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Association of American Medical Colleges Tomorrow's Doctors, Tomorrow's Cures®

New Report Outlines Behavioral and Social Science Foundations for Future Physicians

AAMC Reporter: January 2012

—By Sarah Mann

As lifestyle, behavior, and socioeconomic status play more significant roles in health outcomes and access to care, it is increasingly important for future physicians to have foundational knowledge in social and behavioral sciences and be able to apply this knowledge to medical practice, according to a new AAMC report, “Behavioral and Social Science Foundations for Future Physicians. The report complements a 2009 report from the AAMC and Howard Hughes Medical Institute on the scientific foundations for future physician.

“There are many contributions from the social and behavioral sciences that help us deal with aspects of health and illness,” said Rita Charon, M.D., Ph.D., a professor of clinical medicine and director of the narrative medicine program at Columbia University College of Physicians and Surgeons, who chaired the panel that developed the report. “All medical students need an understanding of these disciplines—for example, to counsel someone to stop smoking, or to help clarify the preferences of a patient facing a serious illness that has many possible treatments.”

An early adopter of a social-behavioral focus in medical education, the University of California, San Francisco School of Medicine (UCSF), in 2001 launched a new curriculum that integrates the behavioral and social sciences across all four years of medical school. In the first two years, students discuss clinical cases and learn how the basic sciences, behavior, culture, and societal factors relate to each case.

“It is a much more engaging way for students to learn,” said Jason M. Satterfield, Ph.D., UCSF director of behavioral medicine and a member of the AAMC report’s expert panel. “They can start connecting the dots and understanding the complexities of that case, what caused the problem, what maintains the problem, and what goes into finding a solution or a treatment.”

UCSF medical students get a dramatic introduction to the intersection of medicine, society, and behavior on their first day of class. A team of actors bursts through the lecture hall doors with a “patient” who has been in a motorcycle accident. Actors portraying doctors and nurses rush to the patient just as they would in the emergency room. In the following weeks, students get updates about the patient. They learn that he is uninsured and had been drinking before the accident. He also recently lost his job and ended a relationship.

“Students who have finished medical school and residency still talk about how this case was their very first patient, even though he was an actor,” Satterfield said. “It really hooks them in and shows them how each of those disciplines has an important role in understanding and providing health care.”

This approach has gained momentum over the past few years, as several leading panels of medical educators have stressed the relevance of the behavioral and social sciences to medical education and practice. Last March, the AAMC MR5 Committee, an advisory group that is making recommendations for a new version of the Medical College Admissions Test® (MCAT®), proposed that the revised MCAT exam include testing on concepts that contribute to an understanding of the social and behavioral determinants of health. In 2005, the National Institutes of Health (NIH) awarded grants to nine medical schools to develop curricula that emphasize cultural sensitivity, patient-doctor interaction, empathy, communication, and teamwork. In addition, two earlier reports from the Institute of Medicine (IOM) and the Royal College of Physicians and Surgeons of Canada underscored the importance of these disciplines in medicine.

The IOM report, released in 2004, outlined six behavioral and social science domains that should be included in medical education: mind-body interaction, patient behavior, physician role and behavior, physician-patient interaction, social and cultural context, and health policy and economics. The Canadian report, “CanMEDS 2005 Physician Competency Framework,” highlighted different roles future physicians should be prepared to fill, such as a professional, communicator, health advocate, and collaborator.

The new AAMC report combines the knowledge and research domains of the IOM document with the physician roles of the CanMEDS report into a teaching and learning matrix that illustrates how practicing physicians and students can apply behavioral and social sciences in their everyday work. For example, a physician serving in the role of a collaborator might help a patient who is trying to quit smoking develop a plan to quit and identify community resources that could provide support. As a health advocate, the same physician might advocate for smokingcessation services.

Despite the seeming consensus about their importance, it has been difficult for medical educators to integrate the social and behavioral sciences throughout curricula, so that students view these disciplines as relevant to their future roles. Among the challenges are a lack of clear, established learning objectives, and a lack of resources to help train students. The new learning matrix presented in the report attempts to offer a tangible tool for educators to use.

If other schools are to successfully integrate these fields into their curricula, a practical approach is key, according to Eric Holmboe, M.D., senior vice president of the American Board of Internal Medicine, who served on the expert panel.

“The curriculum is not just about the knowledge. Students really need to apply these skills in an actual care setting with real patients,” Holmboe said. “It’s hard for me to believe that we’ll truly be able to fix this problem unless we get faculty more deeply engaged in teaching, observing, assessing, and providing feedback.”

As the U.S. medical education community increases efforts to enhance behavioral and social science understanding, physician educators abroad also are recognizing the importance of these disciplines in medical education. During the first week of the report’s release, the Taiwanese Ministry of Education requested permission to translate the report into Mandarin Chinese.