Last week, a triumvirate of headline-making stories seemed well-timed to reinforce the semester’s lessons for the 140 first-year HMS students enrolled in the Introduction to Social Medicine class, newly mandatory for all except HSDM and HST students.
A man flew to Europe and back with an extremely drug-resistant case of tuberculosis. President Bush proposed an additional $30 billion over five years to fight AIDS in developing countries. And discouraging news about the end of a recent decline in U.S. teen smoking rates marked World No Tobacco Day.
The stories mirrored lecture topics on smoking, HIV, and tuberculosis given by the three HMS course directors who are also among the world’s leading experts in these subjects: Allan Brandt, most recently the author of The Cigarette Century, a book on the social and culture history of cigarette smoking in this country; Paul Farmer, the Maude and Lillian Presley professor of social medicine at HMS and co-founder of Partners In Health, a nonprofit organization that provides free health care and advocacy for impoverished people in Haiti, Peru, Russia, and Boston; and Jim Yong Kim, chair of the Social Medicine Department, co-founder of Partners In Health, and former director of the HIV/AIDS Program at the World Health Organization.
The introductory class is part of a larger change that also adds two other requisite social science courses in medical ethics and health policy in place of a potpourri of electives in related areas.
The Social Medicine faculty have used their weekly one-hour lectures on their areas of expertise to introduce broader themes about the powerful social, economic, and political forces that influence who gets sick and with what diseases, what treatments are available, and the outcomes. In one-hour discussion sections, 13 faculty tutors facilitated small-group discussions based on weekly readings. Engaged students extended the day with optional specialized seminars to probe certain themes in global health in more detail.
The new requirements show how important these skills and concepts are for the next generation of doctors, but benefits flow in both directions.
“There is nothing more effective than training HMS students, who are going to go out in the world and do important things,” said Brandt, who is also the Amalie Moses Kass professor of the history of medicine in the Department of Social Medicine. “We see this as having a multiplier effect for the medical education, research, and health care we’re really committed to.”
“We sweat more over these lectures than any other talks we give,” said Kim, “and we’ve talked to groups of 10,000 people and give 100 talks a year.”
“We sweat more over these lectures than any other talks we give.”
The students have responded with equal passion. “This is the only space this year where we have learned how to look at realities, identify questions, and then follow up to answer those questions and address those realities,” said student Amy Saltzman. “It has been more about lighting a fire rather than filling the buckets, more about teaching us how to think than simply giving us more information.”
“It’s not just a skill set, it’s a broader mindset,” said student Laura Medford-Davis, who anticipates putting her lessons into practice as a doctor in this country.
Even the frustration felt by some students about what they view as an overemphasis on international health seems to be a reflection of a kindled desire to learn, analyze, and respond to the social, cultural, economic, and political forces underlying more common diseases, such as obesity and diabetes, said student Ian Barbash.
The faculty will be poring over the substantial feedback from students to make changes in next year’s course, which will be held in the fall term. And the instructors have emphasized they are available for mentorship and advice to interested students at any time during their training. But the most telling feedback may come in February. “We’re all dying to see what the students do with Jim and Paul in the Second Year Show,” said course co-director David Jones, HMS lecturer on social medicine. “If you don’t make it into the show, you’ve made no impression on the students.”