Virgin and extra virgin
A small child is sat at the kitchen table waiting for tea. Her mother is busy across the room washing some food in the sink. The girl pipes up, ‘Mummy can I ask you something?’ The woman says, ‘ Of course dear’. The girls asks, ‘What’s virgin mummy?’ The woman takes a deep breath and starts to explain that a virgin is what people are before they’ve had children and that everyone starts a virgin and it’s a special thing that you stop being when you make love for the first time. She pauses, asking the girl if she understand so far. She replies, Yes mummy’, and picking up the olive oil bottle on the table asks, ‘but what’s extra virgin then?’
Putting aside the way that this story purports to illustrate a peculiarly British attitude towards sex it made me think about the notion of the ‘teachable moment’, affirming its potential importance but also making me reflect on whether we can always recognise it as behavioural and social scientists working in medical education and, indeed, can we always access it?
There are certainly times when we are asked questions – the ‘what’s a virgin?’ moments.
There are also the ones where we might be the proactive player.
I was thinking of the time when I observed students practising chaperoning as they learnt the clinical skills of breast examination. I asked why we assumed that the key dynamic and concern here was about completely and only fixed within a heteronormative framing. What about if a woman presented for examination and identified as lesbian? What would chaperoning mean in that context and who should do it?
In truth I don’t recall the conversation going anywhere beyond a lively discussion about the issue but nonetheless this was teachability in the moment.
But we’re not always there to see the moment and in contexts such as lectures, and indeed even in small group or tutorial work, is there really the opportunity for students to all be in the moment or for the one or two who are to take our time and attention?
And, what about the fact that we often front-load BSS in medical curricula? One oft heard, but nonetheless perfectly plausible observation is that BSS become more intelligible, relevant, meaningful and useful to students as they increase their clinical contact with patients and communities and indeed other clinicians. It is here that the complex nature of health systems become real, the concept of the sick role becomes apparent, the ways that’s deeper concept such as power, identity, diversity, professionalism and professionalization play into situations and encounters may be salient and intelligible.
But are we present there? And if not, why not?
Would it possible to imagine a world in which the social scientists stands alongside the beside with the clinician and student? Is the optional and probably occasional elective in Year 4 with a social science dimensions enough – isn’t it just reaching the already engaged and hence the teachable but not those that might derive as much if not more benefit from being taught?
And what about solutions? Is it working to have more BBS orientation or components in Year 4 electives? There are examples, a long-term clerkship in social care environments for fourth years at Newcastle in NSW, Australia; a similar provision called the Difficult and Deprived Areas Project combining learning in GP and non-clinical contexts in areas of high socio-economic deprivation at Durham in the UK.
Is this enough though? Do we want to and how do we get into the place where the teachable moment is reachable?