This document discusses the integration of social science research methods in undergraduate medical education in the UK, emphasizing the regulatory requirements for medical graduates to understand both qualitative and quantitative research. It highlights challenges in teaching these methods due to curriculum constraints, student engagement, and the perceived relevance of social sciences to medical practice, alongside findings from a survey of UK medical schools. The report underscores the necessity for clearer definitions, improved pedagogic practices, and an increased emphasis on experiential learning to better prepare medical students for incorporating social science insights into their future clinical roles.

1. Teaching social science research methods to undergraduate
medical students: the state of the art and opportunities for
practice and curriculum development
Dr Simon Forrest (University of Durham)
Overview
The relationship between the social sciences and medicine has long and rich history
which has, since the 1970s, been recognised in requirements that UK graduates in
medicine must demonstrate knowledge about the psychological and social
dimensions of health and medicine (Bloom 2002; Todd, 1968). Recently, additional
emphasis has been placed on understanding of social science research methods
(GMC, 2009). Specifically, graduates are now required to demonstrate that they can:
critically appraise the results of research including qualitative and quantitative studies
as reported in the medical and scientific literature; formulate research questions and
design studies including in those within a psychosocial paradigm; and, apply the
findings of studies to specific clinical problem (GMC, 2009: 18). A number of the
other graduate outcomes spelt out by the regulator also imply conversancy with
social science research methods especially those relating to the principles, method
and knowledge base around population health and improving health and health care
(GMC, 2009: 11).
The regulator does not provide detailed guidance in the form of a curriculum on
how these outcomes are to be met meaning that individual Medical Schools within
the UK exercise a considerable degree of freedom in terms of the organisation and
structure of provision and indeed the detailed content which moves learners
towards these high level outcomes. There have, and continue to be efforts to help
populate this space through the production by practitioners in the various fields and
disciplines that make up medical education of core curricula (for example, on ethics
(Stirrat I., 2010), public health (Myles et al., 2013) and psychology (Bundy et al.,
2010)). However, there remains a lacuna around the core content of the sociology
contribution to undergraduate medical education (although work is underway to
plug this gap (Brooks et al, 2011; 2013).
Despite this increasing recognition of the contribution of social science research
methods to medical practice (see also, Alderson, 1999, Pope, Ziebland and Mays,
2000) and the publication of various textbooks and guides (e.g. Bell, 2005;
Cunningham et al. 2013) detailed accounts of pedagogic practice are relatively rare
and there has been no review of the literature (e.g. Rifkin and Hartley, 2001). As a
consequence, little is known about the structure, content and organisation of
teaching and assessment and the associated challenges and opportunities in educating
undergraduate medical students about social science research methods (Forrest,
Brooks and Kendall, 2013; Brooks, Collett, and Forrest, 2013).
Evidence of lack of information about curriculum and pedagogic practice and the
imperatives of regulatory are powerful drivers for work in this field, but there other
rationales of equal weight.

2. Post-graduation and especially in senior roles, medical doctors play important roles
in planning, commissioning, and undertaking research with social science
components. That may be research with direct clinical relevance and hence impact
on patients and/or as teachers seeking to develop their role in medical educators. It
also the case that the numbers of students studying medicine at undergraduate level
in the UK (which at any one time stands at round 30,000) (HESA, 2014) represent a
significant body of learners, and this implies the potential to draw heavily on
expertise in social science research methods in ways that present opportunities but
also challenges for ensuring students have access to sufficient numbers of expert
staff. Finally, there are grounds to assume that teaching social sciences to medical
students has particular challenges. Staff and students in medicine may struggle to see
the relevance of social scientific knowledge; and, epistemological tensions between
the disciplines are particularly manifest around assessment of knowledge and
understanding (Russell et al 2004; Scambler, 2010). Curriculum and timetable
pressures, allied to historic models of pedagogy which are characterized by
extremely high levels of contact time, knowledge input and requirements for its
acquisition create context for social science teaching and learning to be lost such
that is to be found ‘everywhere and nowhere’ in the provision.
Aims and objectives
In this context, the aims of this piece of work were as follows:
 To establish current practice around teaching social science research
methods to undergraduate medical students in the UK: to identify what is
being taught, how teaching and learning are organised within the curriculum,
how content is delivered, to and by whom and how student is learning
assessed.
 And, to explore the challenges and opportunities around developing this
teaching and learning practice and the curriculum and policy contexts that
frame it.
Activities
We undertook a systematic review of scholarship and research relating to the
teaching and assessment of social science research methods in undergraduate
medicine. The review involved a comprehensive search of a range of online
databases, evaluation of the relevance of search results and analysis of extracted
papers and other outputs. These were used to inform the development of the
survey of UK medical schools.
In April 2014 we undertook a survey of UK medical schools. We constructed an
online instrument comprising a combination of primarily closed and scaled response
items supplemented with free-text options which aimed to elicit information about
the following:
 The content of teaching and learning with regard to social science research
methods;
 The organisation of that provision including within the curriculum including
who provides the teaching and to which students and in what context;
 Assessment related to the teaching learning;

3.  Materials and resources used to support teaching and learning;
 Perceptions of the attitudes of staff and students to social sciences with
medical education; student engagement and understanding of the materials
and learning; structural challenges in organisation, delivery and assessment;
contribution to the course, programme and medical education and practice
more widely; and, a variety of factors that (would) help or hinder pedagogy in
this area.
We had planned to organise face-to-face consultations with colleagues in groups.
Due to pressures arising from the cycles of teaching and assessment in the academic
year, we took the decision to conduct consultations via the telephone using the
survey themes as basis for further elaborating discussion.
In late May 2014, initial findings of these activities were presented at HEA Social
Science conference held in Birmingham.
Outcome/Findings
The literature review
The literature review revealed our assertions about the dearth of academic writing
with a specific focus on teaching and learning of social science research methods in
undergraduate medical education to be well-founded. Even with judicious widening
of the search criteria to enable us to draw in for scrutiny writing about teaching
research methods in general, the search identified less than 200 hundred relevant
publications and within these the bulk of the much smaller number that mentioned
social science research methods anywhere in the text, were generally concerned
with broader issues about teaching social science than specific content or skills. The
literature contained little information about organisation of teaching and learning
within the curriculum or assessment of that learning. There was however some
research and scholarship relating to teaching methods and their suitability to social
science learning. A number of important themes can be drawn out as follows:
a) The importance of what might be termed macro-contextual of climatic
factors. These include the power differentials set up by the dominance of
medical profession in medical education with regard to both the status of
knowledge and its practitioners. There is widespread agreement in the
literature that the medical school replicates the hierarchy of the profession,
that is that the most expert clinicians’ knowledge is seen to rank above that
of other health professionals and all these above the knowledge and expertise
of social scientists. Status is determined by both more or less ‘hard’ and ‘soft’
factors including pay differentials, organisational status and power and
perceptions of proximity to and authority in clinical practice. This hierarchy
means that arguments constantly have to be remounted about to prove the
relevance of social science to medicine.
b) The content of social science teaching in medicine is not easily aligned with
what is regarded as the core content of the ‘home’ disciplines. Within
medical education the social science contribution is often compartmentalised
into topics between which the underpinning narrative of disciplinary history
and theories is easily lost or indeed absent from the start. This poses
challenges around the notion of engaging students in deep learning and

4. consideration of ‘threshold concepts’ (Land et al., 2008) with respect to the
social sciences. Understanding tends to be inextricably linked the extent that
the content can be seen to have (and made to have) clinical relevance.
c) Attention and emphasis on the importance of experiential learning as a
context for student acquisition of social scientific knowledge. There is some
literature pointing to the value of using patient experience and contact and/or
project work within the wider patient community as the context for social
science teaching and learning because of the relative ease with which
concepts can be materialised through student contact with the ‘real world’.
Although evidence is not abundant, there is some research pointing to the
use of studies of long-term conditions in individual patients as the context for
social science teaching about topics such as biographical disruption and also
qualitative research methods (Kumagai, 2009), and case material drawn from
clinician experience to teaching about ethnicity, cultural influence on health
and intercultural communication (Hart et al. 2008).
d) Attention is also drawn to the issue of curriculum time and timing of
provision. The importance distinctions between phase 1 from phase 2 (pre-
and clinical years) are noted as is the tendency for social science content to
squeezed into Phase 1 which is characterised as an environment over-
populated with content across the various disciplines which feed into medical
education. The challenge of potential lack of apparent clinical relevance is
most keenly felt here in contrast to phase 2, where there seems to be little
teaching time dedicated to or indeed presence of social scientists. Phase 2
may be a context in which the challenge becomes to ally any opportunities to
contribute to the ‘teachable moments’ that arise around the clinical
situations. However, it has been noted that the clinical urgency of the patient
encounter is what motivates students but may also constrain their capacity to
absorb additional information and knowledge (Hunt and Sobal, 1990).
e) The literature also points to potentially deleterious impact of the lack of
materials and resources to support social science research methods teaching
in medicine within the curriculum (as opposed to the plethora of guides to
medics and allied healthcare professionals on conducting research projects).
f) final important, albeit rarely mentioned observation, is that the contextual,
intellectual and practical challenges posed to the teacher of social sciences in
medical education may be precisely what attracts some colleagues to work in
this environment. The relative freedom represented by often times working
alone or in small team of disciplinary peers coupled to opportunities to have
direct influence on doctors and medical practice can be attractor to some
social scientists.
The survey
The survey of colleagues providing and/or organising social science input into UK
medical schools provided both some confirmation and elaboration of issues arising
from the literature review and detail about current curricula issues and pedagogic
practice. The survey elicited responses from 19 institutions. A narrative account of
the findings showed the following:
a) Respondents occupy a range of roles both within and in relation to medical
schools. This is part reflects the ways that Schools, Faculties and Research
Groups are organised. For example, while the majority of respondents (15)

5. described themselves as employed directly within Medical Schools, 6 were
located in Research Units, Groups of Institutes attached to the School (for
instance situated within the same Faculty where the Medical School is a
Faculty) rather than directly employed in a role within the programme. Both
being within programmes and being employed in a role in a unit alongside the
programme were seen as having advantages and disadvantages. Those
respondents located within programmes saw themselves as on the one hand
better able to understand programmes, including the opportunities for
integration for teaching and learning and positioned in ways that gave access
to some influence on programme and curriculum design and development.
Some of the benefits of the ‘insider’ were perceived to flow from
opportunities for greater interaction with staff and students. Disadvantages
were perceived to be around the demands to contribute to a great deal of
teaching-related and other administration and especially, the risks of
becoming disconnected from ‘home’ disciplines. Career pathways were not
clear to those respondents located within programmes. Those fewer
respondents located in research units, groups and institutes allied to
programmes perceived greater opportunities to maintain a research profile
relevant to their discipline but felt distanced from programme organisation,
staff and students contact in ways that meant they were less clear about the
alignment of their contribution to student learning and the programme as a
whole. The disciplinary background and career trajectories of respondents
were diverse with many having a background in health-related research (16)
but few having made a conscious choice to pursue a career in medical
education. Respondents described themselves as variously sociologists,
medical sociologists, psychologists and health psychologists, anthropologists
and public health practitioners/academics.
b) All 19 institutions identified provision which aims to help students meet the
high level outcomes for graduates laid down by the professional regulator as
identified earlier in this report. There is some consistency in the nature of
the content and broad picture of the organisation of that content via,
although the greater level of granularity adopted in analysis the more the
diversity in terms of detail. Commonalities include the following:
i. A tendency for behavioural social science input to medical curricula to be
‘front-loaded’, that is placed in the first 2 years (Phase 1, pre-clinical);
ii. Teaching about social science research methods in Phase 1to be
integrated across the social science contribution rather than be delivered
in discrete packages;
iii. For this integration to take place in areas such as public health, evidence-
based medicine, project work (see below) and elective provision;
iv. Provision to include teaching and learning about the critical appraisal of
research, about study designs (with a focus on epidemiological studies),
and the value of qualitative research;
v. The offer of Student Selected Components (SSCs) throughout
programmes but increasingly less prescription of topic and format in
Phase 2 (especially Year 4) which offer opportunities for more in depth
teaching and learning about social science research methods. SSCs were
often supervised one-to-one;
vi. Project work (including critical appraisal SSCs) as the context for
qualitative and some limited quantitative research.

6. c) Teaching was widely led by social science experts but often student learning
was supported by tutors with less expertise (frequently, GP tutors).
Respondents felt that GP tutors had an awareness of the technological and
practical aspects of social science research methods but that their
contribution on the epistemological and methodological aspects was often
hampered by lack of qualification, expertise and confidence.
d) The quantity and forms of provision were highly variable between
institutions. The diffuse nature of teaching and learning make estimates of
time dedicated to teaching and learning hard to assess (and especially in
Problem-Based Learning courses where contact time with staff is lower and
student-directed learning greater). However, respondents used a variety of
lectures, tutorials, projects and SDL in the portfolio of teaching methods.
e) Respondents generally felt that topic coverage was satisfactory given the
constraints on timetable time but that some topics were more difficult to
cover and convey than others. Quantitative methods were not felt to be easy
to teach and student understanding of quantitative data and especially
statistical tests and their significance to be highly variable. Challenges with
teaching about qualitative methods clustered around concerns that student
perceived qualitative research to be of lesser value and rigour than studies
employing quantitative methods.
f) All respondents said that learning about social science research methods was
assessed, with modes of assessment including multiple choice and other
closed response questions integrated into summative papers and, through
essays and project reports where these were part of the diet of learning.
Many respondents (13) perceived that there was pressure flowing from staff-
student ratios, orthodoxy in medical education and understanding of
knowledge types and acquisition among medical students to undertake
assessment in forms not always amenable to social science knowledge.
Marking loads associated with project work were identified as problem and
deterrent to maintaining these forms of assessment.
g) The survey suggested that colleagues felt that while staff and students
generally recognised the value of teaching and learning about social science
research methods its applicability to future clinical practice was less clearly
perceived. There are structural challenges to teaching and learning including
allocation of teaching time, access to students in Phase 2, assessment types
and quantity of work, and student engagement with bodies of knowledge and
ideas with which most have no prior familiarity and which may seem hard to
relate to their perceptions and motivations for studying medicine.
Other consultation with the field
As noted above, consultation with the field via face-to-face meetings is ongoing work
planned for completion by the end of the grant period in July 2014. To date,
consultations with individual colleagues have been accomplished through ‘phone
interviews. These have been conducted with 8 of the respondents so far. These
contacts were not systematically selected but chosen on the basis of availability. The
summary findings presented here are therefore highly descriptive and to be taken as
indicative. These consultations have revealed the following:
a) There is some lack of clarity about what social science research methods are.
For example, respondents mentioned both specific methods (surveys,

7. interviews and focus group discussions), analytic techniques and topical
content as factors or components in a definition. It was felt that problem
arose in important ways from the lack of a clear disciplinary identity or
understanding within medicine rather than within social sciences where these
elements align. There was recognition that discussion and debate within
medicine and with medics and other involved in medical education would
help to clarify the issue.
b) A serious challenge to teaching key concepts about epistemology and
ontology was identified as arising from the risk of a technocratic view of what
a social science research method assuming dominance. This was connected
to responses which identified the problems posed by working towards
learning outcomes which refer much more to content than ideas and
approaches. This was seen as side-lining student learning about the core
concepts underpinning social science and its research practice.
c) Constraints on contact time, student capacity to engage in learning activities
such a reading and reflection were identified as challenges bearing on the
design and delivery of teaching and learning. Some respondents suggested
that outcomes need to be modest and proportionate and underlined that
medical students are not being trained to be social science researchers but
effectively well-informed consumers of its outcomes. There was consensus
that increasing content was impractical and possibly counter-productive and
the routes to developing and enhancing provision lie in better integration of
learning into existing curricula content.
d) There was widespread recognition that there are tensions between social
science and biomedical approaches which present challenges but may also
provide the ‘teachable moments’ which allow students to understand the
critical relationship between bodies of knowledge and the utility of this.
Specific issues identified included the differences between conceptions of
rigour and bias, the subtly different ways that ethical concerns are framed and
dealt with by social and biomedical scientists, the core ideas of ‘normal’ and
‘abnormal’ presented by biomedicine and relationship and difference between
reflection and reflexivity.
e) Project work involving students in collection, analysis and presentation of
‘social science’ data were mentioned as important contexts for teaching and
learning. Many courses (6) require students to engage with patients in the
community via studies of long-term (chronic) illness and/or pregnancy and to
use social science methods and knowledge to interpret and enrich their
understanding of patient experience.
f) SSCs were also identified as important opportunities for student learning.
Very many courses (7) include a critical appraisal task in Phase 1 and within
this some students look at social science topics and research. SSCs in Phase 2
were regarded as valuable contexts for one-to-one supervision of students
developing a deeper understanding of social science research and its practice.
A small number of respondents (3) have had opportunities to offer medical
students the chance to work as research assistants on social science projects
allied to or situated in medicine. These were felt to be particularly powerful
learning experiences although the impracticality of offering them to all
students was noted.
g) The increasing recognition of the importance of the links between health and
social inequalities and the impact of lifestyle factors on health, was welcomed

8. and identified as key topical arenas for teaching and learning about social
science research methods.
h) The ‘front-loading’ of provision is seen as challenge. It was felt that it makes it
difficult for students to see the relevance of teaching and learning to clinical
practice (which occurs in Phase 2). The general absence of opportunities to
teach into Phase 2 was perceived as meaning that not only were teaching
opportunities missed but that it made it more difficult for teachers to see
how knowledge was employed and hence how to develop teaching in earlier
years.
i) The interviews added considerable nuance to the survey findings around
colleagues’ perceptions of student and staff support, engagement and
understanding of their work in teaching social science research methods.
One interesting suggestion was that among clinical colleagues understanding
of the relevance and importance and hence support for social science
teaching as a whole was often high among GPs for whom the social
dimensions of health were easily perceived in their practice. Engagement and
support was felt to lower among colleagues with a ‘pure’ science or non-
patient facing clinical role. Student engagement was regarded as highly
variable; the picture of student lack of understanding and confidence around
social science being nuanced by accounts, especially relating to individual
students, of very high levels of engagement.
j) Resources and materials to support teaching and learning were identified as
an issue. Most respondents developed their own materials and resources or
adapted ideas borrowed from colleagues.
k) The potential risks and consequences of adapting a career as a social scientist
to medical education are clear. Respondents were overwhelmingly
committed to making a contribution to medical education, largely perceiving
the opportunity to have an influence on future medical practice as both
satisfying and an indirect route to improving patient experience and
outcomes. However, there are challenges around professional and intellectual
identity and a portfolio of activities commensurate with academic interests
and career plans.
Preliminary conclusions
It is possible to share a number of preliminary conclusions based on this project:
a) There is evidence that UK medical schools are meeting the requirements laid
down around outcomes expected of graduates that they will have
demonstrated conversancy with social science research methods;
b) That the means by which this is achieved in terms of organisation of curricula,
provision of teaching and learning opportunities, modes and modalities of
practice are variable but characterised by a tendency toward provision to be
located in the earlier part of programmes (Phase 1) and to be made via a
combination of activities badged as subject specific and integration into other
topics and themes especially behavioural and social sciences, public health
evidence-based medicine, project work and SSCs.
c) Content clusters around the topically-oriented approach characteristic of
medical education: long-term conditions, studies of the family, health and
social inequalities in particular, and, also requirements for students to be
effective at critical appraisal of research evidence.

9. d) Provision is subject to assessment and this is largely summative in nature.
Formats of assessment are diverse but there is concern about a drift towards
closed item responses formats which may not be suitable for evaluation all
forms of social scientific knowledge.
e) Materials and resources for supporting teaching and learning are often
developed in-house.
f) There is a perception that there is scope for clearer guidance for medical
schools on the importance and contribution of teaching about social science
research methods. This could helpfully acknowledge and advise on how to
achieve effective provision within timetable constraints and also the key issue
of moving from beyond teaching about the means of doing research to core
concepts.
g) There is scope and some interesting and ambitious practice which enables
students to engage in research practice. This tends to be qualitative in nature
and while this approach warrants support, there is scope to build up
knowledge and understanding of quantitative research practice.
Impact
At this point in time, impact is emergent rather than fully realised. This is
appropriate given that dissemination of project outcomes is yet to take place.
Indeed, we plan to be measured in the pace of dissemination so as to create space
for the continued development of dialogue with the regulator about how to use the
findings of this project to best influence policy and practice development. However,
some impact is discernable. The process of collecting information has stimulated and
galvanised interest in the field. It has created dialogue about practice and also begun
to create opportunities for discussion with colleagues in allied health professions
about teaching and learning around social science research methods.
The likely areas for impact going forward are as follows:
a) development of a working group of social scientists teaching in medicine with
a specific focus on research methods;
b) input into the development of a core curriculum for sociology in medicine
currently being worked up by the BeSST network (Behavioural and Social
Scientists Teaching in medicine);
c) And, development of training opportunities for teachers of social science
research methods in medicine, health and social care professions.
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