To the Editor:
We applaud the recent report1 of the Association of American Medical Colleges (AAMC) emphasizing the importance of the behavioral and social sciences (BSS) in undergraduate medical education. As trainees whose schools are engaged in curricular reform, we agree with the AAMC report that deans of education ought to ask not “whether to” but, instead, “how to” better integrate BSS knowledge, practice, and assessment. In addition, we support national efforts to develop robust tools and strategies underscoring the BSS Matrix Instrument.1 Finally, we propose considering the BSS competencies in the following three broad groups, characterized by interrelated but distinct methods of pedagogy and assessment, as well as by how closely these competencies fit within existing curricular constructs.
The first group consists of knowledge-based subjects, including biostatistics, epidemiology, and applied sociology. These are readily integrated into traditional approaches to instruction and assessment favored by medical schools during the preclinical years. Hence, most schools have done well in introducing these subjects to students.
The second group includes fostering competencies that encourage students to turn inward to develop an understanding of the sociocultural dimensions that form the foundation of the physician–patient relationship. These dimensions may be formalized during the clinical years through structured patient encounters, small-group debriefings, BSS attending rounds as a modeled behavior, and narrative medicine as a way of sharing applied principles of patient-centered care.2 For these competencies, we believe most schools have selected from a buffet of pedagogical and assessment approaches, with varying degrees of impact on trainees.
The third group lies at the nexus of the AAMC report’s approach to BSS yet remains the least developed in philosophy and practice. We envision a framework, aligned with the BSS-focused recommendations3 of the MCAT MR5 Advisory Committee, to promote overarching changes in students’ values, beliefs, and lived experiences throughout their training. The self-actualization of empathy, personal leadership, and reflective practice relies on a curriculum and an institutional culture that inspire internal examination of psychosocial conflicts and changes. Some schools have added curricular components, such as portfolios, that collect formalized narratives and 360-degree assessments; these and other creative approaches to framing medical education will require empirical assessment.
Overall, we believe that the salient challenge in contemporary medical education reform is to define how BSS can act in concert with the biomedical sciences to foster holistic teaching and learning environments.
Kevin Koo, MPhil
MD/MPH candidate, Yale University School of Medicine, New Haven, Connecticut, and Harvard School of Public Health, Boston, Massachusetts; firstname.lastname@example.org.
Allison N. Martin
MD/MPH candidate, Vanderbilt University School of Medicine, Nashville, Tennessee, and Harvard School of Public Health, Boston, Massachusetts.
2. Koo K. Six words. J Gen Intern Med. 2010;25:1253–1254