Some of the areas emphasized in instruction in the behavioral and social sciences in medical education have been driven by population health needs and risks. Given the strong interactions between behavioral factors and the etiology and pathogenesis of illness and disease (see Chapter 1), many schools opt to focus on specific biopsychosocial aspects of health and disease that affect populations. For example, substance abuse became the focus of a curriculum with behavioral and social science content for four medical schools in North Carolina because of the large and growing problems of substance abuse nationwide (Fang et al., 1998).

Some behavioral and social science content has already been considered part of classical medical education, serving to enlarge the content of courses in such areas as medical interviewing and the introduction to clinical medicine. Because effective communication skills are important to all physicians, the vast majority of schools teach such skills at some point within their curricula (AAMC, 1999b; Dube et al., 2000). Nevertheless, certain communication skills—such as communicating with diverse populations (in terms of culture, age, gender, and race), building trust in the presence of perceived or actual conflicts of interest, telecommunication, and physician–patient communication—are now receiving increased emphasis. As one example, the Macy Initiative in Health Communication at the University of Massachusetts Medical School was a curriculum designed to develop students’ skills in delivering bad news to parents regarding their fetus or child, with a particular focus on communicating in the areas of genetic counseling, risk assessment, and birth defects (Pettus, 2002). Communication among physicians and other members of the health care team has also received attention in the curriculum, especially given the movement toward more-integrated health care systems.

The curricula in even traditional medical disciplines, such as psychiatry, have seen an expansion of behavioral and social science content. Although all schools of medicine have curricula in psychiatry, some focus on the overlap between mental and somatic health, or psychosomatic medicine, as many patients have significant emotional or behavioral problems expressed as somatic symptoms or personal distress. From a survey of 118 U.S. medical schools between 1997 and 1999 to which 54 schools responded, topics in biopsychosocial medicine were estimated to constitute approximately 10 percent of medical school curricula (Waldstein et al., 2001).

Additionally, some schools are teaching future physicians about their own mental health needs to prepare them to deal with their feelings about sickness, dying, and death, and several have built self-awareness, personal growth, and well-being activities into their curricula and elective offerings (Novack et al., 1999). At the University of Rochester, for example, the Introduction to Clinical Medicine course, which incorporates parts of the previously taught Biopsychosocial Medicine course, helps students explore how their families and cultures influence their attitudes and motivations by sharing genograms and writing per-



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