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Improving Medical Education: Enhancing the Behavioral and Social Science Content of Medical School Curricula
grating the curriculum so that behavioral and social science topics are included as part of other basic science and clinical courses, instead of being presented in separate courses, will enable the educational experience to simulate real-world experience, in which behavioral and social factors in health and disease must be considered in the context of complex clinical situations.
The committee recognizes that there are many important topics to which students must be exposed during their 4 years of medical school. 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. Knowing this, the committee selected potential priority topics on the basis of (1) relevant evidence-based articles and reports in the literature; (2) presentations to the committee by content experts and medical school representatives; (3) literature and other material from the AAMC and LCME; (4) considerations related to the health of the public, driven mainly by root causes of morbidity and mortality; and (5) the gap between what is known and what is actually done in practice.
Following extensive deliberations, a modified Delphi process was used to prioritize this initial list of topics. (A detailed description of this process is included in Appendix A.) Committee members rated each of the topics on the list using a scale system, and then assigned each high, medium, or low priority based on its mean score and standard deviation. This list was further refined and finalized using the collective and individual experience of the committee as experts in medical school curriculum development and reform in the behavioral and social sciences. The low priorities were then discarded, and the remaining 26 topics were categorized as top, high, or medium priority. The results of this process constitute the committee’s recommendation for those behavioral and social science topics that should be included in medical school curricula. In the committee’s view, the 20 topics ranked top and high must be included in medical school curricula and were therefore combined into one high-priority group. The 6 medium-priority topics are also important and would significantly enhance the education of medical students. Inclusion of the medium priorities, as well as the depth of teaching and evaluation, is dependent upon the needs of the individual medical school.
The final listing of topics, presented in Table ES-1, is organized so as to have meaning for medical school curriculum committees.
The 26 recommended topics fall into the following six general domains of knowledge:2
The order in which the various domains are listed is random and does not reflect the committee’s view of their relative importance.