Some of us in BeSST have been exploring creative methods of inquiry, this has led to interesting ways of thinking about and representing the worlds of teaching and learning that we inhabit. In this piece Tracey Collett discusses her 'teaching coat' that she created as part of a BeSST project - https://www.besst.info/general-5 -that provided space for members to reflect personally on the role of being a sociologist in medical education.
Challenges associated with working in medical education have been well documented by sociologists in the US and Europe for some 70 years (and increasingly internationally). Underpinned by deep epistemological differences, issues include ‘a lack of perceived relevance amongst staff and students’ and the idea that ‘sociology is about being nice to people / ‘just common sense’ (Collett, Brookes and Forrest, 2021). At the same time, traditionally, colleagues in mainstream sociology (particularly in the US) have criticised sociologists working in medicine on the basis that their thinking will become subsumed by the disease model: that they will become ‘handmaidens’ to medics.
Driven by a political desire to translate sociology and sociological research to others, for the good of the public, my colleagues and I helped to develop and currently co-lead a popular UK teaching and research network for sociologists working in medical education. Together, over the past 15 years we have taken an ethnographic approach to our work. In a recent paper for the British Sociological Association Annual Conference, we argued that individuals teaching sociology to medical students are involved in a form of occupational ‘edgework’ that produces a number of risks but also opens up unique spaces from which to observe, experience and analyse the social world, as well as to contribute to better healthcare (Kendall, Collett, Harden, Kelly and Wright, 2021).
The idea of teaching coats stems from US teacher, Tiffany Poirier and is based on the book ‘The Courage to Teach’ by Parker Palmer, (2017). Palmer makes the case that teachers can lose heart because of the troubled and toxic systems in which they work and need to reconnect (with themselves and their students) to reclaim their vocational passion. Taking as a starting point a Hassidic tale, cited in Palmer’s book, that states ‘we need a coat with two pockets one with dust and the other with gold’ (to remind us where we are from and where we are going), Poirier painted each pocket of a white laboratory coat then ‘… added some metaphors, inspirations, reflections, memories, goals’. This resulted, she states, in ‘a wearable philosophy’ (Poirier, 2023).
My teaching coat portrays the landscape of medical education and interweaving branches of sociological knowledge. The fault line of positivity runs through the middle: a deep tension caused by the tectonic plates of the scientific paradigm and the broader economic and political ideologies that promote an individual behavioural approach to fixing society’s ills. There are dangerous marshes, big hills to climb and numerous walls and barriers. The swamp of interdisciplinarity is a reminder that the idea of integrated teaching in medical education is far from simple: interdisciplinary work is fraught with bias and power requiring a compassionate, careful approach. At the mountain of assessment, exams drive learning and (based as they are on objective, standardised psychometric testing) are rarely conducive to becoming a socially minded medic. Finally, imposter’s halt acknowledges the stifling, restricting feeling of not being good enough.
Travelling through the terrain is not easy-going. My ‘pocket of dust’ is ‘watered’ (I am a gardener after all) by previous sociologists for example Renee Fox, Margaret Stacey, David Armstrong, Frederick Hafferty and Graham Scambler who, over the past 50 years, have documented and developed the role and fought for the inclusion of social sciences in UK Medical education policy (e.g. in GMC, 1977 - 2021). The left arm of my coat is painted with personal badges (values) to remind me of my position and self in my work, and of the importance of not forgetting to be, at all times, critically reflexive.
Whilst the landscape has a particular morphology and whilst the going can be tough, my coat also shows that travellers can pause for a while and replenish. At ‘Hope Springs’ they are likely to meet wanderers from across the world, doing incredible research, clinical or teaching work in the field. These might be academics, but also those affiliated with social medicine. (For example, individuals working in patient groups, public health doctors who lobby for health centres in deprived areas, certain ‘medical educators’ and medical groups, such as ‘Deep End Doctors’).
Sometimes working in a medical school can feel like trying to push the tide back. Frequent establishment changes, for example, require the need to regroup and re explain my work. Sometimes it is as if my work is written in the sand and the sea washes it away. Last week, I discussed this with my sociology colleagues. ‘The beach metaphor is a good one’, my Southampton friend said: ‘look at the beautiful glass you can find on the shoreline!’
The road may be rocky but with support and community, travellers in medical education can help to forge paths towards an approach to medicine that redresses the academic imbalance between (broadly speaking) the sciences and the arts, for the good of tomorrow’s patients. Go sociologists in medicine!
References
· Collett, T. Brookes, L. and Forrest, S. (2021) The history of sociology teaching in United Kingdom (UK) undergraduate medical education: an introduction and rallying call! MedEdPublish [available at https://mededpublish.org/articles/5-152]
· General Medical Council, (1977). Psychology and Sociology. Basic medical education in the British Isles. The report of the General Medical Council survey of basic medical education in the UK and the Republic of Ireland 1975 - 76. Volume 2. Reports on the teaching of the component disciplines / specialities of the medical courses, page 763. Nuffield Provincial Hospitals Trust London.General Medical Council, (1993). Tomorrow's Doctors: Recommendations on undergraduate Medical Education. UK: Education Committee of the General Medical Council.
· General Medical Council, (2015). Outcomes for Graduates. Tomorrow's Doctors. London: General Medical Council.
· Kendall, K. Kelly, M. Harden, J, Collett, T and White, S. (2021) Teaching sociology to medical students in exceptional times: snapshots from the edge. British Sociological Association Medical Sociology Conference.
· Palmer, P. (2017 The Courage to Teach: Exploring the Inner Landscape of a Teacher’s Life. John Wiley and Sons: New Jersey.
· Poirier, T. (2013) Teaching Coats (University of British Columbia) Youtube video [available at https://teach.educ.ubc.ca/the-teaching-coats-project_tiffany-poirier/]