Sociology in Medical Undergraduate Education: A Survey in Greece

Abstract

The integration of sociology into medical education is essential for cultivating a nuanced understanding of the complex interplay between social determinants and health outcomes. This national cross-sectional survey utilized a qualitative, descriptive research approach to examine the inclusion of sociology as a course in the undergraduate curricula of medical schools in Greek higher education. Data collection and analysis were conducted through a comprehensive review of the syllabi from all seven medical schools in Greece. The analysis revealed that none of the seven undergraduate medical curricula include sociology as a discrete course. Social medicine is offered as a discrete course in three out of the seven programs, whereas sociological concepts are present in the majority of the medical curricula (six out of seven). A significant gap in the integration of sociology as a discrete course within Greek medical graduate education is revealed. To better equip future medical doctors with sociological lenses towards medical practice, a more comprehensive integration of sociology into medical training is recommended.

1. Introduction

Sociology has been instrumental in advancing medicine by providing essential insights that deepen our understanding of health, illness, and healthcare systems [1]. The dominant theme in the sociology of health explores how social stratification—across dimensions such as socio-economic status, gender, class, ethnicity, and age—shapes patterns of health and illness behaviors, risk, disability, and various other healthcare outcomes, emphasizing the critical need to address social inequalities in health [2,3]. A significant corpus of evidence has been accumulated by sociological research means on social determinants of health, health inequalities, social class and stratification, the organization and use of health services, health policy, and family health, dominating the study of population-based health. Notably, sociology and demography have significantly influenced the development of social medicine [4]. Sociology also critically examines the complex dynamics of doctor–patient interactions to understand and interpret communication, trust, and treatment adherence against the context of power dynamics between healthcare providers and patients [5,6].

Medicalization and social control are also important sociological notions with implications for medicine, referring to the process by which non-medical problems are defined and treated as medical issues, such as mental health or normal life processes like childbirth and aging and how medicine acts as a form of social control by regulating behaviors considered unhealthy or deviant [7]. The experience of living with chronic illness and disability constitutes another field where sociology provides significant contributions, since it interprets the social implications of chronic illness, including its impact on identity, relationships, and daily life. Disability studies within sociology focus on how society constructs and responds to disability, advocating for more inclusive policies and practices. Moreover, sociology explores the ethical and moral dimensions of medical practices and policies, providing a framework for addressing complex issues such as end-of-life care and reproductive rights [8].

The development of medical sociology as a distinct field of knowledge occurred in the post-World War II period, catalyzed through substantial funding from the American government via the National Institutes of Health for joint research initiatives between sociologists and medical professionals. A parallel trend emerged in Western Europe, though in contrast to the U.S., relatively few medical sociologists there held positions within university sociology departments, and their connections to the broader discipline of sociology remained weak. The establishment of medical sociology as a subdiscipline was largely driven by the availability of government funding, which encouraged collaboration between sociologists and health professionals. These funding bodies, rather than emphasizing theoretical inquiry, prioritized research with practical relevance to postwar societal needs, as Western governments increasingly acknowledged the critical role of social factors in health [9,10].

The foundations of medical sociology were initially rooted in a structural-functionalist model of society, as its development was significantly influenced by Talcott Parsons, a key proponent of this model. Parsons’ seminal work, The Social System, played a pivotal role in establishing medical sociology as a distinct subdiscipline within the field. However, structural-functionalism, with its focus on value consensus, social order, and macro-level stability, had a brief period of dominance in medical sociology, facing significant criticism. Symbolic interactionists objected to its portrayal of individuals as passive actors, while conflict theorists argued it failed to account for social change and the role of conflict. Its emphasis on equilibrium and consensus was also seen as reinforcing the status quo and supporting dominant elites [10].

The absence of sociology in medical curricula may lead to a low understanding of how social factors influence health, which may escalate to a narrow focus on biological factors alone, potentially neglecting the broader context of patient health and missing critical social determinants that contribute to health disparities [2]. Medical curricula that do not include course sociology may fail to adequately address issues of health inequality and social justice. As a result, future doctors might end up less aware of systemic inequities in healthcare access and outcomes, less prepared to advocate for marginalized populations and work towards reducing health disparities, and even worse, may resort to victim blaming practices [1]. Furthermore, without sociology, medical students might not be adequately trained in recognizing and addressing the reasons behind certain health behaviors, which could result in less effective patient counseling and health promotion strategies, as physicians may not fully grasp the social and cultural influences on behaviors like smoking, poor diet, or non-adherence to treatment plans [1,3].

There is also a risk of over-reliance on medicalization, treating non-medical issues as medical problems without addressing their social roots [11]. This approach can result in inappropriate treatments and interventions, overlooking preventive measures and broader social solutions that could be more effective. Moreover, sociology provides a framework for exploring the ethical and moral dimensions of medical practice, including complex issues like end-of-life care, reproductive rights, and social control. Without this perspective, medical professionals might be less prepared to navigate ethical dilemmas and advocate for policies that promote social justice and patient rights [8].

Several decades ago, in the mid-1950s, medical sociology, the predecessor of the sociology of health, had gained a strong and valuable place in medical curricula. However, early optimism was also accompanied by skepticism over whether medical sociology would retain its prestigious place in medical education. As Strauss, one of its founders, remarked: “Lest we become too confident of our demonstrated worth, it should be noted that a majority of the positions held by sociologists on medical school faculties have been supported by foundations […]. It is encouraging that so many medical schools have taken advantage of this opportunity. However, the true test will come only when these schools are faced with the decision of continuing such positions within their own budgets” [11]. With this perspective, we revisit what Strauss termed “sociology in medicine” to explore whether future medical doctors in Greece receive pre-service training in sociology.

Sociology in Greece was not formed as a discipline until the 1960s [12]. Despite its initially limited presence and influence during the country’s slow modernization and dependency, it demonstrated a notable capacity for renewal. Caught between an insular focus within the Greek academic and public spheres and a humility born from its dependence on prominent sociological centers abroad, the discipline often undervalued its own potential for collaboration and growth, as emphasized in a recent textbook examining the development of the discipline during the last two decades [13]. However, even this comprehensive textbook dedicated to sociology in Greece fails to adequately address this specialty of sociology of health or medical sociology, signaling the marginal place it holds in the wider field.

This case study focuses on the medical undergraduate curricula of the Greek tertiary education, departing, as usually is the case in sociological research, from an empirical observation that this subject is missing from medical doctor’s pre-service training. Hence, we decided to embark on a survey to map out medical sociology or the sociology [12] of health in medical undergraduate education. The literature on the topic is scarce, whereas the sociology of health is mostly found in postgraduate courses organized by medical schools.

In summary, integrating sociology into medical curricula is crucial for developing well-rounded healthcare professionals who are equipped to address the complex interplay between social factors and health, leading to more effective and equitable healthcare outcomes. Within this framework, this survey examines the curricula of all medical schools in Greece, addressing the primary research question of whether sociology or medical sociology is included as a standalone course in undergraduate medical programs, and if so, what its content comprises.

2. Materials and Method

This study employed a qualitative, descriptive research design to explore the inclusion of sociology as a discrete course or the integration of sociological concepts and methods in the undergraduate medical education of public universities in Greece. The research was conducted through a comprehensive review and analysis of the syllabi of all seven medical schools in the country. The research objectives followed a structured valid protocol [14] adopted to the goals of this study (

Table 1. Goals of this study.

Research Objectives Primarily Addressed through Systematic Mapping:
RO1: Mapping the landscape of all undergraduate level programs available in Greece in the field of medical science;
RO2: Determining what constitutes a distinct unit of sociology as a subject and what relevant to sociology modules;
RO3: Systematizing information on the characteristics of these modules of the medical curricula.

).

Data were collected from the official websites and academic catalogs of the following seven medical schools of an equal number of public higher education institutions:

• National and Kapodistrian University of Athens—Faculty of Medicine;
• Aristotle University of Thessaloniki—Faculty of Medicine;
• University of Patras—School of Medicine;
• University of Crete—Faculty of Medicine;
• University of Ioannina—School of Medicine;
• Democritus University of Thrace—Faculty of Medicine;
• University of Thessaly—Faculty of Medicine.

The curricula for the undergraduate medical programs were obtained from these sources, focusing on the most recent academic year available (2023–2024).

The analysis involved the following steps:

Compilation of Curricula: Each medical school’s syllabus, containing the complete undergraduate curriculum, was compiled into a comprehensive dataset. This included course titles, and detailed descriptions, where available.

Identification of Sociology: We specifically searched for courses explicitly contain in the title the term “Sociology of health” or “Medical Sociology”, considering it as a discrete subject (first round of search). In the case of no relevant results, we employed a broader search, seeking to identify relevant courses, such as social medicine (second round of search). In the case of no relevant results, a focus on sociological concepts or methods within their titles or descriptions, such as social theory, social determinants of health, health inequalities, sociocultural issues in health, and the medicalization of health was sought.

Categorization: Each identified course was categorized based on whether it was a full course dedicated to sociology, a relevant course or a course containing significant sociological elements.

Comparison and Contrast: We compared the presence and extent of sociology content across the seven medical schools to identify patterns, similarities, and differences.

Validity and Reliability

To ensure the validity and reliability of the data:

Multiple Data Sources: We cross-referenced the collected curricula with additional resources such as an academic timetable, official announcements, and the faculty area of expertise to ensure that the data accurately represented the content being taught, thus enhancing the study’s validity by confirming that the collected data measure the intended educational aspects.

Inter-rater Reliability: Three independent reviewers examined the curricula to identify sociological content. Discrepancies were resolved through discussion and consensus, ensuring reliability through consistency in the interpretation of the curricula across different evaluators.

Four Rounds of Searching: The seven comprehensive syllabi under investigation contained obligatory modules and elective obligatory modules within the medical curricula of the medical schools or faculties. Four rounds of searching were employed to extract data, ensuring the thoroughness and reliability of the search process, although future studies could explore validity by assessing whether these methods are the best suited for answering the research question.

The first round searched for courses explicitly labeled as sociology of health or medical sociology. If no results were found, the second round searched for courses labeled with relevant sociological terms (i.e., social medicine, social theory, social determinants of health, health inequalities, sociocultural issues in health, medicalization of health, etc.).

If the second round yielded no results, the third round examined courses unrelated to sociology which contained sociological concepts (e.g., social theory, social determinants of health, health inequalities, sociocultural issues in health, medicalization of health, etc.). If no relevant content was identified, the fourth and final round recorded zero results in total.

If the first or second round yielded results, the ECTS, the type of module (obligatory or selective obligatory), and the hours in the timetable were also recorded.

In the third and fourth rounds, ECTS, hours in the timetable, and module type were not recorded, as these data were considered irrelevant in that the course was irrelevant to sociology.

In what follows, the syllabi are described in reference to (a) the full academic title of the medical school, (b) the sectors of the medical school, and (c) the titles and type of courses of the curriculum (obligatory or elective obligatory, represented with acronyms in

Table 2. Sociology in undergraduate curricula of medical schools.

Institution	Discrete Course	Relevant Course	Relevant Modules	Type/ECTS
National and Kapodistrian University of Athens		X	√	OE
	X
Aristotle University of Thessaloniki	X	√	√	OE/4
University of Patras	X	X	X	-
University of Crete	X	X	√	OE
University of Ioannina	X	X	√	-
University of Thessaly	X	√	√	O/4
Democritus University of Thrace	X	√	√	O/4

).

3. Results

The outcomes of the survey are reported according to each institution, while a synthesis is cited by the end of this section.

National and Kapodistrian University of Athens

The faculty consists of six sectors: (a) Basic Medical Sciences, (b) Clinical Laboratory Studies, (c) Internal Medicine, (d) Surgery, (e) Mother–Child Health, (f) Social Medicine–Psychiatry–Neurology. The current syllabus (2023–2024) consists of 378 pages that are accessible online [URL: https://school.med.uoa.gr/fileadmin/depts/med.uoa.gr/school/uploads/Odigos_Spoydon/Odigos_Spoydon_2023-2024.pdf (accessed on 1 August 2024)]. The curriculum consists of 49 obligatory courses and 82 elective ones. The students, apart from the obligatory ones, are required to attend 12 obligatory elective courses.

First round: no results. Second round: no results. Third round: On page 132, the course “Epistemology, History and Ethics of Medicine” (obligatory), offered in the first winter semester, includes the module “Epistemology and Humanities in Medicine” which contains the following description: “The evolution of hospitals and healthcare infrastructure over time and their interaction with society”, “Stigma in Medicine”, “The great scourges of humanity and their impact on the evolution of medicine, society, health policy, and literature (plague, cholera, influenza, leprosy, syphilis, tuberculosis)”, “Humanitarian Medicine—Medicine and refugees in Greece (19th–21st century)” and “The evolution of pharmaceuticals and their impact on humans and society”. On page 148, in the course “Preventive Medicine & Public Health” (obligatory) offered in the first winter semester, it is mentioned that the concepts to be analyzed in the lectures include “Inequalities and disadvantaged population groups”. On page 160, the course “Paediatrics” (obligatory), offered in the sixth semester during spring, includes a module termed “Social Pediatrics”, which addresses “the goals of pediatrics, the modern bio-social morbidity of infancy, common child-rearing and behavioral issues, child abuse and neglect, the care and management of a child with a chronic condition and adolescent problems”. On page 227, the course “Palliative care in Chronically ill patients” (elective obligatory), offered in the spring semesters (sixth, eighth, tenth, twelfth), mentions the following as one of the educational goals: “to be able to address the psychological, social, and spiritual needs of the patients”. On page 238, the course “Humanitarian Values and Modern Medicine” (elective obligatory), offered in the winter semesters (first, third, fifth, seventh, ninth, and eleventh), makes a reference to sociology as follows: “The lectures focus on the value of life, illness, the role of the physician, the doctor–patient relationship, and death, drawing relevant insights from the fields of Philosophy, Theology, Sociology, Literature, and the Arts”. It is noted that it does not belong to the social medicine sector as anticipated. On page 256 the course “Geriatrics” (elective obligatory), offered in the winter semesters (seventh, ninth, eleventh), mentions as one of its learning objectives “to be able to discuss the social and bioethical issues that complicate the medical care of elderly patients, including end-of-life care”. On page 279, “Disaster medicine and Humanitarian aid in the 21st century and the EU” (elective obligatory), offered in the winter semesters (seventh, ninth, eleventh), includes in the learning outcomes: “at the end of this course, students should be able to become familiar with the concepts of humanitarian medicine, disaster medicine, emergency humanitarian assistance, global health, as well as the social, legal and historical contexts that characterizes the humanitarian sector and its evolution”. On page 291, the course “Developmental and Behavioral Pediatrics” (elective obligatory), offered in winter semesters (third, fifth, seventh, ninth, eleventh), includes in its modules “the understanding of the biopsychosocial mechanisms governing human development from birth to adulthood”. On page 292, “Adolescent Medicine” (elective obligatory), offered in the winter semesters (third, fifth, seventh, ninth, eleventh) includes “strategies for the prevention and promotion of adolescent health, the study of the physical, psychological, behavioral, cognitive, and social characteristics of adolescents (individuals aged 10–21 years), the diagnosis and management of their health problems, and the care of their specific needs”. On page 307, the course “Drug Dependence: Biological, Psychological and Social Approaches”, offered in the spring semesters (fourth, sixth, eighth, tenth, twelfth), aims “to develop skills related to demonstrating social, professional, and ethical responsibility and sensitivity to gender issues related to addiction. Students should be able to propose ways to address addiction on both an individual and societal level”.

Aristotle University of Thessaloniki

The faculty consists of six sectors: (a) Radiology, Anatomy, Pathological Anatomy, and Technologies, (b) Physiology, Pharmacology, Biological Sciences and Preventive Medicine, (c) Pathology, (d) Surgery, (e) Child Health, and (f) Neurosciences and Sensory Organs. The “reformed curriculum”, implemented since the academic year 2019–2020, requires students to successfully complete 76 obligatory courses, totaling 39 courses up to the tenth semester, seven clinical rotations in the eleventh and twelfth semesters, and five elective obligatory courses. The current syllabus consists of 59 pages online [URL https://www.med.auth.gr/sites/default/files/odigos_spoydon_23-24.pdf (accessed on 1 August 2024)].

First round: no results. Second round: “Social Medicine and Public Health” is offered as an obligatory course in the sixth semester. The course “Paediatric Developmental and Social Paediatrics” is offered as an elective obligatory in the tenth semester. However, this syllabus does not offer descriptive frameworks of each course to respond to the third round of searching. The page of the Faculty of Medicine was scrutinized subsequently to identify the descriptive frameworks of the relevant course, which were identified through the following link: https://www.med.auth.gr/course/koinoniki-iatriki (accessed on 1 August 2024). From this is traced the relevant following excerpt, but only for the first of the above courses: “Reading this chapter will enable you to answer the following questions: What is the impact of social, economic, and demographic factors on health? Why is unemployment considered a risk factor for diseases? How are health inequalities addressed? Definitions and objectives of social and preventive medicine, Epidemiology: research design and methodology—Meta-analysis, Health promotion and quality of life: design and evaluation of interventions, General and specific epidemiology of cancer, General epidemiology and prevention of infectious diseases, Epidemiology of selected infectious diseases, Epidemiology and prevention of coronary artery disease, Accidents, Smoking, Alcoholism, Demography, Family planning—Contraception, Health inequalities”. As it appears from the above, merely 1 out of 13 topics covered through the module (i.e., health inequalities) is relevant.

University of Ioannina—School of Medicine

The school consists of seven sectors: (a) Functional-Clinical Laboratory, (b) Morphological Laboratory, c) Clinical Laboratory, (d) Surgery, (e) Pathology, (f) Child Health, Social Medicine, and Mental Health, and (g) Nervous System and Sensory Organs. Students are required to complete 12 semesters of study and successfully pass the compulsory courses outlined in the curriculum, as well as nine elective courses, totaling 360 ECTS credits. The current syllabus (2023–2024) consists of 117 pages accessible online [URL: https://med.uoi.gr/wp-content/uploads/2024/05/programma-spoudon-2023-2024-1.pdf (accessed on 1 August 2024)].

First round: no results. Second round: The sector of Social Medicine and Mental Health refers to the Laboratory of Social Medicine and Health Education. However, this particular laboratory does not seem active; there is no member of faculty or adjunct faculty assigned to this, there is no course description, and it is not mentioned in the timetable.

University of Patras

The school consists of five sectors: (a) Basic Medical Sciences I and II, (b) Clinical Laboratories, (c) Pathology I and II, (d) Surgery and Pediatrics, and (e) Obstetrics and Gynecology. The study program is structured into 12 semesters and corresponds to 360 ECTS credits. The current syllabus (2022–2023) consists of 1223 pages accessible online [https://www.med.upatras.gr/uploads/%CE%9F%CE%94%CE%97%CE%93%CE%9F%CE%A3%20%CE%A3%CE%A0%CE%9F%CE%A5%CE%94%CE%A9%CE%9D%202022-2023.pdf (accessed on 1 August 2024)].

All three first rounds of searching yielded no results.

University of Crete

The school consists of ten sectors: (a) Radiology, (b) Basic Medical Sciences, (c) Laboratory Medicine, (d) Social Medicine, (e) Mother–Child, (f) Morphology, (g) Neurology and Sensory Organs, (h) Pathology, (i) Surgery, and (j) Psychiatry. The requirements for obtaining a degree are as follows: For compulsory courses, the successful completion of all compulsory courses with a total workload of 226 ECTS. For clinical training, the successful completion of all clinical exercises with a total workload of 112 ECTS. For elective courses, the successful completion of elective courses with a total workload of at least 22 ECTS. For the total ECTS, the accumulation of at least three hundred sixty (360) ECTS. The current syllabus (2023–2024) consists of 24 pages accessible online [URL: https://med.uoc.gr/wp-content/arxeia-greek/proptyxiaka/anatheorimeno-pps_odigos-spoudon-2022-2023.pdf (accessed on 1 August 2024)]. Since the descriptions of the modules were not included in the above text, we accessed the relevant text consisting of 424 pages [URL: https://med.uoc.gr/wp-content/arxeia-greek/proptyxiaka/anatheorimeno-pps_perigrammata-mathimaton-2023-2024.pdf (accessed on 1 August 2024)].

First round: no results. Second round: no results. Third round: The course “Introduction to Public Health” mentions as one of its goals “The contribution of sociology and anthropology of health to the interpretation of health and illness”. The course “Epistemology & History of Medicine” mentions among its goals “The sociological interpretation of medicine, health, and illness”, “Biological, Behavioral, and Social Determinants of Health”, and “Indicators of Social Inequality in Health”. The course “Medicine and Human Sciences” claims that it helps students in “Acquiring competencies and skills for an interdisciplinary approach to medicine and the humanities and social sciences”. The course “Compassion in Clinical Care”, offered at the third winter semester, mentions that “Upon completion, the student will have the necessary skills to provide care to patients in primary health care, in the hospital, within the family, and in the broader community”. The course “Patient-centered care: Concepts and Principles”, offered at the eighth spring semester, states that “The main objective is to introduce the medical student to the need for developing the essential relationship and effective communication with the patient, and more generally with individuals who interact with health services, as well as acquiring the necessary skills for behavior change”. Its goals include “The Respect for diversity and multiculturalism”, “The Demonstration of social, professional, and ethical responsibility and sensitivity on gender issues”, and “The Approach to vulnerable populations, such as the unemployed, patients with multiple comorbidities, end-stage patients, and those of low socio-economic status”. Finally, the course “Clinical Practice in Primary Health Care”, offered at the eleventh winter and twelfth spring semesters, mentions among its goals that “Upon completion, the student will be able to apply in practice concepts such as social determinants, understand the importance of the connection between Primary Health Care and public health, as well as interprofessional collaboration based on what was taught in the course ‘Society and Health’”.

University of Thessaly

The medical school consist of seven sectors: (a) Basic and Applied Biomedical Sciences, (b) Clinical Laboratory Sciences, (c) Mother and Child, (d) Morphology, (e) Neurology and Sensory Organs, (f) Pathology, and (g) Surgery. The current syllabus (2023–2024) consists of 98 pages and it is accessible online [URL: https://med.uth.gr/Files/Odigos-Spoudon/%CE%9F%CE%94%CE%97%CE%93%CE%9F%CE%A3%20%CE%A3%CE%A0%CE%9F%CE%A5%CE%94%CE%A9%CE%9D%202023-2024.pdf (accessed on 1 August 2024)]. The workload for each full-time student during an academic year is estimated at sixty (60) ECTS credits, with thirty (30) ECTS credits per semester.

First round: no results. Second round: The obligatory course “Social and Preventive Medicine” is traced.

Democritus University of Thrace

The medical school consists of seven sectors: (a) Functional—Clinical Laboratory Sciences, (b) Morphological—Clinical Laboratory Sciences, (c) General Pathology, (d) Internal Medicine, (e) Surgery, (f) Neurology, Psychiatry and Sensory Organs, and (g) Child Health. The current syllabus (2023–2024) consists of 73 pages accessible online [URL: https://med.duth.gr/wp-content/uploads/2024/02/%CE%9F%CE%94%CE%97%CE%93%CE%9F%CE%A3-%CE%A3%CE%A0%CE%9F%CE%A5%CE%94%CE%A9%CE%9D-%CE%A4%CE%95%CE%9B%CE%99%CE%9A%CE%9F-11.10.2023%CE%9D-2.pdf (accessed on 1 August 2024)]. The curriculum comprises courses that correspond to 360 ECTS credits, with 54 compulsory courses, 56 elective courses, and 6 clinical training courses offered. To obtain the degree, students must successfully complete 54 compulsory courses, 14 elective courses, and 5 clinical training courses.

First round: no results. Second round: The obligatory course “Social Medicine” is traced, which includes the following modules: Practice of Medicine at the community level (as opposed to individual-level medicine), Investigation of the social causes of morbidity and mortality, Research methodology in Social Medicine and Public Health, Preventive measures and their evaluation, Health education and promotion within the community, in collaboration with community organizations, Health determinants (and illness) related to social and environmental factors, Health inequalities, Sociogenic diseases, Provision of healthcare services, Health systems, Issues of special epidemiology from the perspective of Social Medicine, Epidemiology of external causes of injury, and Clinical dimensions of Social Medicine.

Summary

None of the seven medical undergraduate curricula surveyed include sociology as a standalone course in pre-service medical training. Three out of the seven (3:7) curricula offer Social Medicine as a distinct course, which is related to sociology but treated as a separate discipline. Six out of the seven curricula (6:7) incorporate sociological concepts and ideas, while one curriculum stands out as an extreme case, with no sociological concepts identified at all.

4. Discussion

Sociology provides critical insights into the social determinants of health, patient behaviors, and the complex relationships between healthcare systems and society [15]. The inclusion of sociology in medical curricula may equip future doctors with a holistic understanding of patients, beyond biological symptoms, emphasizing the importance of social context in diagnosis and treatment. However, the inclusion of sociology into the medical curricula differs, appearing either as a standalone course or as module of other courses. When offered as an autonomous course, sociology benefits from dedicated time, allowing for a deeper exploration of the subject and greater control over its content, delivery, and assessment [16].

The extent to which sociology is integrated into medical education varies considerably. In countries like the United Kingdom, Canada, and the United States, sociology has appeared as part of the pre-service medical training for several decades, although the depth and emphasis can vary from one institution to another [16]. A survey conducted in the UK several years ago [17] discovered considerable variation on the topic, with two medical schools having no course, and two schools providing over sixty hours per year [17]. A detailed, albeit dated, article documented the presence of medical sociology faculty and outlined the role and content of sociology in the curricula of Canadian and American medical schools [18]. However, although it is reported that six medical schools in Canada include sociology in their undergraduate medical education, the article does not provide the total number of medical schools in Canada, limiting the potential for meaningful comparisons.

Medical sociology is often included in the early years of medical training, with a focus on topics such as health inequalities, doctor–patient interactions, and the impact of social policies on health. However, in other parts of the world, particularly in countries with more traditional medical education systems, sociology is less prominently featured. In many cases, it is incorporated into broader courses on medical ethics or public health, rather than being offered as a standalone subject [11].

This survey discovered that none of the seven medical schools within Greek tertiary education offer sociology as a standalone course in their undergraduate medical curricula. This finding clearly highlights the marginalization of medical sociology and the sociology of health within the core education of medical students. It is noteworthy that, despite the presence of a social medicine department in most medical schools, these departments do not consistently offer courses in sociology or even social medicine, as evidenced by institutions such as the University of Athens, the University of Ioannina, and the University of Crete. The University of Patras represents the most striking case, where sociology is entirely absent from the curriculum, with no sociological content integrated into the six-year medical program.

Social medicine is offered as a distinct course in four out of seven medical schools, highlighting again a peripheral presence of sociological concepts in the education of medical graduates. However, social medicine is a distinct discipline from sociology, seeking to bridge clinical medicine and preventive medicine with the aim of benefiting both fields. According to a classical definition by Hobson in 1949, it is the study of the environmental factors that affect health and has two main applications. On the one hand, the use of this knowledge is for the benefit of the individual both in health and in disease; this is the responsibility not only of the physician and surgeon but of each individual. On the other hand, this knowledge can be used on a community basis; this is a responsibility of the community. It has been known in the past as “public health “or “state medicine” [19].

However, it is recognized that seeds of sociological notions are traced within undergraduate medical curricula. This set of findings reveals that several challenges hinder the effective integration of sociology into medical curricula. One significant barrier is the perception among some medical professionals and educators that sociology is less relevant or too “soft” compared to the hard sciences [8,20].

This perception can lead to sociology being underemphasized or marginalized in the curriculum. Additionally, there is often a lack of qualified faculty to teach medical sociology, particularly in regions where sociology is not well-established as a discipline. This shortage can result in sociology being taught by non-specialists or in a manner that does not fully convey its importance to medical practice. Furthermore, the packed nature of medical curricula, which must cover extensive biomedical content, leaves little room for subjects like sociology. As a result, when sociology is included, it may receive minimal time and attention, making it difficult for students to grasp its relevance fully.

Despite these challenges, the inclusion of sociology in medical education has been shown to have numerous benefits, even leading to a new paradigm of healthcare, as Sarah Nettleton describes explicitly in her work on the Sociology of Health and Illness. This paradigm shift reflects how individuals are increasingly seen not just as passive recipients of healthcare but as active participants in their own health maintenance and aligns with trends in modern health policy, which encompass health promotion, community care, and consumerism in healthcare choices. This paradigm marks a shift from traditional, paternalistic biomedical-oriented healthcare models toward a more patient-centered approach, where lay knowledge and social determinants play a significant role in equitable health outcomes [1].

Studies have demonstrated that medical students who receive training in sociology are more likely to appreciate the social dimensions of healthcare and adopt a more patient-centered approach in their practice [21]. They are better equipped to understand and address health inequalities, communicate effectively with patients from diverse backgrounds, and navigate the ethical complexities of modern medical practice [22]. In some cases, the integration of sociology has also been linked to improved patient outcomes, as doctors who understand the social determinants of health are better prepared to address the root causes of illness, rather than merely treating symptoms [23]. It is argued that the classic theoretical work of May and Clark (1980) on medical sociology needs to be revisited to reinforce a debate on the value of this academic discipline in medical education.

5. Limitations, Conclusions and Recommendations

This study is the first of its kind in Greece and one of the few in the international literature. However, several limitations should be acknowledged. First, the study would have benefited from input by a panel of experts in the field (medical sociologists) or key stakeholders (academics and faculty members in prominent positions within medical schools) to share their perspectives. Future research could build upon the findings through a Delphi study, which could gather evidence on the reasons why sociology maintains a marginal role in medical education. Second, this study focuses on a single case, that of Greek tertiary education, which limits the generalizability of the conclusions. Nonetheless, it may serve as a point of comparison for medical curricula in other countries.

While the inclusion of sociology in medical curricula varies globally, and faces several challenges, its benefits are well documented. Future efforts should focus on enhancing the presence of sociology in medical education, addressing barriers to its inclusion, and ensuring that it is taught by qualified professionals who can convey its importance to future doctors. Strauss’ optimistic observation that “the number of medical organizations now employing sociologists suggests that the profession is fast coming to recognize a value and a need for sociological contribution”, articulated back in 1957 (p. 202) [11], needs to be heard again.

However, the issue of medicalization may also be traced within other healthcare-related disciplines (i.e., nursing, midwifery, health visiting), as historically, these professions have often been perceived as auxiliary to medicine, with their curricula and practices significantly shaped or even dominated by medical frameworks and perspectives. With this frame of mind, we plan to conduct relevant research in the near future.

The marginal status of sociology in medical education could be challenged by reuniting the two distinct sciences of medicine and sociology, which, while traditionally separate, have the potential for a productive and enriching collaboration. Bridging this gap may require enhancing funding opportunities that mandate interdisciplinary synergies between the two fields as a prerequisite. Additionally, key academic stakeholders could solidify the role of sociology in medical education by revising existing curricula to incorporate sociology as a distinct and integral course.