Relevant behavioural and social science for medical undergraduates: a comparison of specialist and non-specialist educators

AIM: To compare what medical educators who are specialists in the behavioural and social sciences and their non-specialist counterparts consider to be core concepts that medical graduates should understand. BACKGROUND: Previously perceived as 'nice to know' rather than 'need to know', the General Medical Council (GMC) now places behavioural and social sciences on the same need-to-know basis as clinical and basic sciences. Attempts have been made to identify what components of these topics medical students need to know; however, it remains unknown if decisions over programme content differ depending on whether or not educationalists have specialist knowledge of the behavioural and social sciences. METHODS: In a survey of medical educationalists within all UK medical schools, respondents were asked to indicate from a comprehensive list of psychological, sociological and anthropological concepts what they considered a minimally competent graduate should understand. Comparisons were made between the concepts identified by specialist behavioural and social science (BSS) educators and those without such training. RESULTS: Despite different disciplinary backgrounds, non-specialist educators largely concurred with BSS specialist educators in the concepts they considered tomorrow's doctors should know about. However, among BSS specialists there remained disagreement on what BSS content was relevant for graduates. Differences reflect specialist knowledge and recognition of the role of theoretical underpinning of BSS and reveal gaps in non-specialists knowledge. CONCLUSIONS: Educationalists with formal training in the full range of behavioural and social sciences should be involved in the development of BSS curriculum content at both national and school levels.     

A suitable case for Technik: behavioural science in the postgraduate medical curriculum

The role of the behavioural and social sciences in the postgraduate medical curriculum is considered. It is argued that the behavioural and social sciences can play a vigorous and dynamic part both in medical education and in medical practice. However, in order for that role to be achieved a Technik approach must be adopted. Technik means an emphasis on know-how, capability and on unifying theory and practice. It is suggested that the behavioural sciences frequently fail to excite interest because they adopt only a humanistic and/or critical approach at the expense of the needs of medical training. Some examples of a Technik approach drawn from health education, the management of chronic disease and surgical audit are briefly examined.     

Growth of medical knowledge

BACKGROUND: Knowledge is an essential component of medical competence and a major objective of medical education. Thus, the degree of acquisition of knowledge by students is one of the measures of the effectiveness of a medical curriculum. We studied the growth in student knowledge over the course of Maastricht Medical School's 6-year problem-based curriculum. METHODS: We analysed 60 491 progress test (PT) scores of 3226 undergraduate students at Maastricht Medical School. During the 6-year curriculum a student sits 24 PTs (i.e. four PTs in each year), intended to assess knowledge at graduation level. On each test occasion all students are given the same PT, which means that in year 1 a student is expected to score considerably lower than in year 6. The PT is therefore a longitudinal, objective assessment instrument. Mean scores for overall knowledge and for clinical, basic, and behavioural/social sciences knowledge were calculated and used to estimate growth curves. FINDINGS: Overall medical knowledge and clinical sciences knowledge demonstrated a steady upward growth curve. However, the curves for behavioural/social sciences and basic sciences started to level off in years 4 and 5, respectively. The increase in knowledge was greatest for clinical sciences (43%), whereas it was 32% and 25% for basic and behavioural/social sciences, respectively. INTERPRETATION: Maastricht Medical School claims to offer a problem-based, student-centred, horizontally and vertically integrated curriculum in the first 4 years, followed by clerkships in years 5 and 6. Students learn by analysing patient problems and exploring pathophysiological explanations. Originally, it was intended that students' knowledge of behavioural/social sciences would continue to increase during their clerkships. However, the results for years 5 and 6 show diminishing growth in basic and behavioural/social sciences knowledge compared to overall and clinical sciences knowledge, which appears to suggest there are discrepancies between the actual and the planned curricula. Further research is needed to explain this.     

Psychosocial factors in coronary heart disease -- scientific evidence and recommendations for clinical practice

Psychosocial risk factors like low socio-economic status, lack of social support and social isolation, chronic work or family stress, as well as negative emotions, e. g. depression and hostility, contribute significantly to the development and adverse outcome of coronary heart disease (CHD). Negative effects of psychosocial risk factors are conveyed via behavioural pathways including unhealthy lifestyle, e. g. food choice, smoking, sedentary life, inadequate utilisation of medical resources, and psychobiological mechanisms like disturbed autonomic and hormonal regulation: all these factors contribute to metabolic dysfunction and inflammatory and haemostatic processes, which are directly involved in the pathogenesis of CHD. Interventions to improve pychosocial factors are available and have demonstrated positive effects on risk factors and - at least in part - on CHD morbidity and mortality. The prevention of CHD should therefore include screening for psychosocial risk factors and adequate interventions. Recommedations for the screening of risk factors, behavioural change and further management of psychosocial risk factors in clinical practice are pointed out.     

THE SOCIAL WORKER AS EDUCATOR OF FAMILY PRACTICE RESIDENTS

Social workers have been involved in medical education for several decades. The field of family practice offers new opportunities and challenges for social work educators to help family physicians address not only the biological needs of their patients, but their psychosocial needs as well. To be successful, the educator will need to be familiar with resident learning styles and preferences, with their attitudes toward the behavioral sciences, and with differential teaching strategies. Research about the impact of training programs on the family practice resident will make for more effective curriculum planning efforts by social workers.     

Growth of knowledge in psychiatry and behavioural sciences in a problem-based learning curriculum

PURPOSE: To evaluate the effectiveness of undergraduate medical education in the domains of psychiatry and behavioural sciences, we examined the growth of knowledge in those disciplines in a 6-year, problem-based learning (PBL) curriculum. Psychiatry and behavioural sciences are taught in the 4 preclinical years and in the psychiatric clerkship. The integrative nature of this PBL curriculum led us to hypothesise that the knowledge growth curves for these disciplines are similar and show a steady upward trend throughout the curriculum. METHODS: All items pertaining to psychiatry and behavioural sciences in the progress tests administered in the period from September 1993 through May 2001 were identified. For those items, the percentage of correct scores in the 6 year groups were considered a multivariate observation reflecting knowledge growth across the 6-year programme. RESULTS: Knowledge growth for psychiatry and behavioural sciences increased significantly, from 12% to 59% and from 28% to 60%, respectively, between Year 1 and the end of Year 6. Apparently, students know more about behavioural sciences than about psychiatry when they enter medical school, but this difference vanishes in the last 2 years of training. Moreover, the growth curves for psychiatry and behavioural sciences started to level off after Years 3 and 4, respectively, with no additional significant growth in any of the later years. CONCLUSIONS: Psychiatry and behavioural sciences showed different patterns of knowledge growth and the 2 growth curves levelled off in Years 5 through 6. Because a student-centred, horizontally and vertically integrated PBL curriculum is aimed at effecting steady growth in knowledge in all disciplines, the slowdown in growth in the later years was among the reasons for initiating a major curricular innovation in 2001.     

满意医疗服务的基本原则

自然科学与人文科学的统一与融合，促使医学内涵蕴义和框架结构的嬗变，进而提高了医学的科学品位。医学科学领域中科学、技术、经济、社会与人文科学的高度一体化，深刻揭示了人文精神在医疗服务中的重要性。医疗服务诚信、服务公平、服务有效和服务满意，是医疗服务中人文精神的体现，表证着医院品格和核心价值观念，是满意医疗服务的前提和保证。作者强调指出，医疗服务中的伦理道德和人文思想建设，是现代医院文化建设的核心，也是医院经济增长的重要基础。     

Handwashing: a simple, economical and effective method for preventing nosocomial infections in intensive care units

As most nosocomial infections are thought to be transmitted by the hands of healthcare workers, handwashing is considered to be the single most important intervention to prevent nosocomial infections. However, studies have shown that handwashing practices are poor, especially among medical personnel. This review gives an overview of handwashing in health care and in the community, including some aspects that have attracted little attention, such as hand drying and cultural issues determining hand hygiene behaviour. Hand hygiene is the most effective measure for interrupting the transmission of micro-organisms which cause infection, both in the community and in the healthcare setting. Using hand hygiene as a sole measure to reduce infection is unlikely to be successful when other factors in infection control, such as environmental hygiene, crowding, staffing levels and education, are inadequate. Hand hygiene must be part of an integrated approach to infection control. Compliance with hand hygiene recommendations is poor worldwide. While the techniques involved in hand hygiene are simple, the complex interdependence of factors that determine hand hygiene behaviour makes the study of hand hygiene complex. It is now recognized that improving compliance with hand hygiene recommendations depends on altering human behaviour. Input from behavioural and social sciences is essential when designing studies to investigate compliance. Interventions to increase compliance with hand hygiene practices must be appropriate for different cultural and social needs.     

The content of the medical curriculum at McMaster University: graduates'' evaluation of their preparation for postgraduate training

This paper describes McMaster University medical graduates' perceptions of how well their medical curriculum prepared them for postgraduate training. The graduates view their overall preparation for postgraduate work as sound. These perceptions were compared with independent assessments by internship supervisors for one graduated class. The graduates suggest their preparation for postgraduate work differs somewhat from fellow interns. Graduates reported feeling very well prepared compared to fellow postgraduate trainees in independent learning, self-evaluation and problem solving skills. They also judge their preparation in data gathering skills, behavioural science knowledge, ability to deal with social and emotional problems of patients, medical record keeping skills, preventive, follow-up and in-patient care as very good compared to peers. They identified two content areas, pharmacology and the basic medical sciences, as requiring more attention in the curriculum. These findings are discussed and related to the approach to medical education at McMaster University.     

Measuring knowledge and clinical reasoning skills in a problem-based curriculum

The purpose of this study was to investigate the validity of the Progress Test that was specially designed for measuring the growth of knowledge and clinical reasoning skills in a problem-based medical curriculum. Scores and subscores of students from the different categories of the Progress Test were compared with their scores on a Clinical Reasoning Tests. Both the Progress Test and the Clinical Reasoning Test revealed the same pattern of increasing scores over the years, and had a high intercorrelation. Further analyses revealed that the clinical sciences subscore in the progress test explained the variations in the clinical reasoning test scores. The knowledge of the behavioural sciences subscore made a small but independent contribution. The knowledge of the biomedical sciences subscore did not have this independent effect. These outcomes are discussed in this paper from the perspective of development of medical expertise research and theory. Some educational consequences are also discussed.     

Creating an ideal social and behavioural sciences curriculum for medical students

Medical Education 2010: 44 : 1194–1202 Objectives Undergraduate medical education programmes universally struggle with overfull curricula that make curricular changes quite challenging. Final content decisions are often influenced by available faculty staff, vocal champions or institutional culture. We present a multi‐modal process for identifying ‘need‐to‐know’ content while leveraging curricular change, using the social and behavioural sciences (SBS) as an exemplar. Methods Several multi‐modal approaches were used to identify and triangulate core SBS curricula, including: a national survey of 204 faculty members who ranked the content importance of each of the SBS content areas; a comprehensive review of leading medical SBS textbooks; development of an algorithm to assess the strength of evidence for and potential clinical impact of each SBS construct; solicitation of student input, and review of guidelines from national advocacy organisations. To leverage curricular change, curriculum mapping was used to compare the school’s ‘actual’ SBS curriculum with an ‘ideal’ SBS curriculum to highlight educational needs and areas for revision. Clinical clerkship directors assisted in translating core SBS content into relevant clinical competencies. Results Essential SBS content areas were identified along with more effective and efficient ways of teaching SBS within a medical setting. The triangulation of several methods to identify content raised confidence in the resulting content list. Mapping actual versus ideal SBS curricula highlighted both current strengths and weaknesses and identified opportunities for change. Conclusions This multi‐modal, several‐stage process of generating need‐to‐know curricular content and comparing it with current practices helped promote curricular changes in SBS, a content area that has been traditionally difficult to teach and is often under‐represented. It is likely that this process can be generalised to other emerging or under‐represented topic areas.     

Social and behavioural science education in UK medical schools: current practice and future directions

INTRODUCTION: The increasing importance accorded the social and behavioural sciences in medical education presents opportunities for developing new and innovative forms of teaching and learning in this field. Yet social and behavioural scientists often feel isolated and marginalized. This research was designed to build a network of such practitioners to share and compare current practice, and to develop better models and resources. METHODS: Questionnaire survey and workshop discussions describe current practice among social and behavioural scientists in UK medical education, and identify current and future issues. RESULTS: Most UK medical curricula feature a significant social and behavioural science component, often in multidisciplinary contexts. Questions of core content, and how this relates to desired learning outcomes, particularly in the attitudinal sphere, remain unresolved. Identity problems result from differing perspectives of medics and social and behavioural scientists, staffing constraints, assessment regimes, and relationships with external examiners. DISCUSSION: This project identified barriers and opportunities for providing adequate training in the social and behavioural sciences in medical schools. Some of the barriers are common to higher education generally. Through our network, a database of core cases and assessments can be developed that would be available to all for teaching purposes. CONCLUSION: Social and behavioural scientists involved in medical education show commonality and difference in the extent and scope of their input. While they have made great progress, there remains much to achieve.     

Elective modules in the behavioural sciences

An elective modules programme in the behavioural sciences was designed for the undergraduate medical curriculum at The Ohio State University College of Medicine. The programme provides a mechanism by which a broad range of behavioural science content can be introduced into the curriculum without increased allocation of teaching staff or budget. Student preference data indicate some clear differences with the more popular modules being those which focus on skills or behaviours that students perceive to be useful in the immediate practice of medicine. The elective aspect of the programme was part of its initial appeal, both to students and teaching staff. Two years of course evaluation data from the students indicate that most individual modules and the programmes as a total have been successful in achieving their intentions. The programme has now been included as a permanent component of the curricula.     

Medical students' attitudes towards and perception of the basic sciences: a comparison between students in the old and the new curriculum at the University Medical Center Utrecht,The Netherlands

OBJECTIVES: The attitudes towards the basic sciences of medical students enrolled in either of 2 different curricula at the University of Utrecht Medical School in The Netherlands were investigated. The purpose of this study was threefold: first, to compare students (beginning clerks) in a conventional and an innovative curriculum; second, to compare beginning clerks with advanced clerks; and third to compare the present results with those of 2 previous American and Canadian studies in which the same questionnaire was used. SETTING: Beginning clerks in the old and in the innovative curriculum, and advanced clerks in the old curriculum, rated 9 statements on a 5-point (disagree - agree) Likert scale. The statements assessed students' attitudes toward the basic sciences. RESULTS: The results showed that beginning clerks in our innovative curriculum, unlike those in a conventional curriculum, consider the basic sciences as somewhat less important for medical practice and do not think that as many biomedical facts as possible should be learned before entering clinical practice. On the other hand, students in the innovative curriculum are more excited by the faculty's teaching of the basic sciences. This latter result confirms the findings in a previous Canadian study. No significant differences were found between beginning and advanced clerks in the conventional curriculum. CONCLUSION: Students experience teaching of the basic sciences as more exciting when they are integrated in organ system blocks with clinical bearings, though they are somewhat less positive about the actual importance of these sciences.     

Behavioural self-analysis in the medical curriculum: a comparison of Malaysian and American experiences

Behavioural self-analysis projects were introduced into the second year medical curriculum in behavioural sciences at the University of Malaya. Student performance and evaluation of the experience were compared with those of American medical students. It was concluded that receptivity of medical students to principles of behaviour therapy is relatively similar in the two societies.     

医学院校中加强哲学社会科学研究管理的思考

在医学科学研究工作中,哲学社会科学研究与自然科学研究是同等重要的。本文结合首都医科大学哲学社会科学研究管理的实际情况,指出对于医学院校而言,当前的哲学社会科学研究管理工作尚存在许多不足之处,其中三大首要问题是重视程度及梯队建设不足、自身定位及优势把握不足、社科研究成果转化不足并针对每类问题逐一进行了分析,提出了解决对策。呼吁要进一步加强医学院校中的哲学社会科学研究管理工作。     

Turner syndrome

The adolescent with Turner syndrome usually enjoys good health, satisfactory school performance, and normal peer relationships. Some girls, however, have medical, developmental, or social problems that need to be addressed in a timely fashion. Newly diagnosed patients require baseline evaluations for cardiovascular, endocrine, gastrointestinal, and audiologic abnormalities. In those with an established diagnosis, routine health supervision requires an expanded and individualized approach that considers the natural history and known risk factors. Multiple medical specialists may need to provide additional diagnostic and treatment services. Primary care physicians also need to be aware of the neurobehavioral and psychosocial complications that may be encountered so that they may be an effective advocate for appropriate academic and psychological interventions. This chapter focuses on the basic science and clinical aspects of Turner syndrome that can serve as a foundation for development of appropriate health supervision strategies.     

A research program for behavioral studies in COPD research]

The demands for medical care of patients with chronic non-specific lung disease (CNSLD) and the prevalence of CNSLD will increase. The need, therefore, for behavioural research on CNSLD will also grow. In order to steer behavioural research in CNSLD, research programming is of great importance. Forty-seven Dutch and 13 foreign expert medical and behavioural scientists were asked via an interview about the most prominent topics and conditions for future research in this field. In addition a literature survey with the same aim was carried out. Important topics for future research include: quality of life of CNSLD patients, patient needs, psychophysiological investigation, social and psychosocial aspects of CNSLD, compliance, problems at work and school, and the education of those involved in patient care.     

河南省地方医学院校人文社科发展现状及改革路径

医学院校人文社科发展水平是影响医学生人文精神培养、医学人文教育教学改革的决定性因素。研究选取河南省两所独立设置的本科医学院校,以河南省20所本科高校为参比对象,发现地方医学院校与综合性大学、其他行业类型高校在人文社科建设投入和产出方面存在较大差距,主要由于基础薄弱、受重视程度不够、资源投入有限等原因造成,医学院校应从重视人文社科发展、遵循学科发展规律、科学制定发展规划、完善激励机制等方面加强人文社科建设工作。     

Why do GPs perform investigations?: The medical and social agendas in arranging back X-rays

OBJECTIVE: We aimed to determine the most important medical and psychosocial reasons GPs report for requesting back X-rays. METHODS: All GPs in a single health district were mailed a questionnaire and asked to document their reasons for requesting back X-rays. RESULTS: A total of 166/236 (70%) of GPs responded. There were 445 comments (mean 2.7 per doctor): 319 (72%) were medical indications (mean 1.9 per doctor) and 126 (28%) psychosocial reasons (mean 0.8 per doctor). GPs' medical criteria for requesting back X-rays were mainly in line with current guidelines. The most common psychosocial reasons were patient satisfaction (17%), work related (14%) and reassurance (8%). CONCLUSION: GPs' reported medical criteria for arranging back X-rays are mainly 'appropriate', but psychosocial reasons-especially patient satisfaction and reassurance-are also likely to be important factors. If psycho-social agendas are important in ordering investigations, then clinical guidelines which discuss only medical criteria may not be effective in reducing 'inappropriate' investigations.