to have completed course work in the behavioral and social sciences during their prebaccalaureate education and should inform prospective applicants of its behavioral and social science–related requirements and/or recommendations. Behavioral and social science instruction in medical school should build on this prebaccalaureate foundation. The committee also believes that material from the behavioral and social sciences should be included in the post–medical school phases of the medical education continuum. These phases include residency and fellowship training, as well as continuing (postgraduate) medical education. While the emphasis in this report is on the 4 years of medical school, the importance of continuing behavioral and social science education throughout a physician’s career cannot be overemphasized.

This section presents the committee’s response to the second part of its charge, to develop a list of prioritized topics from the behavioral and social sciences for possible inclusion in medical school curricula. The committee considers this to be the most important part of its work. The committee’s recommended list of topics is supported by two conclusions reached during its deliberations.

Conclusion 2a. Human health and illness are influenced by multiple interacting biological, psychological, social, cultural, behavioral, and economic factors. The behavioral and social sciences have contributed a great deal of research-based knowledge in each of these areas that can inform physicians’ approaches to prevention, diagnosis, and patient care.

Some areas of the behavioral and social sciences have been more thoroughly researched and rigorously tested than others. This observation does not diminish the importance of those areas with less verifiable evidence, but rather points to the need for more research. One such example is the strong influence physicians’ actions can have on the attitudes and values of medical students, even though this nonverbal form of communication has not been thoroughly tested (Ludmerer, 1999). In contrast, the importance of effective physician communication has received a fair amount of attention by researchers. 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).

Conclusion 2b. Within the clinical encounter, certain interactional competencies are critically related to the effectiveness and subsequent outcomes of health care. These competencies include the taking of the medical history, communication, counseling, and behavioral management.

Providing the core content in the behavioral and social sciences identified in this report during the 4 years of medical school will introduce this material at a time when students perceive it to be most relevant and facilitate reinforcement of important concepts throughout the preclinical and clinical years. Moreover, inte-



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