Improving Medical Education Enhancing the Behavioral and Social Science Content of Medical School Curricula (2004) / Chapter Skim
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Executive Summary
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It also recommends that medical students be provided with an integrated behavioral and social science curriculum that extends throughout the 4 years of medical school. The committee identifies 26 topics in six behavioral and social science domains that it believes should be included in medical school curricula.
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Medical Licensing Examination currently places insufficient emphasis on test items related to the behavioral and social sciences, the commit tee recommends that the National Board of Medical Examiners ensure that the exam adequately covers the behavioral and social science sub ject matter recommended in this report. ROLE OF BEHAVIORAL AND SOCIAL FACTORS IN HEALTH AND DISEASE For more than a decade it has been well established that approximately half of all causes of morbidity and mortality in the United States are linked to behavioral and social factors (McGinnis and Foege, 1993; NCHS, 2003a)
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. Theories underlying behavioral interventions aimed at modifying disease course are based on the assumptions that behavioral and psychosocial influences on disease course are modifiable and that curtailing unhealthy practices will slow disease progression or minimize the recurrence of disease following treatment (IOM, 2000)
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Given the demographic trends noted above, this will inevitably translate into physicians encountering more elderly patients and those from a greater variety of cultures, who will need guidance in how best to utilize available therapeutic services within the changing health care system. These matters, too, are covered by a comprehensive behavioral and social science curriculum.
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For the purposes of this report, the behavioral and social sciences as applied to medicine are ideally defined as those research-based disciplines that provide physicians with empirically verifiable knowledge that serves as a foundation for understanding and influencing individual, group, and societal actions relevant to improving and maintaining health. In reviewing the curricular content across U.S.
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These conclusions and recommendations, as well as strategies for accomplishing the specific tasks outlined in the committee's charge, are presented below. Routine Survey of Behavioral and Social Science Curricula The lack of national standardization among medical school curricula, of standardization in the terminology used to describe curricular content, and of a comprehensive strategy for creating a national database of medical school curricula makes it difficult to describe systematically the subject matter medical schools 1An integrated curriculum for the purposes of this report is one in which behavioral and social science subject matter is taught as part of other courses in the basic and clinical sciences, not as separate courses.
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Existing national databases provide inadequate information on behavioral and social science content, teaching techniques, and assess ment methodologies. This lack of data impedes the ability to reach conclu sions about the current state and adequacy of behavioral and social science instruction in U.S.
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The results of this research indicate that physicians need basic communication skills in order to take accurate patient histories, build therapeutic relationships, and engage patients in an educative process of shared decision making (IOM, 2001a, 2003a; Peterson et al., 1992; Safran et al., 1998)
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As with any suggested change to medical school curricula, calls to include the behavioral and social sciences must be balanced against similar requests from other disciplines that are vying for precious teaching time. As noted earlier, however, evidence is mounting that tremendous strides could be made in preventing disease and promoting health if more attention were given to the behavioral and social science priorities outlined in this report.
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10 IMPROVING MEDICAL EDUCATION TABLE ES-1 Behavioral and Social Science Topics of High and Medium Priority for Inclusion in Medical School Curricula Domain High Priority Medium Priority MindBody · Biological mediators between · Psychosocial, biological, and Interactions in psychological and social management issues in Health and Disease factors and health somatization · Psychological, social, and · Interaction among illness, behavioral factors in chronic family dynamics, and culture disease · Psychological and social aspects of human development that influence disease and illness · Psychosocial aspects of pain Patient Behavior · Health risk behaviors · Principles of behavior change · Impact of psychosocial stressors and psychiatric disorders on manifestations of other illnesses and on health behavior Physician Role · Ethical guidelines for and Behavior professional behavior · Personal values, attitudes, and biases as they influence patient care · Physician well-being · Social accountability and responsibility · Work in health care teams and organizations · Use of and linkage with community resources to enhance patient care PhysicianPatient · Basic communication skills · Context of patient's social and Interactions · Complex communication skills economic situation, capacity for self-care, and ability to participate in shared decision making · Management of difficult or problematic physicianpatient interactions Social and Cultural · Impact of social inequalities in · Role of complementary and Issues in Health Care health care and the social factors alternative medicine that are determinants of health outcomes · Cultural competency Health Policy and · Overview of U.S. health care system · Variations in care Economics · Economic incentives affecting patients' health-related behaviors · Costs, cost-effectiveness, and physician responses to financial incentives
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At a minimum, this curriculum should include the high-priority items delineated in this report and summarized in Table ES-1. Medical students should demonstrate competency in the following domains: · Mindbody interactions in health and disease · Patient behavior · Physician role and behavior · Physicianpatient interactions · Social and cultural issues in health care · Health policy and economics Strategies for Incorporating Behavioral and Social Sciences into the Medical School Curriculum The committee found that many barriers exist to incorporating the behavioral and social sciences into medical school curricula.
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A well-supported career development program in the behavioral and social sciences would free promising faculty members from competing responsibilities so they could develop leadership skills and work toward incorporating the behavioral and social sciences into medical school curricula. Individuals receiving career development awards could also serve as resources to assist other medical schools attempting to enhance their behavioral and social science curricula.
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Evaluation, which can occur within a specific course or on a medical licensing examination, is a critical process for determining the extent to which medical students have mastered course objectives. Faculty should be provided with the knowledge and other resources required to develop effective methods for evaluating student competence in the behavioral and social sciences.
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