Teaching Social Medicine as Collaborative Ethnographic Research and Advocacy on Homelessness and Serious Mental Illness

Abstract

We review our attempts in multiple medical schools since the 1990s to build critical social medicine intellectual and practitioner communities dedicated to reducing health disparities and to promoting social justice for medically underserved/mis-served vulnerable populations. Our participation in the periodic “overhauls” of the required undergraduate medical student curriculum has been disappointing and time-consuming. We have had to humbly recognize the practical limits of a required social science of medicine curriculum, despite our conviction that exposure to social science and humanities concepts can make better physicians and researchers. Our smaller scale focused elective courses and clinical-/community-based practicums have been better received. Building MD/PhD social science tracks in physician/scientist training programs also has been intellectually rewarding. The exceptional ambition and intelligence of physician/social scientists, coupled with the “fragmented occupational and institutional habitus” imposed on them, promotes innovative thinking (following Bourdieu) (Bourdieu, Homo academicus, 1st edn. Stanford University Press, Stanford, 1990; Bourdieu, Outline of a theory of practice, 1st English edn. Cambridge University Press, Cambridge, 1977). Living simultaneously in the applied world of medicine and the world of social science/humanities steeped in theoretical critique, they face the contradictory epistemologies, funding logistics, and practical professional priorities of their training, and this often leads to creative critical analysis. More practically, the MD/PhD programs have anchored our intellectual communities of critical social scientists and dedicated clinicians. Frustrated, however, by the zero-sum time competition between teaching undergraduate medical students versus the passion we feel for research and social justice advocacy, we experimented by integrating first-year medical students into our ongoing research. We trained them as ethnographers, working side by side with them. Their energy and the quality of the research data they collected exceeded our expectations. Furthermore, their enduring intellectual bonds and friendships spawned new social medicine initiatives independent from us. They enrich the intellectual environment of the medical school and motivate other students to pursue their commitments to health and social equality. Integrating the excitement of medical research on urgent social problems with teaching and mentorship obligations has proved more sustainable and inspiring than our over one dozen multiple – often more expensive and time-consuming – pedagogical and program-building initiatives over the years. Our challenge now is to bring social medicine research/advocacy opportunities for medical students to scale, as an integral component of the required undergraduate medical school curriculum.