We know it takes courage to teach, but I’d argue it takes great courage, resilience and conviction to teach that course within a medical or similar degree program. The course that stands out like a sore thumb, that situates the human body within its social context, that requires that students connect the dots between medicine, science and politics, the course that cannot give definitive answers and instead requires time spent within the grey areas. I consider myself a ‘newbie’ lecturer, having taken up my post in the summer of 2019. It’s been an eventful introduction to this role, and this blog is my attempt to reflect and take stock. Ultimately, this blog will remind me of why I do what I do, and why teaching social sciences within medical and biomedical schools is so important.
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‘Teaching a topic to students who have no interest (nor, indeed, trust) in social sciences is not something that I wish to spend my time on any longer. It is an experience that is frustrating, and at times utterly demoralising’ - (PGCAP entry, 2018).
I wrote the blog, from which the above quote comes, when I was a teaching fellow on the course that I now run which, broadly conceived, introduces Medical Sciences students to social and structural determinants of health, critical public health and sociology of health and illness. You’d be forgiven for thinking that taking up the lectureship was an odd choice, given my obvious frustration. The only thing I can say is, yes, it was an odd choice, but it was an opportunity for security in a workplace increasingly characterized by casualization, so I went for it. What has happened since is a lot of soul-searching and reflection on my part, along the lines of: ‘is this the right place for me’? ‘Will I always feel ‘out of place’’? ‘Is this always going to be an uphill battle’? ‘Why am I doing this to myself’? And, more recently, ‘this is precisely where I need to be’. But first, some context.
The students I teach are a heterogeneous bunch, in as much as they hope to go into a number of different fields, including laboratory research, health policy, journalism, and global public health. Some will go on to study medicine. What this means is that I am painfully aware of two things when I meet these students. First, they are well versed in positivism, but often know very little about other ways of seeing the world and, related to this, they carry with them a scepticism (at best) of, and even outright hostility towards, the ‘soft’ and ‘political’ social sciences. So, the sales pitch – mentioned by Harden (2020) in a previous blog – begins in earnest in an effort to get students ‘on side’ and excited about considering the known territory of the human body situated within and shaped by the world in which it exists.
Around the same time as I was vowing never to teach these students again, I was faced with a particularly challenging student who frequently complained that the course was ‘too political’. At the time, as a teaching fellow, I did not know how to respond. Already feeling like an imposter, this accusation triggered complex feelings about my role – feelings that Harden (2020) captures in a reflection on their own identity as an educator: ‘I can feel at various times in a day, week, month or year like an outsider, an explorer, a servant to the medical elite, an underdog, a maverick’. Now, having gained more confidence by virtue of time and experience, I would have asked this student to show me evidence that health is not, in fact, a political matter.
Looking back now, I am learning to see the course, myself, and my students in a new light. I am now entirely convinced that the course offers a rare opportunity for students to be challenged (with a supportive teaching team ready to encourage them), and to develop their understanding of the interconnectedness of the world. Surely, this is what university is for? I am also actively rejecting the ‘imposter’ and, instead, assuming the pride I feel in being a social scientist who works out-with a social science department: I am precisely where I need to be. It can be so exciting and energising to introduce students to a new way of seeing the world – to support them as they navigate and battle with threshold crossing. In the past year or so, I’ve experienced moments of pure joy, as students who might have been unconvinced start to come round to things, and begin to work out how to integrate this new knowledge into their worldview. The suspicion with which some students arrive to my class has been cultivated by their learning thus far, and I now see it as an exciting challenge (rather than a reluctant sales pitch) to get them thinking beyond their positivist silo. I am energized by figuring out ways to help students make connections and see the relevance of different types of knowledge. These are, after all, students who enrolled to study Medical Sciences. It was naïve of me to think that they would come to this course with anything other than hesitation. Indeed, if somewhere in the midst of my undergraduate degree in Anthropology I’d been required to take a trip into the world of medical sciences – with all of the paradigm shifting that would entail – I’d likely have been somewhat annoyed. So, with greater confidence and certainty of my place, I have cultivated a more compassionate approach.
Of course, there are hard days when you are a social scientist swimming against the tide of biomedical knowledge, and the dominant positive paradigm within medical schools. It can sap my enthusiasm. Yet we are undoubtedly in a moment of shift, one which was identified by Kendall et al (2021) in their blog post on students’ engagement with social scientific knowledge in the context of the COVID pandemic, the killings of George Floyd and Breonna Taylor by the police in the United States (to name just two high-profile instances of violence), and the ongoing climate crisis. These events have brought to the fore the fundamental necessity of an understanding of the interrelatedness of medicine, society, ethics, politics and the environment that previously might only have been held by a minority of students in a cohort. We can – as social scientists working on the frontier – capture this emerging interest and run with it. We can feel lucky to be able to connect with students, to spark their sociological and political imaginations and encourage them to think beyond disciplinary, siloed ways of seeing. As one student said recently in their feedback:
‘The course opened my eyes to this world, to have a glimpse on the actual world, instead of drowning in textbooks all day. It connects the things we have studied to the real world. I do realise that I by myself am not able to change everything, but I do believe that I can play a role as part of that change’.
To close, then, I’m giving myself a ‘pep talk’. I’m going to continue to challenge the pre-occupation I’ve had with the minority of students who might be openly dismissive of what I do and, instead, focus on the majority for whom this presents an intriguing new perspective. Connected to this, I am learning to embrace the scepticism that students might bring with them, as I realize that this is simply often a position borne of lack of exposure to other ways of thinking. Rather than feeling an ‘imposter’ within the department and among my colleagues, I’m growing into a new academic identity of ‘activist’: relishing the challenge set by these students to support them as they cross the threshold into a new way of seeing the world. This is the challenge that they set me, and I am (mostly!) grateful. I want to be able to say that I’ve done my best to curate a course that convincingly resonates with a diversity of imagined futures, while ensuring that the socially situated body remains at the heart of it. What I am learning is to be unapologetic: what we all do truly matters, and we should remind ourselves of this when having one of those down days. To quote a recent correspondence in The Lancet on undoing various forms of supremacy in global health knowledge and practice:
‘We must undo another important supremacy … the disciplinary supremacy that places the quantitative biomedical and epidemiological sciences … above the qualitative political and anthropological sciences. One of the many great lessons of the COVID-19 pandemic is that achieving equity in (the circumstances that create) health is at least as much a domain of the political and anthropological sciences as it is one of the biomedical and epidemiological sciences’ (Abimbola and Pai 2021: 1059).
References
Abimbola, S. and Pai, M., 2021. Undoing supremacy in global health will require more than decolonisation–Authors' reply. The Lancet, 397(10279), pp.1058-1059.
Harden, J., 2020. So far from you. [Blog] BeSST, Available at: <https://www.besst.info/post/so-far-from-you-by-jeni-harden> [Accessed 19 March 2021].
Kendall, K., Collett, T., De Iongh, A., Forrest, S., Harden, J., Kelly, M., 2021. It was the worst of times, it was the BeSST of times. [Blog] Cost of Living, Available at: <https://www.cost-ofliving.net/it-was-the-worst-of-times-it-was-the-besst-of-times/> [Accessed 20 March 2021].
Sarah Wright is a social scientist working at the Biomedical Teaching Organisation, The University of Edinburgh. Sarah has a keen interest in the social and structural determinants of health, and social scientific perspectives on health, illness and disease. Sarah runs a core course for Junior Honours Medical Sciences students, and contributes to teaching and supervision across all years of the Medical Sciences degree program. In all of her teaching, Sarah advocates for in-depth, person-focused perspectives of health, illness and disease which situates the experiential within the structural determinants of people’s lives.