There’s more to being a doctor than recognizing and treating an illness. There’s more to the patient, too, than the illness that needs treatment.
A newly developed integrative Social Medicine course within the Schulich School of Medicine & Dentistry aims to tackle this fundamental aspect of physician training, said Teresa Van Deven, the school’s curriculum co-ordinator.
“I have an international background and I’ve looked at how health intersects with community in different countries. When I came (to Schulich), we didn’t have anything that was solid that taught the (intersection) of social determinants of health and a patient’s health,” said Van Deven, who developed the course two years ago.
“There were pieces embedded throughout the curriculum, but I thought we needed to highlight the importance of this in terms of physician identity formation and teaching our physicians about the whole patient and the whole community.”
The idea of social medicine isn’t new, Van Deven noted. Physicians in the 1800s dealing with cholera outbreaks were among the first to discuss illness as something potentially affected, or exacerbated, by the community one lives in, she explained. But instead of just teaching medical students about how homelessness, domestic violence, economic challenges and other such issues might affect an individual’s health, Van Deven wanted the learning to happen outside the classroom.
In-class lectures that focus on social, cultural and economic impacts of medial phenomena – as well as lessons on population health, epidemiology and medical ethics – are supplemented with a service learning component that totals 18 hours during the term. Van Deven decided she would send the class of nearly 200 students into the community, to work with social agencies and partners, without offering medical support or assistance to their clients and, instead, just learning from them.
Students have to identify a demographic they feel might not have optimal health or optimal access to health care. Students have worked with Indigenous communities, homeless populations, HIV/AIDS organizations, women’s shelters, immigrants, refugees and more. Between London and Windsor, the course has 45 – 60 community partners students can work with.
“They have to go out and find what is available in the community. Students like a bit more structure, but I wanted them to choose. They have to be brave enough to approach people they don’t know and approach a situation they might not be comfortable with. A lot of first-year medical students are very academically strong but for them to go out, this might be a new thing for them,” Van Deven said.
“It’s important in becoming a physician. The skillset they get is transferrable anywhere, but knowing they have to be aware of who their patients are, whether they are working in an Indigenous community or they are in Toronto and have an inner-city community, it’s important for them to ask their patients where they live and what they do, to understand how (their situations and lives) affect their health and to provide better care.”
Van Deven plans to continue bringing in guest speakers from community partners and sees the course becoming integrated into the four years of medical training, once a competency-based curriculum is implemented in 2019.
One group of students from last year has extended its work with London’s LGBTQ community through the Middlesex-London Health Unit to focus on a project that aims to address inequities in delivery of health care, refusal of care and discrimination. The project will help facilitate culturally competent care, build awareness for physicians of existing resources and enable them to provide the best care possible for the LGBTQ community in London.
“These skills are important, understanding there’s more to the patient than just their disease,” Van Deven said.
“I hope wherever our physicians go, whether they leave the country or go down the road, that they ask those questions and they are aware.”