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- Publisher
- Oxford University Press
- Copyright
- Copyright © 2022 Faculty of Public Health
- ISSN
- 1741-3842
- eISSN
- 1741-3850
- DOI
- 10.1093/pubmed/fdy058
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- See Article on Publisher Site
Abstract
Downloaded from https://academic.oup.com/jpubhealth/article/40/4/886/4953714 by DeepDyve user on 20 July 2022 Journal of Public Health | Vol. 40, No. 4, pp. 886–890 | doi:10.1093/pubmed/fdy058 | Advance Access Publication March 26, 2018 Perspectives Infiltrating history into the public health curriculum Virginia S. Berridge Centre for History in Public Health, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK Address correspondence to Virginia S. Berridge, E-mail: virginia.berridge@lshtm.ac.uk ABSTRACT The insertion of history into the medical school curriculum has been discussed over a long period of time. But the role of history in the public health curriculum has not been the subject of much discussion, despite the changes in UK public health training and the advent of multidisciplinary public health. This article reviews the history of inserting history into the curriculum in a leading public health postgraduate institution. It discusses the strategies used to secure acceptance for history; the positioning of history within the curriculum both as a core and a special subject; and the different curriculum content and learning approaches which have been used over time. It reviews recent developments in distance learning and the launch of a history Massive Open On line Course. It concludes that no one approach can be recommended for inserting history and that flexibility, persistence, alliances and the willingness to adapt to local circumstances are important. Students themselves are now more receptive to historical approaches and can appreciate the value of a discipline which teaches critical skills of analysis and assessment of evidence. It remains to be discussed how the discipline and such approaches can be transferred into wider professional public health training and at the undergraduate level. Keywords education, employment and skills, methods, public health European countries, Germany in particular, have a long Background 7,8 tradition of medical history teaching. The recent discus- The purpose of this study is to examine the history of sion in the UK dated from the publication of the General inserting history into the public health curriculum in a post- Medical Council’s 1993 document ‘Tomorrow’s Doctors. graduate public health institution and the lessons to be Outcomes and standards for undergraduate medical educa- drawn for public health training. It is primarily a personal tion’. History was one of several social science disciplines memoir, not a research paper. There has been wide discus- recommended with the potential to broaden the medical cur- sion of the role of history in the medical school curriculum. riculum.The choice for medical schools was left open. Some But history in the public health curriculum has not received hired sociologists, ethicists and anthropologists and others the same attention, although there has been much discussion appointed historians. Wellcome Trust funding for research 1–3 of that curriculum in recent years. I will briefly review into the history of medicine and health was the wider con- some relevant literature and the context of history and pub- 9 text. A surge of interest occurred elsewhere: Jaclyn Duffin’s lic health training. I will review strategies used to develop discussion of the insertion of history into the medical curric- history teaching at the London School of Hygiene and ulum at Queen’s University (Kingston, Canada) was widely Tropical Medicine; the structure of the programme over 10 cited. Duffin was dealing with longer medical training and time; problems encountered; and ways forward. developed both core courses and electives. She stressed that there was no perfect format and that individual teachers and institutions had to develop a curriculum which suited local History in the medical and public health circumstances. ‘Tomorrow’s Doctors’, which went through curriculum The discussion of history in the medical school curric- 4–6 Virginia S. Berridge, Professor of History ulum dates back to the 1940s and has continued. Some © The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), 886 which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. Downloaded from https://academic.oup.com/jpubhealth/article/40/4/886/4953714 by DeepDyve user on 20 July 2022 INFILTRATING HISTORY INTO THE PUBLIC HEALTH CURRICULUM 887 several revisions, the latest in 2009, was replaced in 2016 by (Duffin, op cit, Sheard, op.cit). For those in policy positions, 15,16 a new GMC document ‘Promoting excellence; standards for it also has relevance. When history should be studied medical education and training’. The arrival of medical has been discussed. Should it be a topic which is core for all humanities more centrally has meant that the interest in his- students or should it be in a special study module available tory is less strong than it was. Nevertheless the legacy of the to those who particularly want to take it? Should history be post 1993 change is notable, in particular in universities such a part of other topic based courses offered to students? as Liverpool and Birmingham which enthusiastically adopted What should the content of the history curriculum be? This 12,13 the suggestions of the GMC document. Teaching is is all discussed below. done by professional historians. However, a survey of his- tory of medicine in Student Selected Components (SSCs) Infiltrating the curriculum published in 2011 found that 15 of the 32 medical schools in the UK offered a history of medicine SSC. Most teaching When I came to the London School of Hygiene and was offered by medical professionals not by trained histor- Tropical Medicine as Senior Lecturer in 1988, teaching the ians.The focus was on the 20th and 21st centuries. history of public health was initially far from my mind. I was Public health has also undergone changes in its profes- part of a research programme, the AIDS Social History sional curriculum, reflecting changes in the workforce and Programme, and, in those days, teaching was not part of the the arrival of multidisciplinary public health. History plays core requirement. Jane Lewis, Professor of Social Policy at almost no role in the Part A curriculum or the Faculty of LSE, had been taking history classes with Masters students Public Health training competencies. The competencies at LSHTM after the publication of her book on the post developed by ASPHER (Association of Schools of Public war public health profession. She suggested collaboration Health in Europe) do include history of public health and to offer teaching on a wider basis, which I proposed to my practice, alongside epidemiology, demography, sociology, new head of department. There had been history teaching social psychology and anthropology. A 2014 survey which in the School before. Major Greenwood, Professor of mapped the core modules of public health Masters courses Epidemiology before World War Two, had given history in the United States and in England showed no specific role lectures. Sidney Chave, a non-historian member of the for history in the core curriculum, with the exception of the Department of Community Medicine, had given lectures in Mailman School of Public Health at Columbia University, the 1960s and 1970s, but these ended after his retirement. New York. There, public health history was part of a core We have no knowledge of the content of Greenwood’s lec- course on the Foundations of Public Health, along with eth- tures. Chave’s appear, from his slides, to have covered a ics and health and human rights (Document on public health standard ‘heroic’ history of 19th century public health training prepared for LSHTM teaching review 2014). There extending into topics such as health education and housing may be a history option available but it does not appear as a post World War Two. core requirement. Getting history into the curriculum was not easy. The School was going through extensive curriculum and other organizational change. For teaching, this meant central Why history: when and what? organization of the curriculum with core courses in term It is worth discussing briefly why students might gain benefit one followed by modular courses, some optional and some from studying history both of medicine and of public health; core, in terms two and three and a dissertation to complete when they should do this; and what they should study. the year. The changing public health curriculum was a battle The value of history lies, so it has been argued, in its ground for different interests: my development of history ability to foster critical thinking and scepticism about the was disruptive of an agenda for the insertion of social sci- content of the formal curriculum. It can also foster crit- ence based on sociology. Misogyny (bullying, which led to ical analysis of historical ‘heroes’ (John Snow and Edwin the departure of one senior female member of staff) was Chadwick for public health). It inculcates the notion of also involved. An initial after hours history class offered to change; that things have not always been as they are now the students was deliberately disrupted by two colleagues sit- and will change again in the future. History is recognized ting at the back of the class, talking and laughing. With per- as a research discipline, with its own research questions, sistence, a system for history emerged from these rough methods and materials, not so different from the research waters. I gained the support of the new Faculty teaching dir- approaches of the basic sciences but with different ques- ector, who wrote to all course organizers suggesting that tions, which can open up new issues for health professionals they consider an historical lecture in their course. Several Downloaded from https://academic.oup.com/jpubhealth/article/40/4/886/4953714 by DeepDyve user on 20 July 2022 888 JOURNAL OF PUBLIC HEALTH took this offer up. I lectured on the history of health promo- have not been published although they may be still in LSHTM tion or of environmental health on core courses. A review library). of the history of the School was inserted into the introduc- The approach was too unstructured and thus difficult for tory week. The core methods course, Principles of Social some students. In ~2003–4 we developed the curriculum Research, took a lecture on the role of history and on histor- and approach which still operates, with some changes, today. ical methods. This integration into linear courses in term 1 The arrival of my historian colleague Martin Gorsky, another prepared the way for a special history module, in term 3 trained teacher, was very helpful. He imported techniques after Easter. It had been agreed that it would be compulsory used with undergraduate history students at Wolverhampton for students. But another course, also compulsory, was mys- University. The course starts with an exercise where students teriously timetabled at the same time. So I focussed my use and learn how to assess primary source materials to attention on getting it recognized by the organizers of differ- approach a big historical question. Lectures analyse the ent Masters in the School. A course which was ‘blobbed’ as changes in what public health meant from the 18th century a Masters option (given a blob against it for that Masters in through to the near present. There are lectures on global the student handbook) was automatically higher profile with public health; on sexual health; drugs and alcohol; the com- students. The strategy was one in which students overall parative development of health services; and bringing history were exposed to historical input in term 1 through a variety into policy. A seminar follows,on a topic which expands on of entry points. Some chose to take the more specialist the lecture, for example, vaccination after the lecture on course in term 3. A pathway had been established. A com- 19th century public health. The students have access (now petitive Wellcome funded Masters studentship for students on line) to seminar materials we have chosen, a mix of pri- choosing history gave some funding. mary source materials and secondary historical analysis. The content of the module has gone through three itera- These are read in advance and form the basis of a facilitated tions. Initially I was the only historian on the School staff. I seminar discussion. The skills of assessing evidence and dis- had experience in teaching non specialists through the cussing historiography and interpretation are to the fore. University of London extra mural department and through Stand alone sessions cover public health films; a visit to the my membership of the Open University course team on School archive, and to the Wellcome library. The assessed Health and Disease. The modular arrangement is a 5-week work is an essay based on primary and secondary source course in which the students spend half a week (2 and a half material, which we provide as part of the on line curated days) each week on the subject. I gave lectures on the history course material. of public health overall and on health policy. I drew on the The positioning of the course had to change a few years services of neighbouring London health historians such as ago. Bringing the School Masters curriculum in line with the Dorothy Porter on Europe. We visited the Wellcome library European Bologna process meant teaching after Easter and archive and also the Science Museum. The module was came to an end. We had attracted students who wanted to assessed by presentation and essay and the marks formed study a real interest after they had completed ‘bread and but- part of the grade point average which went towards the final ter’ courses. Our internal module numbers, which had overall mark for the Masters. reached the upper twenties, dropped. But we reach a wide Gradually the group of historians expanded. Jenny Stanton, range of internal students in those terms now through the who joined as research fellow in the mid 1990s, was a trained expansion of history lectures on topic based modules, teacher. We tried a different approach. Rather than formal lec- including Social Epidemiology; Malaria; and Drugs Alcohol tures, we asked the students all to read a core paper in advance and Tobacco. of the scheduled teaching session. This would then be intro- In 2011, colleagues and I published a book, ‘Public duced and discussed with its implications drawn out. For Health in History’, as part of the School’s distance learning example, we used Simon Szreter’s well known paper question- (DL) series. There were difficulties getting history into the ing the McKeown thesis and talked about its implications for DL system because of the relatively small number of in- both past and present. The assessed work was a research house students. Persistence on my part in forwarding the project of the student’s own choosing for which staff support DL agenda paid off and the course has regularly attracted was available. This produced some wonderful mini disserta- 50 or so students each year, covering similar ground to the tions; for example, one on the history of the almost final in-house course. Assessment is by examination, although an smallpox outbreak in the UK, which had originated in the essay may become the preferred option. DL is meant to be School. The student concerned tracked down papers and inter- part of ‘blended learning’, where an in-house student can viewed staff who had been there at the time (These projects take a distance based course if there are timetable clashes. Downloaded from https://academic.oup.com/jpubhealth/article/40/4/886/4953714 by DeepDyve user on 20 July 2022 INFILTRATING HISTORY INTO THE PUBLIC HEALTH CURRICULUM 889 A significant development has been a public health history Acknowledgements Massive Open On line Course (MOOC). The School has I am grateful to the many colleagues both within LSHTM developed very successful MOOCs on topics such as Ebola. and in other centres, who have advised me on this topic. The offer to develop a history MOOC came from the School, Some appear in the text of the article and in the endnotes. I and my colleague Alex Mold took the lead. The course lasted am also grateful to the organizers of the conference on 3 weeks in 2017 and was open to all. It covered post war ‘Teaching the history of medicine in medical faculties in the British public health and attracted nearly three thousand stu- Netherlands’ held in Leiden in November 2015, who invited dents. It has run a second time and again attracted large num- me to speak about the British experience. The article has bers, with a third planned. Some internal students followed it. been much improved by consideration of an excellent set of referees’ comments and I am grateful for the time and atten- Future opportunities tion they gave to it. Our in-house and DL courses regularly receive excellent eva- luations and students ask why they are not exposed to more Funding history earlier.A teaching review completed in 2014 did pro- No specific funding to acknowledge or conflicts of interest. pose a Columbia style core course which would incorporate history for all,but the future of that initiative is uncertain. The expansion of historian numbers in the School—now References three core funded historians and a range of research fellows— 1 Gillam S, Maudsley G. Public health education for medical students: means that there is no problem in staffing. We have a tropical rising to the professional challenge. J Public Health 2010;32:125–31. historian, John Manton, whose expertise fits well with the 2 Lyon AK, Hothersall EJ, Gillam S. Teaching public health in UK international students. The LSHTM History Centre has taken medical schools: ‘things have improved: teaching no longer feels like on the humanities brief and is currently developing ideas, such an expensive hobby’. J Public Health 2016;38:e309–15. as our long interest in film and the media in teaching. 3 Gillam S, Rodrigues V, Myles P. Public health education in UK History teaching in the School is also delivered by non- medical schools-towards consensus. J Public Health 2016;38:522–25. historians. Auditing public health courses in the course of 4 Rosen G. The place of history in medical education. Bull Hist Med research for a book on public health, I discovered my non- 1948;22:594–627. historian colleagues gave lectures using history. Here the ‘old 5 Risse GB. The role of medical history in the education of the style’ history of public health was much to the fore and his- humanist physician. J Med Educ 1975;50:458–65. torical interpretation unknown. History is one of those disci- 6 Jones DS, Greene JA, DuffinJ et al. Making the case for history in plines which anyone thinks they can practise. Nevertheless medical education. J Hist Med Allied Sci 2015;70(4):623–52. these inputs also serve to acclimatize students to the idea of 7 Huisman F, Harley Warner J (eds). Locating Medical History: The history and to give it legitimacy. Stories and Their Meanings. Baltimore: Johns Hopkins University What we have developed in the School has not carried Press, 2004. over into the wider area of public health professional train- 8 Fangerau H, Bondio MG. Stresses in the young medical history: legitimization strategies and conflicting goals—a contribution to the ing. The newer undergraduate degrees in Public Health do discussion. NTM 2015;23(1–2):33–52. not incorporate history, at least from their published curric- 9 General Medical Council. Tomorrow’s Doctors: Recommendations on ula. Returning to Duffin’s conclusions, it is indeed the case Undergraduate Medical Education. London: GMC, 1993. there is no one model which can be applied and no curric- 10 DuffinJ.Infiltrating the curriculum: an integrative approach to his- ulum for all. Duffin’s model of core and electives has been tory for medical students. J Med Humanit 1995;16:155–74. achieved, although not in quite the same way. It has been 11 GMC. Promoting Excellence: Standards for Medical Education and important to be flexible, persistent and to keep long-term Training. http://www.gmc-uk.org/education/standards.asp (2 objectives in view. There has been a continual seeking of November 2017, date last accessed). opportunities for development, in alliance with non-historian 12 Sheard S. Developing history of medicine in the University of colleagues. Our students are not trained historians and have Liverpool Medical Curriculum 1995–2005. Med Educ 2006;40: many demands on them in a 1-year Masters. Infiltrating the 1045–52. curriculum at various points has ensured that they have 13 Reinarz J. University of Birmingham, personal communication. been given exposure to the critical analytical skills of history. 14 Metcalfe NH, Brown AK. History of medicine student selected It still remains to be acknowledged that these are also essen- components at UK medical schools: a questionnaire based study. tial in the wider field of public health training. J R Soc Med Short Rep 2011;2:1–6. Downloaded from https://academic.oup.com/jpubhealth/article/40/4/886/4953714 by DeepDyve user on 20 July 2022 890 JOURNAL OF PUBLIC HEALTH 15 Berridge V. History in Public Health: who needs it? Lancet 2000; 18 Webster C (ed). Caring for Health: History and Diversity, 2001 edn. 356:1923–5. Buckingham: Open University Press, 1993. 16 Berridge V. History Matters? History’s role in health policy making. 19 Szreter S. The importance of social intervention in Britain’s mortal- Med Hist 2008;52:311–26. www.historyandpolicy.org. ity decline c 1850–1914: a reinterpretation of the role of public health. Soc Hist Med 1988;1:1–37. 17 Lewis J. What Price Community Medicine? The Philosophy, Practice and Politics of Public Health since 1919. Brighton: Wheatsheaf, 20 Berridge V, Gorsky M, Mold A (eds). Public Health in History. 1986. Maidenhead: Open University Press, 2011.
Journal
Journal of Public Health – Oxford University Press
Published: Dec 1, 2018
Keywords: public health medicine