discussion of informed consent, this time would be reported under both “communication skills on challenging issues” and “ethical decision making.” A grand total of hours is therefore not reported.

Table 2-2b presents indicator measures of the year of medical school in which the various topics are taught. There are several major limitations to interpreting these data. First, as noted earlier, the reporting of curricular content to the CurrMIT database is voluntary, and the data used by AAMC staff to determine the indicator measures are from only 67 of the 126 U.S. medical schools. Next, even within the universe of schools that do report data to the CurrMIT database, more information about the curriculum is generally made available for years 1 and 2 (the preclinical years) than for years 3 and 4 (the clinical years). Therefore, the lower prevalence of teaching specifically focused on hot topics related to the behavioral and social sciences in the third and fourth years is particularly vulnerable to inaccuracy, especially to being underestimated. The best use of the data on the percentage of medical schools teaching specific topics, then, is to compare the prevalence of teaching activity from one topic area to another (up and down the column). It should be noted that some teaching of the topics listed does occur across all 4 years, at least in some schools.

Finally, data in Table 2-2c are from the AAMC Graduation Questionnaire. Nearly all students complete this questionnaire because many schools use the data for educational quality improvement efforts and make completion of the survey a prerequisite for graduation.

After reviewing the data in these tables, the committee made the following observations. First, the data in Table 2-2a reveal substantial variations in the behavioral and social science topics taught in medical school curricula. In the topic domains for which LCME data were available, the topics with the greatest representation (inclusion in the curricula) appear to be communication skills, epidemiology, human development/life cycle, medical ethics, substance abuse, and nutrition. Among these topics, clinical communication skills are reported as receiving the most curriculum time—nearly twice as much as any other topic. The topics that appear to have the least representation and number of required hours within the curricula are health care quality improvement and medical (socio)economics. Even in schools reporting that these topics have a place in the curriculum, the total number of required hours on these topics is small.

The committee also observed that although the data in Table 2-2b are based on only 67 medical schools, it appears that most of the teaching across all the topics listed takes place in the first 2 years of the undergraduate medical curriculum, with some topics (e.g., epidemiology, prevention, and substance abuse) being better represented in the second year than in the first. Other topics (e.g., communication skills, human development/life cycle, and medical ethics) show the reverse pattern. Although the data indicating the extension of these topics into the third and fourth years are incomplete, it is noteworthy that some of the topics (e.g., communication, palliative care/pain management, nutrition, medical ethics,

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