Integrating the social and behavioral sciences in an undergraduate medical curriculum: the UCSF essential core.

Dramatic global-migration patterns over recent decades have forever changed the racial, ethnic, social, and cultural makeup of the people of the United States. Simultaneously, the patterns of disease and risk factor distribution within the U.S. population are changing in ways that accentuate the role of lifestyle, behavior, and social and economic differences in the onset and outcomes of disease. Medical school curricula must prepare students to address these demographic realities. The University of California, San Francisco's (UCSF's) redesigned curriculum, launched in September 2001, integrates social, behavioral, and biomedical science education in an early and sustained way. The traditional undergraduate medical structure of two years of basic science plus two years of clinical rotations was replaced with a model divided into three stages spanning four years: the Essential Core, the Clinical Core, and Advanced Studies. The authors summarize the role of the social and behavioral sciences in the UCSF Essential Core-the first 16 months of instruction divided into integrated blocks, each centered on clinical cases. Basic thematic areas (e.g., behavior change, health disparities), content illustrations (e.g., Introduction to the Biopsychosocial Model, The Culture of Medicine), and process considerations (e.g., integration, content order, evaluations) are presented. Special challenges and limitations are also discussed.     

Overcoming barriers to exercise among parents: a social cognitive theory perspective

Parents face numerous barriers to exercise and exhibit high levels of inactivity. Examining theory-based determinants of exercise among parents may inform interventions for this population. The purpose of this study was to test a social-cognitive model of parental exercise participation over a 12-month period. Mothers (n = 226) and fathers (n = 70) of children <16 completed measures of exercise, barriers self-efficacy, perceived barriers, and exercise planning at baseline and 1 year later. Panel analyses were used to test the hypothesized relationships. Barriers self-efficacy was related to exercise directly and indirectly through perceived barriers and prioritization/planning. Prioritization and planning also mediated the relationship between perceived barriers and exercise. These paths remained significant at 12 months. These results suggest efforts to increase exercise in parents should focus on improving confidence to overcome exercise barriers, reducing perceptions of barriers, and helping parents make specific plans for prioritizing and engaging in exercise.     

Challenging linguistic barriers to health care: students as medical interpreters.

Inadequate medical interpretation services are a barrier to the delivery of optimal health care to persons with limited English proficiency. Even though Title VI of the Civil Rights Act of 1964 requires that interpretation services be available to persons speaking limited English, many health care institutions are struggling to reach full compliance. Communication through untrained interpreters is likely to include mistranslations or omissions of physicians' questions, truncated or slanted patient responses, and inadequate information to facilitate accurate diagnosis and treatment. The Interpreter's Aide Program (IAP) is a service-learning program that was implemented at Brown Medical School in 1997. The IAP is a collaborative effort among Brown students, the Rhode Island Hospital Department of Social Work, and Brown Medical School. This three-way partnership strengthens the IAP and expands interpretation services to Spanish- and Portuguese-speaking patients at Rhode Island Hospital. Bilingual undergraduate and medical students become trained medical interpreters and render community service while developing cross-cultural skills. The authors review the development and implementation of the IAP. There is potential for other academic health centers to develop similar partnerships with local colleges and universities, and to provide service-learning opportunities for future physicians and health care consumers.     

German developments in teaching psychosomatics and psychotherapy to medical students.

The necessities for a reform of teaching German medical students were manifold. With the help of those doctors responsible for primary care and by founding a society representing all behavioural scientists within medical teaching it was possible to firmly institutionalize psychosomatics and psychotherapy within the new Medical Approbation Law. It is too early to assess the impact of this drastic reform but some of its advantages are already obvious.     

Teaching medical students social responsibility: the right thing to do.

As academic medicine has become more focused on the economic pressures of the marketplace, some educators have expressed concern about whether appropriate attention is being given to the character development and moral education of medical students. The authors conclude that medical schools do indeed have a duty to teach their medical students to be socially responsible. They define a socially responsible individual as a person who takes part in activities that contribute to the happiness, health, and prosperity of a community and its members. They suggest that medical students should participate in carefully designed, socially responsible activities in order to (1) practice and have reinforced such qualities as reliability, trustworthiness, dependability, altruism, and compassion; (2) partially reimburse society for the cost of their medical education; (3) increase their exposure to a population-based approach to health care; and (4) help medical schools fulfill their social contract with the public. The authors outline the process for developing a curriculum to teach social responsibility to medical students and list some of the key questions faculty and administrators must address in the processes of development and implementation. They conclude that while faculty responsible for implementing a curriculum in social responsibility must be highly committed and prepared to address numerous difficult questions concerning the curriculum's philosophy, structure, and function, the potential benefits of such a curriculum are well worth the effort.     

An interdisciplinary course in the basic sciences for senior medical and PhD students.

Integrating clinical and basic sciences throughout the medical school curriculum has become a major objective of various innovations in medical education. While early clinical exposure has evolved as an efficient means of introducing clinical studies in the preclinical years, interdisciplinary integration of basic sciences during the clinical years remains a challenge. The authors describe their three years of experience with an interdisciplinary course designed to demonstrate the continuum of medical information from the clinic to the basic sciences. In this course, sixth-year medical students are required to choose one of three to four different one-week programs, each of which requires them to conduct an in-depth investigation of a defined clinical topic. Program coordinators are encouraged to work in clinician-basic scientist teams and to use a variety of teaching methods, with an emphasis on tutored individual and group learning based on critical readings of original papers. Coordinators are also encouraged to enable graduate research students to participate. From 1998 to 2000, students participated in nine programs, seven of which were coordinated by interdisciplinary teams. Several clinical and basic science disciplines were represented in each program, and various teaching methods were used. Graduate students participated in two of the programs. Evaluation of the programs (a debriefing discussion as well as short written evaluations) indicated moderate to good achievement of the course objectives.     

Anatomy teaching with portable ultrasound to medical students

Background

The management of medical conditions is influenced by whether clinicians regard them as "disease" or "not a disease". The aim of the survey was to determine how medical students classify a range of conditions they might encounter in their professional lives and whether a different name for a condition would influence their decision in the categorisation of the condition as a 'disease' or 'not a disease'.

Methods

We surveyed 3 concurrent years of medical students to classify 36 candidate conditions into "disease" and "non-disease". The conditions were given a 'medical' label and a (lay) label and positioned where possible in alternate columns of the survey.

Results

The response rate was 96% (183 of 190 students attending a lecture): 80% of students concurred on 16 conditions as "disease" (eg diabetes, tuberculosis), and 4 as "non-disease" (eg baldness, menopause, fractured skull and heat stroke). The remaining 16 conditions (with 21-79% agreement) were more contentious (especially obesity, infertility, hay fever, alcoholism, and restless leg syndrome). Three pairs of conditions had both a more, and a less, medical label: the more medical labels (myalgic encephalomyelitis, hypertension, and erectile dysfunction) were more frequently classified as 'disease' than the less medical (chronic fatigue syndrome, high blood pressure, and impotence), respectively, significantly different for the first two pairs.

Conclusions

Some conditions excluded from the classification of "disease" were unexpected (eg fractured skull and heat stroke). Students were mostly concordant on what conditions should be classified as "disease". They were more likely to classify synonyms as 'disease' if the label was medical. The findings indicate there is still a problem 30 years on in the concept of 'what is a disease'. Our findings suggest that we should be addressing such concepts to medical students.     

Role of the medical museum in teaching medical students

We describe the Educational Museum of Modern Medicine of Kawasaki Medical School of Kurashiki, Japan, and its use in medical education. The extraordinary speed of recent medical advances confronts medical educators with many difficulties. With the aim of improving medical education at our school, we have imposed some roles of medical education, especially regarding pathology, on the medical museum, because it has attracted students to a greater extent and facilitated their independent learning in a more fruitful way than the audiovisual materials previously available in our library. We hope to provide some insights for the improvement of medical education and lead to enthusiastic discussion of this matter.     

The coming influence of a social sciences perspective on medical education.

Medical education will change from within in response to continued advances in biological sciences and technology, but changes that are occurring outside the natural sciences can have greater impact, especially (1) the reconceptualization of the meaning of health, (2) the increase in the number and range of different health improvement strategies, (3) the growing awareness of the paradox of the relatively low health status of the U.S. population and high per-capita and national health care expenditures, and (4) shifts in the causes of illness and death. These changes make it necessary for medical students to be given a foundation in both the natural and the social sciences, for most ill health has causal roots in both the social and physical environment, even though it is not understood how some of these outside influences are translated into disease or biologic derangements that lead to disease. Consideration should be given to changes in medical education that include (1) interpreting the sociology as well as the biology of health, (2) expanding the horizons of medicine to incorporate health improvement as well as disease cure, (3) training for population-based health care at the community level, and (4) learning to assess medical outcomes with more than biometric measures to include measurements of functioning and well-being. The author presents in detail a health input-output model to show the complex interrelationships of socio-ecologic (i.e., outside) factors and the individual's genetic-biologic makeup (inside factors) that determine the individual's state of health.     

An interpersonal model for teaching psychiatry to medical students

Many medical students and hospital physicians hold negative images of psychiatry, perhaps because of unnecessarily complex teaching models used at the undergraduate level. The interpersonal teaching model described here allows physical symptoms to be related to interpersonal relationships. This helps the practitioner detect nonpsychotic emotional illness in medical patients. With the aid of a three-question screening test, students learned to recognize emotional illness in medical patients and to arrange psychiatric consultations. Student response to the model has been positive, and students have carried the screening skills with them to other rotations.     

A core syllabus for the teaching of neuroanatomy to medical students

There is increasingly a call for clinical relevance in the teaching of biomedical sciences within all health care courses. However, this presupposes that there is a clear understanding of what can be considered core material within the curricula. To date, the anatomical sciences have been relatively poorly served by the development of core syllabuses, particularly for specialized core syllabuses such as neuroanatomy. One of the aims of the International Federation of Associations of Anatomists (IFAA) and of the European Federation for Experimental Morphology (EFEM) is to formulate, on an international scale, core syllabuses for all branches of the anatomical sciences using Delphi Panels consisting of anatomists, scientists, and clinicians to initially evaluate syllabus content. In this article, the findings of a Delphi Panel for neuroanatomy are provided. These findings will subsequently be published on the IFAA website to enable anatomical (and other cognate learned) societies and individual anatomists, clinicians, and students to freely comment upon, and elaborate and amend, the syllabuses. The aim is to set internationally recognized standards and thus to provide guidelines concerning neuroanatomical knowledge when engaged in course development. Clin. Anat. 28:706–716, 2015. © 2015 Wiley Periodicals, Inc.     

A multi-institutional randomized controlled trial of adjuvant Web-based teaching to medical students.

PURPOSE: To investigate the impact of an adjuvant Web-based teaching program on medical students' learning during clinical rotations. METHOD: From April 2003 to May 2004, 351 students completing clinical rotations in surgery-urology at four U.S. medical schools were invited to volunteer for the study. Web-based teaching cases were developed covering four core urologic topics. Students were block randomized to receive Web-based teaching on two of the four topics. Before and after a designated duration at each institution (ranging one to three weeks), students completed a validated 28-item Web-based test (Cronbach's alpha = .76) covering all four topics. The test was also administered to a subset of students at one school at the conclusion of their third-year to measure long-term learning. RESULTS: Eighty-one percent of all eligible students (286/351) volunteered to participate in the study, 73% of whom (210/286) completed the Web-based program. Compared to controls, Web-based teaching significantly increased test scores in the four topics at each medical school (p < .001, mixed analysis of variance), corresponding to a Cohen's d effect size of 1.52 (95% confidence interval [CI], 1.23-1.80). Learning efficiency was increased three-fold by Web-based teaching (Cohen's d effect size 1.16; 95% CI 1.13-1.19). Students who were tested a median of 4.8 months later demonstrated significantly higher scores for Web-based teaching compared to non-Web-based teaching (p = .007, paired t-test). Limited learning was noted in the absence of Web-based teaching. CONCLUSIONS: This randomized controlled trial provides Class I evidence that Web-based teaching as an adjunct to clinical experiences can significantly and durably improve medical students' learning.     

A core syllabus for the teaching of embryology and teratology to medical students

Clinical relevance in the teaching of biomedical sciences within health care courses presupposes that there is internationally agreed core material within the curricula. However, with the exception of a syllabus for neuroanatomy and gross anatomy of the head and neck for medical students, core syllabuses within many of the specialized anatomical sciences have yet to be developed. The International Federation of Associations of Anatomists aims to formulate internationally accepted core syllabuses for all anatomical sciences disciplines initially using Delphi Panels that comprise anatomists, scientists, and clinicians who evaluate syllabus content. Here, the suggestions of a Delphi Panel for embryology and teratology are presented prior to their publication on the website of the International Federation of Associations of Anatomists. Hence, to obtain a more definitive syllabus, it is required that anatomical and embryological/teratological societies, as well as individual anatomists, embryologists and clinicians, freely comment upon, elaborate and amend, this draft syllabus. The goal is to set internationally recognized standards and thereby provide guidelines concerning embryological and teratological knowledge when involved with course development. Clin. Anat. 30:159–167, 2017. © 2016 Wiley Periodicals, Inc.     

Survey of clinicians' attitudes to the anatomical teaching and knowledge of medical students

There is considerable and ongoing debate surrounding the teaching of anatomy to medical students, and the anatomical knowledge of those medical students once they graduate. Few attempts have been made to gather the opinions of clinicians on this subject. A questionnaire was sent to 362 senior clinicians in hospitals affiliated to the University of Aberdeen. A total of 162 replies were received, with this sample being representative of the population of hospital consultants. Our results indicate that the majority of clinicians feel that the current anatomical education of medical students is inadequate, and below the minimum necessary for safe medical practice. There is widespread support among clinicians for more vertical integration of anatomy teaching throughout the undergraduate curriculum.