Johns Hopkins University School of Medicine
Medical Humanities and Social Medicine in the Context of COVID-19
Course Directors: Dr. Carolyn Sufrin, MD PhD ([email protected]) Office: (410)-550-0337, Cell: (415)-515-2796 Dr. Joseph Carrese, MD MPH ([email protected]), Office: (410)-550-2247 Jeremy Greene MD PhD ([email protected]), Office: (410)-955-4849 Gail Geller, ScD, MHS ([email protected]), Office: (410)-614-5556
Course Coordinator: Ruoxi Yu, MS4/Class of 2021 ([email protected]) Course Facilitators: (see above) Class Schedule: 6/22/2020 – 7/02/2020, part time (1 week of elective credit) (See under “Daily Schedule”: https://docs.google.com/document/d/17xxk5Ah5HkMBdONVIu12PivGaVHE8KYC9Mx6MxwHzYk/edit? usp=sharing)
Course Description: This two-week, part-time elective explores the ways that social structures influence the practice, research, and politics of healthcare through the lens of the COVID-19 pandemic. The course is designed for medical students seeking deeper study into the relationship between medicine and its social contexts, and who want to develop or advance their own scholarly projects on a topic of their interest in social medicine or medical humanities. “Social medicine,” for this course will be broadly defined and may include any number of themes—such as the production of health inequalities, racial justice in medicine, structural competency, and the application of social determinants of health. “Medical humanities” is similarly interdisciplinary and may include intersections with literature, philosophy, visual and musical arts, history or religion.
By focusing specifically on medical humanities and social medicine in the era of COVID-19, the course will use the pandemic to contextualize and discuss institutional and societal issues in medicine. The course will also provide a structural framework to the field of medical humanities and social medicine. Students will learn how they can use medical humanities and social medicine frameworks to make various aspects of clinical settings/encounters visible in different ways than the standard therapeutic goals of the clinic. Students will engage with interdisciplinary scholarly work on past pandemics and apply these concepts to the present covid pandemic.
Participants in the course will meet daily with course coordinators and facilitators to discuss the social implications of COVID-19 in medicine and reflect on its lessons to their developing clinical practice. Discussions will be guided by pre-assigned readings and in-session activities. By the end of the course, students can expect to have been introduced to various methods for examining the relationship between medicine and society, and to have created one’s own proposal of a potential project in the subject of medical humanities and social medicine.
Course Structure: The course is composed of synchronous and asynchronous components. Synchronous components (~8 hours/week) include formal course meetings every other day for 2.5 hours. 90 minutes will be dedicated to group discussion of assigned readings and the final hour will involve in-class, interactive exercises applying thematic assignments to current events related to the COVID-19 pandemic. Asynchronous components (~11 hours/week) involve assigned readings prior to each synchronous class. Readings (see under assignments) will focus on first, an overview of the background of medical humanities and social medicine and, then, specific thematic implications during COVID-19. These selected readings serve as the basis for discussion during synchronous meetings and allow students the opportunity to apply their observations and experiences in clinical settings through the frameworks of medical humanities and social medicine. Students will also work towards a written proposal in the topic of their choice for presentation at the end of the course.
Each student will be paired with a fellow student to receive active feedback and work collaboratively throughout the course (~1 hours/week). Students will also be offered an optional mid-course feedback meeting with a faculty mentor to discuss their progress. At the end of the course, students will submit a written research proposal in the topic of their choice. They will also present this proposed project as a 5-10 minute presentation on the last day of class for peer and faculty feedback.
Course Learning Objectives: By the end of the elective, students will be able to: ● Summarize the field of medical humanities and social medicine ● Describe the role and clinical application of interdisciplinary work in medicine, particularly as it applies to medical humanities and social medicine ● Participate in discussion on themes of health inequalities, social justice and social determinants of health in everyday practice ● Apply and present medical humanities and social medicine frameworks to a scholarly research proposal
Required Text: See daily schedule of readings under “Assignments”
Assignments: 1) Written proposal on scholarly project due by Friday, 7/3/2020, 11:59PM: a) At the beginning of the course, students will identify and set their goals for accomplishing meaningful progress toward a research question of their choosing in the medical humanities and/or social medicine. This written proposal should focus on the background, validity, similar work and implications of the research question. The written proposal should be limited to 1000 words. 2) Presentation in class on Thursday, 7/2/2020 3-5PM: a) At the final class, all students will give a 5-10 minute presentation, in whatever form best matches their written proposal. This might mean a powerpoint presentation, a multimedia project, or other performance. 3) Peer presentation feedback: a) Each student will be assigned to a fellow student to provide peer feedback throughout the course. At the end of the course, each student will be responsible for completing a feedback of their assigned peer’s written proposal, presentation and setting up an informal, one-on-one debriefing session. 4) Required readings on core topics: a) There will be readings assigned for each class day. Note that while we have selected readings already, this may be dynamic so that we can adapt topics to student interests. After completing the readings, students should be prepared to guide in-class discussion and actively engage in critical thinking about topics covered. Questions to consider for large group discussion include: i) What is the author’s main argument? ii) What concepts of social medicine and/or medical humanities frame this piece? iii) Can you think of a case or clinical experience you have encountered that resonates with/contrasts to what is presented here?
Daily Schedule
Themes Readings
Day 1 Medical humanities, Required: (6/22) social medicine ● Jeremy A. Greene, MD, PhD, and David S. Jones, MD, PhD. 2017. “The Shared Goals and Distinct Strengths of the Medical Humanities: Can the Sum of the Parts Be Greater Than the Whole?” Academic Medicine. 92: 661-664 ● Dorothy Porter. 2006. “How did social medicine evolve and where is it heading?” PLoS Medicine.3: 1667-1672 ● David S. Jones. 2020. “History in a crisis—lessons for Covid-19.” New England Journal of Medicine. 382(18): 1681-1683. ● Zackary D. Berger, Nicholas G. Evans, Alexandra L. Phelan, and Ross D. Silverman. 2020. "Covid-19: control measures must be equitable and inclusive." The BMJ. Day 2-3 Infectious disease in Required: (6/24) ● Farmer, Paul. "Social inequalities and emerging infectious context diseases." Emerging infectious diseases 2, no. 4 (1996): 259. ● Rosenberg, Charles E. 1989. "What is an epidemic? AIDS in historical perspective." Daedalus. 118(2): 1-17. ● Kleinman, Arthur M., Barry R. Bloom, Anthony Saich, Katherine A. Mason, and Felicity Aulino. 2008. "Asian flus in ethnographic and political context: a biosocial approach." Anthropology & Medicine 15(1): 1-5. ● Downs, Jim. 2020. “The Epidemics America Got Wrong.” The Atlantic. March 22. https://www.theatlantic.com/ideas/archive/2020/03/role- apathy-epidemics/608527/ (accessed May 27, 2020). Day 4-5 Structural Required: (6/26) ● Feagin, Joe, and Zinobia Bennefield. "Systemic racism and inequalities US health care." Social science & medicine 103 (2014): 7-14. ● Massoglia, Michael. 2008. Incarceration as Exposure: The Prison, Infectious Disease, and Other Stress-Related Illnesses. Journal of Health and Social Behavior. ● Kendi, Ibram X. 2020. "What the racial data show." The Atlantic, April 6. ● Kinner, Stuart A., Jesse T. Young, Kathryn Snow, Louise Southalan, Daniel Lopez-Acuña, Carina Ferreira-Borges, and Éamonn O'Moore. "Prisons and custodial settings are part of a comprehensive response to COVID-19." The Lancet Public Health 5, no. 4 (2020): e188-e189. ● Page, Kathleen R., Maya Venkataramani, Chris Beyrer, and Sarah Polk. "Undocumented US immigrants and Covid-19." New England Journal of Medicine 382, no. 21 (2020): e62. Optional: ● https://www.themarshallproject.org/2020/03/25/no-your- coronavirus-quarantine-is-not-just-like-being-in-prison
Day 6-7 Disease stigma and Required: (6/29) ● Wailoo, Keith. "Stigma, race, and disease in 20th century racism America." The lancet 367, no. 9509 (2006): 531-533. ● Wailoo, Keith. "Sickle cell disease—a history of progress and peril." N Engl J Med 376, no. 9 (2017): 805-7. ● Eichelberger, Laura. "SARS and New York's Chinatown: the politics of risk and blame during an epidemic of fear." Social Science & Medicine 65, no. 6 (2007): 1284-1295. ● Sangaramoorthy, Thurka and Adia Benton. From #EbolaBeGone to #BlackLivesMatter: Anthropology, misrecognition, and the racial politics of crisis. Savage Minds, January 16, 2015. ● Carter, Chelsea and Ezelle Sanford III. 2020. “The myth of Black immunity: Racialized Disease during the COVID-19 pandemic.” Black Perspectives, AAIHS, April 3. Optional: ● Benton, Adia. 2020. “Race, epidemics, and the viral economy of health expertise.” The New Humanitarian, February 4 2020. Day 8 Advocacy in Required: (7/1) ● Conrad, Peter, and Kristin K. Barker. "The social healthcare construction of illness: Key insights and policy implications." Journal of health and social behavior 51, no. 1_suppl (2010): S67-S79. ● Earnest, Mark A., Shale L. Wong, and Steven G. Federico. "Perspective: physician advocacy: what is it and how do we do it?." Academic medicine 85, no. 1 (2010): 63-67. ● Huddle, Thomas S. "Perspective: Medical professionalism and medical education should not involve commitments to political advocacy." Academic Medicine 86, no. 3 (2011): 378-383. ● Best, Rachel Kahn. "Disease politics and medical research funding: three ways advocacy shapes policy." American Sociological Review 77, no. 5 (2012): 780-803. Optional: ● Gruen, Russell L., Eric G. Campbell, and David Blumenthal. "Public roles of US physicians: community participation, political involvement, and collective advocacy." Jama 296, no. 20 (2006): 2467-2475.
Day 9 N/A Student Presentations (7/2) (No required readings) Note: Day 1 readings should be completed prior to large group discussion on Day 1 of class.
Evaluation and Grading Participation (60%) Written proposal (20%) Presentation (15%) Peer presentation feedback (5%)
Grading Scale: Grading scale is determined by the School of Medicine. Electives are graded on a P/F scale. This course is intended to help students understand and engage with the field of medical humanities and social medicine. The quality of reflection and participation will be determined by the course director. ● Fail (F): Student has unexcused absences, fails to participate in group discussions, or does not complete assignments. Student should meet with the course director to plan remediation. ● Pass (P): Student has an average equal to or exceeding 70% and/or has met all required assignments for the class, including being present at all sessions and participating in group discussion and completing assignments in a thoughtful manner.
Expectations Participation in online discussions and other activities is essential for this elective, including engaging with required reading. Students are expected to participate regularly. Those who have to miss class meetings should inform the course director of the reasons for absences in advance. Class participation and attendance will be included in student grading and evaluation. These expectations will be clearly communicated by course directors, coordinators and facilitators to students.
Professional Behavior Expectations on Clinical Clerkships Clerkship students are expected to demonstrate professional behaviors as outlined in the JHU SOM Honor Code and in the AAMC subcompetencies on professionalism: 1. Demonstrate behaviors that show compassion, integrity, and respect for others 2. Demonstrate behaviors that show responsiveness to patient needs that supersedes self-interest 3. Demonstrate behaviors that show respect for patient privacy and autonomy 4. Demonstrate behaviors that show accountability to self, patients, colleagues, the profession, and society. [Link to Accountability Policy ]
Clerkship directors will communicate discipline specific expectations/tasks for which students will be held accountable. As with other Clerkship domains such as knowledge and skills, students who deviate from these expectations, may have their final grade lowered, or the deviation may result in failure of the clerkship.
Serious breaches of professionalism should be expected to result in failure of the clerkship in which the breach is detected. These breaches will be handled on a case-by-case basis by the clerkship director. All such matters will also be referred to the Disciplinary Committee. Examples of such unprofessional behaviors include but are not limited to: cheating, plagiarism, or other forms of academic dishonesty; forgery or falsification of documents/records; lying or misrepresentation of facts, figures, or clinical data; failure to obtain appropriate supervision for clinical care; physical violence, bullying or harassment against others, or other significant lapses in personal ethical conduct that raise concern regarding the moral character of the student in question.
JHUSOM Policy on Attendance This course is heavily dependent on participation, if you need to miss a required session, you need to let the course leader and course coordinator know ahead of time. The JHUSOM policy on attendance in the curriculum is posted at https://hpo.johnshopkins.edu/som/policies/886/39178/policy_39178.pdf.
Classroom Accommodations for Students with Disabilities If you are a student with a documented disability who requires an academic adjustment, auxiliary aid or other similar accommodations, please contact the Office of Student Affairs at 410-955-3416. You must also notify the course director and course coordinator in advance of the start of the course and well in advance of any exam or assessment so that appropriate preparations can be completed before an event requiring accommodation.
Statement of Diversity and Inclusion Johns Hopkins University is a community committed to sharing values of diversity and inclusion in order to achieve and sustain excellence. We believe excellence is best promoted by being a diverse group of students, faculty, and staff who are committed to creating a climate of mutual respect that is supportive of one another’s success.
Teacher Learner Conduct Policy The Johns Hopkins University School of Medicine is committed to fostering an environment that promotes academic and professional success in learners and teachers at all levels. The achievement of such success is dependent on an environment free of behaviors, which can undermine the important missions of our institution. An atmosphere of mutual respect, collegiality, fairness, and trust is essential. Students should review the JHUSOM Guidelines for Conduct in Teacher/Learner Relationships http://www.hopkinsmedicine.org/som/students/policies/.
Student Honor Code Students are reminded of the honor code developed by the medical student body, introduced in September 1991, is as follows: As a student at The Johns Hopkins School of Medicine, I pledge: ● To do my own work and be honest in my interactions with peers, faculty, and staff. This applies to my work on examinations, assignments, and papers as well as work in the laboratory. ● To uphold the high standard of conduct in patient care which has always been maintained by the Johns Hopkins medical community. ● To base my interactions with other students on mutual respect and cooperation. ● To act on infractions of the honor code and to maintain the confidentiality of all parties involved. ● To encourage my peers to uphold this honor code. It is the expectation that Hopkins students live by this code.
Course Evaluation Please remember to complete the course evaluation for this course. For preclerkship courses, evaluations will be required from a rotating sample of 25% of the class. For the clinical clerkships and clinical electives, 100% of the students are expected to complete the course evaluations. Course evaluations are an important tool in the School of Medicine’s ongoing efforts to improve instructional quality and strengthen its programs. The results of the course evaluations are kept anonymous — your instructor will only receive aggregated data and comments for the entire class. For the clinical clerkships and clinical electives, 100% of the students are expected to complete the course evaluations.