The current status of medical genetics instruction in US and Canadian medical schools.

PURPOSE: Relatively little is known about how medical genetics is being taught in the undergraduate medical curriculum and whether educators concur regarding topical priority. This study sought to document the current state of medical genetics education in U.S. and Canadian accredited medical schools. METHOD: In August 2004, surveys were sent from the Indiana University School of Medicine to 149 U.S. and Canadian medical genetics course directors or curricular deans. Returned surveys were collected through June 2005. Participants were asked about material covered, number of contact hours, year in which the course was offered, and what department sponsored the course. Data were collated according to instructional method and course content. RESULTS: The response rate was 75.2%. Most respondents (77%) taught medical genetics in the first year of medical school; only half (47%) reported that medical genetics was incorporated into the third and fourth years. About two thirds of respondents (62%) devoted 20 to 40 hours to medical genetics instruction, which was largely concerned with general concepts (86%) rather than practical application (11%). Forty-six percent of respondents reported teaching a stand-alone course versus 54% who integrated medical genetics into another course. Topics most commonly taught were cancer genetics (94.2%), multifactorial inheritance (91.3%), Mendelian disorders (90.3%), clinical cytogenetics (89.3%), and patterns of inheritance (87.4%). CONCLUSIONS: The findings provide important baseline data relative to guidelines recently established by the Association of American Medical Colleges. Ultimately, improved genetics curricula will help train physicians who are knowledgeable and comfortable discussing and answering questions about genetics with their patients.     

The teaching of cultural issues in U.S. and Canadian medical schools.

PURPOSE: Despite the importance of culture in health care and the rapid growth of ethnic diversity in the United States and Canada, little is known about the teaching of cultural issues in medical schools. The study goals, therefore, were to determine the number of U.S. and Canadian medical schools that have courses on cultural issues, and to examine the format, content, and timing of those courses. METHOD: The authors contacted the deans of students and/ or directors of courses on cultural issues at all 126 U.S. and all 16 Canadian medical schools. Using a cross-sectional telephone survey, they asked whether each school had a course on cultural sensitivity or multicultural issues and, if so, whether it was separate or contained within a larger course, when in the curriculum the course was taught, and which ethnic groups the course addressed. RESULTS: The response rates were 94% for both U.S. (118) and Canadian (15) schools. Very few schools (U.S. = 8%; and Canada = 0%) had separate courses specifically addressing cultural issues. Schools in both countries usually addressed cultural issues in one to three lectures as part of larger, mostly preclinical courses. Significantly more Canadian than U.S. schools provided no instruction on cultural issues (27% versus 8%; p = .04). Few schools taught about the specific cultural issues of the largest minority groups in their geographic areas: only 28% and 26% of U.S. schools taught about African American and Latino issues, respectively, and only two thirds of Canadian schools taught about either Asian or Native Canadian issues. Only 35% of U.S. schools addressed the cultural issues of the largest minority groups in their particular states. CONCLUSIONS: Most U.S. and Canadian medical schools provide inadequate instruction about cultural issues, especially the specific cultural aspects of large minority groups.     

Extent of teaching of psychosocial medicine in Canadian medical schools

To investigate the extent to which psychosocial aspects of medical practice are currently taught in Canadian medical schools, a brief questionnaire was distributed to the 16 directors of psychiatric undergraduate education. Twelve of the fourteen departments that replied offered some theoretical and clinical teaching on this subject, amounting on the average to not quite 10% of teaching time. The major teaching components were the physician-patient relationship and the biopsychosocial model. Psychosocial clinical teaching was offered mainly by consultationliaison (C-L) services, whose availability influenced the extent of such teaching. Various approaches to incorporating C-L teaching into the undergraduate curriculum are touched upon.     

Services for students with learning disabilities in U.S. and Canadian medical schools.

Between September 1, 1990, and March 31, 1991, 103 of the 142 medical schools in the United States and Canada responded to a questionnaire regarding their services and programs for learning-disabled medical students. Ninety-three schools accepted such students (and ten did not), but only two-thirds had support programs and half lacked the capacity to diagnose learning disability disorders. Twenty-five did not know they could administer licensing examinations in a nonstandard manner, and 19 had no senior administrator or faculty member coordinating learning disability services. The author concludes that these results suggest that medical schools are poorly informed about and unprepared to help learning-disabled students.     

Medical training in school-based health centers: a collaboration among five medical schools.

School-based health centers (SBHCs) have tremendous untapped potential as models for learning about systems-based care of vulnerable children. SBHCs aim to provide comprehensive, community-based primary health care to primary and secondary schoolchildren who might not otherwise have ready access to that care. The staffing at SBHCs is multidisciplinary, including various combinations of nurse practitioners, physicians, dentists, nutritionists, and mental health providers. Although this unique environment provides obvious advantages to children and their families, medical students and residents receive little or no preparation for this type of practice.To address these deficiencies in medical education, five downstate New York state medical schools, funded by the New York State Department of Health, collaborated to define, develop, implement, and evaluate curricula that expose health professions students and residents to SBHCs. The schools identified core competencies and developed a comprehensive training model for the project, including clinical experiences, didactic sessions, and community service opportunities, and they developed goals, objectives, and learning materials for each competency for all types and levels of learners. Each school has implemented a wide range of learning activities based on the competencies.In this paper, the authors describe the development of the collaboration and illustrate the process undertaken to implement new curricula, including considerations made to address institutional needs, curricula development, and incorporation into existing curricula. In addition, they discuss the lessons learned from conducting this collaborative effort among medical schools, with the goal of providing guidance to establish effective cross-disciplinary curricula that address newly defined competencies.     

Literature in our medical schools.

Despite many relevant benefits, the study of literature has been rejected by medical schools this century. However, the role of literature and the arts is coming to the fore again in many branches of medicine, including education, leading to a broader approach to medical practice than the purely scientific approach. This is likely to enrich the profession and individuals therein. As well giving as a wider general education, areas of medical training and practice that a literary education will benefit directly include critical reading and appraisal, communication skills, history taking, 'surrogate experience', understanding the role of the physician, ethics, and self-expression. Many of these are central to our understanding of good medical practice.     

Assessing personal occupational safety and health training for students at U.S. medical schools.

Medical students potentially are exposed to numerous occupational hazards. This study examined the training and preventive measures medical schools use to protect the health and safety of students. In late 1990, questionnaires were mailed to the 126 schools in the United States. One hundred (79%) responded, reporting numerous incidents of illness and injury. Of the 100 schools, 60 agreed with the statement that their students were adequately prepared to work safely; 11 disagreed, and 24 gave neutral responses (five did not respond to the statement). However, 36 indicated that they planned to revise health and safety training. The authors recommend that schools adopt policies, procedures, and a uniform curriculum regarding students' occupational safety and health.     

Physical activity curricula in medical schools.

Regular physical activity has many known health benefits, yet relatively few physicians counsel their patients about physical activity or exercise. The cited barriers to performing this type of counseling include lack of knowledge and skill, and data show that physicians are more likely to counsel patients about physical activity if they have adequate knowledge of the subject. Health promotion and disease prevention are watchwords in medical education today, yet with regard to these there are relatively few data on exercise or physical activity curriculum in medical schools. A recent survey showed that only 13% of U.S. medical schools provide a curriculum in physical activity. The authors discuss the need for changing the medical school curriculum to increase knowledge of the benefits of physical activity and develop counseling skills for modifying patients' behaviors.     

An inventory of the personal computers for students' use at 143 U.S. and Canadian medical schools

The National Board of Medical Examiners (NBME) has been developing new tests to be administered using computers. As these tests near readiness for use, logistical issues of test administration have become important. In 1989-1990, in order to plan for the implementation of computer-based testing in NBME examinations of the future, the authors, under the auspices of the NBME, conducted a telephone survey of knowledgeable individuals at the 143 LCME-accredited medical schools in the United States and Canada to gauge the numbers and types of microcomputers and workstations available for students' use at these schools. The findings, based on the responses of all the schools surveyed, are reported.     

Resources in bioethics at osteopathic medical schools.

PURPOSE: Medical students must have some exposure to bioethics, whether it be at the undergraduate or the postgraduate level. The authors sought to determine the range and ranking of topics taught in bioethics courses at U.S. osteopathic medical schools. METHOD: A qualitative study using a repeated-measures design was used to determine curricular offerings at all 19 U.S. osteopathic medical schools. Nominal groups were held to identify an initial topics list. A modified reactive Delphi technique was constructed and three survey iterations were administered. RESULTS: Bioethics is taught in all osteopathic medical schools, although the numbers of hours dedicated to the subject in the course of a four-year curriculum vary greatly (range 0-40). To further differentiate a curriculum in bioethics, the respondents were asked to rank bioethics topics as essential, foundational, or peripheral to the undergraduate medical curriculum. A total of 16 topics, including confidentiality, informed consent, truth-telling, death and dying, palliative care, and refusal of care, were identified as "essential" for a bioethics curriculum. CONCLUSIONS: Bioethics is taught at osteopathic medical schools, but further studies are needed to recommend guidelines to standardize the curriculum.     

An admission model for medical schools.

Complex societal issues affect medical education and thus require new approaches from medical school admission officers. One of these issues--the recognition that the attributes of good doctors include character qualities such as compassion, altruism, respect, and integrity--has resulted in the recent focus on the greater use of qualitative variables, such as those just stated, for selected candidates. In addition, more emphasis is now being placed on teaching and licensure testing of the attributes of the profession during the four-year curriculum. The second and more contentious issue concerns the system used to admit white and minority applicants. Emphasizing character qualities of physicians in the admission criteria and selection process involves a paradigm shift that could serve to resolve both issues. To make this or any paradigm shift in admission policy, medical schools must think about all the elements of admission and their interrelationships. A model of medical school admission is proposed that can provide understanding of the admission system and serve as a heuristic guide. This model consists of (1) the applicant pool; (2) criteria for selection; (3) the admission committee; (4) selection processes and policies; and (5) outcomes. Each of these dimensions and the interrelationships among the dimensions are described. Finally, a hypothetical example is provided in which the model is used to help a medical school change its admission process to accommodate a new emphasis in the school's mission.     

Health education programs in U.S. medical schools.

To examine the status of teaching programs on health education in undergraduate medical education, the author in 1990-91 surveyed representatives of all 126 U.S. medical schools. Of the 97 institutions that responded, 63 (65%) offered instruction in patient education and 72 (74%) offered instruction in community health promotion. The responses indicated that a number of departments participated in instruction and that diverse methods of instruction and evaluation were used. Opinions of the representatives regarding the importance and adequacy of instruction in health education were quite favorable. The author concludes that more information is needed to determine the effectiveness of the instructional programs and their impact on the quality of medical care.