NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Institute of Medicine (US) Committee on Behavioral and Social Sciences in Medical School Curricula; Cuff PA, Vanselow NA, editors. Improving Medical Education: Enhancing the Behavioral and Social Science Content of Medical School Curricula. Washington (DC): National Academies Press (US); 2004.

Cover of Improving Medical Education

Improving Medical Education: Enhancing the Behavioral and Social Science Content of Medical School Curricula.

Show details

AMethods

This appendix describes the methods used by the committee to collect information for its review, assessment, and consideration. Four types of data collection were undertaken: a literature review, invited presentations, a survey of selected medical schools, and a modified Delphi process for prioritizing topics (see Chapter 3). Each activity is described below.

LITERATURE REVIEW

The committee's initial literature search (Figure A-1) concentrated on journals found in the MEDLINE database. A second, expanded literature search (Figure A-2) included multiple databases. As noted throughout this report, these searches yielded a relatively small number of articles specific to the inclusion of the behavioral and social sciences in medical education. Broad search terms were used to cast as wide a net as possible. The articles obtained by the search terms were reviewed for their relevance to the committee's charge. To be viewed as relevant for this report, an article had to be in English and meet one of the following criteria: (1) describe or review medical school curriculum content identified as relevant to the behavioral and social sciences; (2) describe or review medical school curricula or curriculum change; or (3) include a discussion of undergraduate medical school education.

FIGURE A-1. MEDLINE search results.

FIGURE A-1

MEDLINE search results. The numbers in parentheses indicate the number of articles found in each category; some articles fall under more than one category. The search was limited by language (English), species (human), and year (1970–2003).

FIGURE A-2. Results of electronic multiple-database search.

FIGURE A-2

Results of electronic multiple-database search. The numbers in parentheses indicate the number of articles found in each database. The second number in parentheses (refined) indicates the number of articles that remained after nonrelevant articles had (more...)

Systematic reviews or descriptions of behavioral and social science content in undergraduate medical school curricula were not found. Articles describing the rationale or goals of a behavioral and social science program, including examples of course content, were obtained. However, these articles did not provide enough information to allow a review of the approaches that have been or are successful in teaching the behavioral and social sciences in medical school or an evaluation of the effectiveness of current programs. The majority of the articles describing or reviewing curriculum change were not specific to the behavioral and social sciences, but were deemed to address overarching principles and strategies applicable to these disciplines.

INVITED PRESENTATIONS

The committee held multiple open sessions at which invited speakers representing interested organizations, associations, and medical schools provided information. During the sessions, the committee was able to discuss the information presented and gain additional insight from different perspectives regarding the inclusion of the behavioral and social sciences in medical school curricula. A list of the associations, organizations, medical schools, and respective institutions represented by the invited speakers appears in Box A-1.

Box Icon

BOX A-1

List of Interested Associations, Organizations, and Medical Schools Represented by Invited Speakers. Association of American Medical Colleges Association for the Behavioral Sciences and Medical Education

MEDICAL SCHOOL SURVEY

To obtain additional information on the current status of behavioral and social science content in medical school curricula, the committee surveyed a limited number of medical schools using a two-step data collection method. Four schools were selected and surveyed based on initial information that indicated their behavioral and social science program could serve as an example of current approaches being used. The survey consisted of two parts: a brief questionnaire completed by an official of the medical school, followed by a telephone interview with that individual. The four schools surveyed were Ohio State University College of Medicine; University of California, San Francisco, School of Medicine; University of Rochester Medical Center; and University of North Carolina School of Medicine.

MODIFIED DELPHI PROCESS

The committee used a modified Delphi process to establish the priority topics delineated in Chapter 3. The initial step was to establish a list of all possible topics in the behavioral and social sciences that could be included in a curriculum for medical students (see Box A-2). The topics on this list varied in subject area, specificity of material, and level of relevance to undergraduate medical school education. Background materials that aided in establishing the original list encompassed (1) relevant, evidence-based articles and reports in the literature; (2) presentations to the committee by content experts and medical school representatives; (3) literature and other material from the Association of American Medical Colleges and the Liaison Committee on Medical Education; (4) considerations related to the health of the public, driven mainly by root causes of morbidity and mortality; and (5) the gap between what is known and what is actually done in practice.

Box Icon

BOX A-2

Suggested Curriculum Content Organized by Five Domains. Biological Domain Psychological Domain

The committee's collective and individual experience in curriculum development and reform in the behavioral and social sciences largely directed the prioritization of the topics on the original list. The rating scale used to prioritize the topics ranged from 0 to 3, with 0 being the lowest score, and included “U” (for unknown) as an option for rating a topic if the level of priority was unknown or could not be determined by a committee member. Each topic was then assigned high, low, or medium priority based on its mean score and standard deviation.

Given the number of topics with large standard deviations, it was determined that a second round of ratings was needed to clarify the appropriate rating for each topic. For the second round of ratings, several decisions were made:

  • Topics ranked as low or with a mean score equal to or less than 1 were removed from the list.
  • Topics added by a committee member were placed as the first item in the appropriate category or subcategory.
  • Committee members were given the opportunity to provide a rationale or clarification for their ratings.

The results of this second round provided additional clarification of topics, and the variance in standard deviations was reduced.

The next step in developing the list was to apply the following set of criteria:

  • Is the content of this topic included in or overlapping with other topics on the list?
  • Is undergraduate medical school the most appropriate level for this topic to be taught?
  • Is the topic of limited value for general physician education?
  • Is the topic part of a core behavioral or social science curriculum?

Based on a combination of the answers to the above questions, mean scores, standard deviations, and the expert opinion of the committee, topics were removed from the list and/or reassigned high, medium, or low priority. The committee reviewed a third ranked list and performed a final rating, this time using a 0 to 5 scale similar to the one discussed previously. This list was refined and finalized using the collective and individual expertise of the committee members in medical school curriculum development and reform in the behavioral and social sciences. The final list of topics is in Chapter 3, Table 3-1. In this list, the 11 items ranked top and the 9 items ranked high were combined into one high-priority group.

QUESTIONNAIRE SENT TO MEDICAL SCHOOLS

  1. At your school, the primary strategy for teaching behavioral and social science material is: primarily: (Please circle the appropriate letter)
    1. Integrated as a content theme across several course in the curricula. Taught as a content theme in more than two courses in the curricula
    2. Concentrated in a few courses.
  2. Please complete the chart below.
Please indicate if this information is taught by checking yes or no YES NO Title of course(s) that includes information Department(s) responsible for teaching behavioral and social science content Circle Year Taught Teaching method* (circle all that apply)
Communication Skills
Image pb.jpg
Image pb.jpg
1 2 3 4 PBL SG L U O
Community Health
Image pb.jpg
Image pb.jpg
1 2 3 4 PBL SG L U O
Cultural Diversity
Image pb.jpg
Image pb.jpg
1 2 3 4 PBL SG L U O
End of Life Care
Image pb.jpg
Image pb.jpg
1 2 3 4 PBL SG L U O
Epidemiology
Image pb.jpg
Image pb.jpg
1 2 3 4 PBL SG L U O
Family/Domestic Violence
Image pb.jpg
Image pb.jpg
1 2 3 4 PBL SG L U O
Health Care Quality Improvement
Image pb.jpg
Image pb.jpg
1 2 3 4 PBL SG L U O
Health Care Systems
Image pb.jpg
Image pb.jpg
1 2 3 4 PBL SG L U O
Health Literacy
Image pb.jpg
Image pb.jpg
1 2 3 4 PBL SG L U O
Human Development/ Life Cycle
Image pb.jpg
Image pb.jpg
1 2 3 4 PBL SG L U O
Medical Social Economics
Image pb.jpg
Image pb.jpg
1 2 3 4 PBL SG L U O
Pain Management
Image pb.jpg
Image pb.jpg
1 2 3 4 PBL SG L U O
Palliative Care
Image pb.jpg
Image pb.jpg
1 2 3 4 PBL SG L U O
Patient Health Education
Image pb.jpg
Image pb.jpg
1 2 3 4 PBL SG L U O
Population based Medicine
Image pb.jpg
Image pb.jpg
1 2 3 4 PBL SG L U O
Prevention and Health Maintenance
Image pb.jpg
Image pb.jpg
1 2 3 4 PBL SG L U O
Substance Abuse
Image pb.jpg
Image pb.jpg
1 2 3 4 PBL SG L U O
*

L = lecture, PBL = problem based learning, SG = small-group, U = unknown, O = other (describe).

  1. Does your school provide formal faculty development in behavioral and social science content for participation in these courses? (Circle the appropriate letter.)
    1. Yes
    2. No
  2. Is there a faculty or staff position that is principally responsible for faculty development? (Circle the appropriate letter.)
    1. Yes, please provide the position title __________________
    2. No
  3. What activities are part of your formal faculty development program? (Circle all that apply.)
    1. Small group discussions
    2. Demonstrating/teaching techniques of problem-based learning
    3. Examples of incorporating behavioral and social science into clinical exam
    4. Career development awards for behavioral and social science
    5. Formal didactic sessions teaching faculty behavioral and social science material
    6. Other _____________________________________________
    7. None
  4. What rationale, if any, was stated as the primary reason for including this behavioral and social sciences content in the curriculum? (Circle all that apply.)
    1. Meets licensing or accreditation requirement(s)
    2. Better prepare medical students to care for patients
    3. Communicates belief in multilevel approach to disease
    4. Supports mission of the school
    5. Meets societal expectations
    6. Other ___________________________________________
    7. No formal rationale explicitly stated
  5. There are several other topics of relevance to your behavioral/social science curriculum we would like to explore with a key, knowledgeable person in a telephone appointment of 15-20 minutes' length. Whom should we contact for this appointment and conversation?

Name __________________________________

Telephone number ________________________

E-mail address ___________________________

THANK YOU

Copyright © 2004, National Academy of Sciences.
Bookshelf ID: NBK10234

Views

  • PubReader
  • Print View
  • Cite this Page
  • PDF version of this title (4.0M)

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...