More behavioral, social sciences education needed

Incorporating behavioral and social science instruction into medical school curriculum is not merely advisable, according to a new Institute of Medicine report, it is no longer acceptable not to do so.

Noting that the top three causes of preventable deaths in the United States are smoking, sedentary lifestyle/poor diet and alcohol abuse, the report declares that efforts within standard medical practice to change these behaviors appear to be "less than successful."

Entitled "Improving Medical Education: Enhancing the Behavioral and Social Science Content of Medical School Curricula," the report assesses how behavioral and social sciences are currently taught, makes recommendations on what should be taught and how, and then lists strategies for making this happen.

If these strategies are successful, the report predicts "measurable improvements in the health of Americans," brought about by physicians who "recognize, understand, and effectively respond to patients as individuals, not just to their symptoms."

Curricula already crowded

Neal A. Vanselow, MD, professor emeritus of medicine at Tulane University, chaired the committee that wrote the report. He acknowledged that changing attitudes and curricula will not be an easy task.

"The medical school curriculum is crowded," Dr. Vanselow said. "If you put in something new, you have to take something out, and people get very protective of what they teach. Still, I think the worse thing you could ever do is to have curricula that never change."

Faculty leadership is cited as both a barrier and a catalyst for change. While acknowledging that a general lack of leadership is a common factor in blocking change, it also mentions how "curriculum change rarely occurs without a champion or leader pushing the agenda forward."

Although the report states that "the importance of continuing behavioral and social science education cannot be overemphasized," Dr. Vanselow said continuing medical education was beyond the scope of what the committee was assigned to work on. Nevertheless, he added that physicians need to be life-long learners.

"Our charge was very specific, and that was to look at the four years in medical school," he said. "But there's no way you can present everything doctors need to know in the four years of medical school. Every year there's more and more information, but med school is still only four years long."

Dr. Vanselow and the report recommend that physicians' behavioral and social science education should begin before medical school. The report says medical schools should let aspiring physicians know that they are expected to have completed coursework in behavioral and social sciences in their prebaccalaureate years and that medical education should build on that undergraduate foundation.

Dr. Vanselow noted that the committee was very impressed by the way behavioral and social sciences were taught at the medical schools of the University of California, San Francisco, and the University of Rochester in New York.

Rather than teach them as separate courses, he said these institutions blend instruction of behavioral and social sciences into the curricula of every course.

"The main reason we were impressed was because teaching this in an integrated manner simulates the real world," Dr. Vanselow said.

The report also singled out the behavioral and social science content of courses on substance abuse at University of North Carolina medical schools as an example of using these subjects to focus on a specific health problem.