of Students (NUS) survey in November 2020, which found that 52% of students polled feel more political because of Coronavirus, up from 46% in September. In particular, many were said to be involved in campaigns against educational injustice and digital poverty as well as rent strikes. The fact that younger students aged 16-22 were more likely to respond this way led the NUS to conclude that the current moment may galvanise the politics of a new generation.  These findings are reflected in a Guardian piece capturing the reflections of young people about the past year, titled ‘Generation Z and the Covid Pandemic: “I’m 100% more politicised”.

Mills believed that that the sociological imagination should be used to improve the lives of individuals and their communities. This vision lies at the heart of what we do. We teach sociology to medical students in order to help them, as individual doctors and members of a powerful profession, better understand and care for the patients and communities they work with. As was the case fifty years ago, we are in a unique position, at this time, to help medicine meet its social responsibilities.

One way or another, the events of 2020 made sociology feel much closer to home for our students. The national lockdowns imposed across all four UK countries, the declaration of a major incident in London due to the rapid spread of Covid-19, and events in Washington at the start of this year, indicate that the social problems they encountered will continue into 2021 and that fresh ones will surface. Their burgeoning sociological imaginations and activism nonetheless give us hope that tomorrow’s doctors will contribute to a healthier and more just society.

About the authors: 

Kathleen Kendall is Associate Professor in Sociology as Applied to Medicine at the University of Southampton where she is the subject lead for sociology. She co-chairs BeSST (@BeSSTUK) and her main research interests include medical education and mental health in prisons.

Tracey Collett is (@Traceloader)Associate Professor of the Sociology of Health and Illness at the University of Plymouth. She has worked on sociology in medicine for 20 years and co-chairs BeSST.

Anya de Iongh (@anyadei) is an OT student, member of BeSST and visiting lecturer across a range of UK medical schools. She has an active interest in sociology, in particular the role of people with lived experience of illness who are supporting teaching in medical schools. @anyadei

Simon Forrest  is Principal of the College of St Hild & St Bede and a Professor of Sociology at Durham University. He has worked on sociology in medicine for 20 years and co-chairs BeSST.

Jeni Harden (@JeniHarden)is Senior Lecturer in Social Sciences and Health at the University of Edinburgh and co-chair of BeSST.

Moira Kelly is Honorary Senior Lecturer in Medical Sociology at Queen Mary University of London, visiting tutor (communication skills) at St George’s University of London, and a member of BeSST.