Although sociology has been a core part of medical curricula for some time, students can struggle to see its relevance to their future careers. Is covid-19 changing that?
As autumn leaves fall across our campuses, we have the privilege of meeting new medical students and being reunited with returning ones. But this year is not like any other. We now do so via our computer screens or from behind a plastic screen in the classroom because of covid-19.
Despite these challenges, and the early stage of the academic year, we have observed that students appear to grasp the relevance of sociology to medicine and their future careers more readily than previous cohorts have done. Has this pandemic awakened their “sociological imaginations”?
The term “the sociological imagination,” coined by sociologist C Wright Mills, refers to a vivid awareness of how individual experiences (personal troubles) are shaped by social factors (public issues). We think that there are several ways in which experiences of covid-19 may be bringing this perspective into sharp focus for our students.
Mills argued that as individuals we are often unaware that the challenges we face frequently have their roots in wider social structural forces largely outside of our control. In medical education this has been linked to the need for students to develop “structural competency”—an approach to clinical practice that aims to reduce enstructured health inequalities.
Our students often find it challenging to recognise and appreciate structural influences on health and medicine, concentrating instead almost wholly on the behaviours and beliefs of individual patients. For example, when considering health inequalities they tend to propose behaviour modification techniques for individuals rather than consider upstream interventions to address issues, such as poverty, racism, sexism, housing, and the food industry.
We believe that covid-19 has made our students more aware of social structures because they recognise the direct impact these have had on their personal troubles. For example, the cancellation of their exams in response to the pandemic and use of algorithms to determine results threw the plans of many to study medicine into doubt. In response, students joined forces to protest against the structures of government imposing these measures and their actions led to a change in practice so that grades were finally determined by teachers’ estimates.
Many of our students have been working for the NHS during the pandemic. They have observed delays to the implementation of adequate contact tracing and seen the impact of shortages of personal protective equipment. The consequence of these events put them, their colleagues, and the patients they care for at risk. These experiences illustrate the significance of political decision making and resource allocation for health and medicine.
The events of recent months have also highlighted the importance of understanding how and why illness is socially patterned. Students have seen news headlines indicating that people from black and minority ethnic backgrounds are at higher risk of contracting and dying from covid-19. For black and minority ethnic students this is likely to have a very personal impact, but for all students, it has demonstrated the importance of understanding how racism, intersectionality, social inequalities, and occupational differences contribute to this disparity.
Students will also have witnessed (and likely experienced) the mixed response to health protection measures introduced to control the spread of the virus. Since returning to campus, students have been vilified by some as irresponsible and thoughtless, and many are now experiencing significant degrees of constraint over their movements and activities on and off campus. A number of students have been disciplined for breaking rules designed to protect them and others from the virus. These events may help them to appreciate key sociological concepts relevant to medicine including power, deviance, agency, social control, labelling, and stigma.
Medical students are living through this, and our conversations with many suggest that they have a growing awareness of how social structures and other social forces, including social rules and norms, are contributing to their own and others’ personal experiences. Although sociology has been a core part of medical curricula for some time, students can struggle to see its relevance to their future careers.1 Covid-19 appears to have engaged the students’ sociological imagination not only because they are directly affected by it, but also because they have been able to connect its influence on their lives with societal structures outside of their control.
When some of our first year students discussed a case relating to failure to comply with lockdown, their insightful contributions illustrated their application of the sociological imagination to clinical outcomes and clinical care. This was beyond what we would normally see at this stage in their education. For those of us involved in teaching sociology in medical education, covid-19 offers an opportunity to engage students in ways that we can seek to build in, and our clinical colleagues can build upon, throughout the years to come. This is perhaps a shard of light as we face the many challenges that this academic year will bring.
Kathleen Kendall, associate professor in sociology as applied to medicine, University of Southampton, and co-chair of Behavioural and Social Sciences Teaching (BeSST) in Medicine.
Tracey Collett, associate professor in the sociology of health and illness, University of Plymouth, and co-chair of Behavioural and Social Sciences Teaching (BeSST) in Medicine.
Anya de Iongh, member of Behavioural and Social Sciences Teaching (BeSST) in Medicine, and occupational therapy student.
Simon Forrest, principal of college of St Hild and St Bede, Department of Sociology, University of Durham, and co-chair of Behavioural and Social Sciences Teaching (BeSST) in Medicine.
Moira Kelly, honorary senior lecturer in medical sociology, Queen Mary University of London, and member of Behavioural and Social Sciences Teaching (BeSST) in Medicine.
Jeni Harden, senior lecturer in social science and health, University of Edinburgh, and co-chair of Behavioural and Social Sciences Teaching (BeSST) in Medicine.
Competing interests: Nothing further to declare.
- Kendall K, Collett T, de Iong A, Forrest S, Kelly M. AMEE Guide 122. Teaching Sociology to Undergraduate Medical Students. AMEE, 2020. Available from: https://amee.org/shop/publications/amee-guides