Weaving a web of social science in medicine.
By Dr Jeni Harden
It is perhaps appropriate in the year of the referendum on Scottish independence, and the 700th year anniversary of the Battle of Bannockburn, that I am reminded of a great Scottish legend. King Robert the Bruce was said to have hidden in a cave after defeat by the English. While there he watched a spider fail time again in spinning its web. Robert was inspired by its perseverance and ultimate success, and went on to lead his army to victory. It is this event that is said to have given rise to the phrase ‘if at first you don’t succeed- try, try again’. While an admirable statement about the value of perseverance in the face of repeated failure, it seems that this raises a further question – how do we define success or indeed failure? For the spider, success was clearly the spinning of its web, for King Robert, it was defeat over the English at Bannockburn, but for those involved in teaching within medicine, what is success? Is it the percentage of students passing the module or the percentage rating the module as well taught, or the quality of the work students produce? For the last 2 years I have been redesigning a course aimed at teaching social science to medical students and the question of how to define success has been a key to that process.
I drew on a number of sources of information in reviewing the existing module: statistics on student performance; a review of student work; and feedback from students. What was most interesting was that these different modes of evaluation provided very different answers to the question of whether or not the module was succeeding. Statistical evidence from student pass rates and grade distribution was very similar to their other modules, so could be considered successful. Yet when looking at the assessment tools used (MCQs and SAQs in exams) and the quality of work the students were producing, I began to question whether they were adequately achieving the learning outcomes. Although the students were passing, they were not demonstrating a good understanding of social science as applied to medicine, and in this respect I felt that the module was failing the students and failing to genuinely address the GMC Tomorrow’s Doctors outcomes. Feedback from the students, coming from the end of semester module evaluations and meetings with student reps also raised many issues about which the students were not satisfied, indicating that from a student experience perspective, the module was not entirely succeeding.
In redesigning the module I took all these factors into account, leading to significant changes to the module in terms of what was taught, how it was taught and how it was assessed (dropping the exam in favour of an essay). So did I succeed? Pass rates were initially worse so by this measure I had failed. I tried again, making the classes and independent study tasks more explicitly related to the assessment and this year all students have passed. The quality of the work of students is now also significantly better and has been commended by our external examiner; another indicator of success. Student evaluations have also become more positive but remain critical and this is the one part of my web that I have not yet got to stick. This makes me feel that the whole web’s hold on the wall is somewhat precarious. While the pass rates and the quality of the work students produce can be viewed as good indicators of success in achieving the learning outcomes, I also want the students to rate the module well, not just in relation to organisation or teaching quality but because they enjoy it and value having the module as part of their curriculum. I am aware that in the context of teaching social science to medical students, this may be akin to the spider trying to stick its web to TEFAL; there are always some students who are clear in their evaluation that they do not consider social science to be relevant to their degree. Perhaps there will always be some who hold this view but I will persevere, reshaping my web and seeing if it sticks, recognising the importance of students’ views as indicators of success.
Thanks Jenni, some very important learning points for all of us there. Your reflection made me think about the course I am presently running in Poland, which is around the subject of Social Accountability. The audience is a mixed group of faculty and students- all at different stages of development. The discussions got around to " so what is a good doctor?" What really surprised me was the dichotomy that exists between these two groups, with faculty representing a much older vision, and the students presenting a much more global, all inclusive, socially responsive image. In a structure that listens and values students, that's a good thing, but if not then try as they may to influence they will not be heard.
My advice to students who came in a group to chat to me at the end was try and try again, eventually you will be heard.
Keep on persevering with your course- even Tefal doesn't last forever !!
Thanks Trevor. 'What makes a good doctor' is usually my starting point with the students and most spontaneously acknowledge many of the skills that we would use social science to help them to develop.