The People Side Of Medical Education: It's Essential

IUSM has a prescription for what ails new doctors - at least when it comes to "people" skills and professionalism.

Over the next four years, the School will implement an ambitious and innovative change to the standard medical school curriculum. It is called the competency-based curriculum and has already begun at the nine sites where the first two years of medical school are taught in Indiana. The implementation will be complete when the class of 2003 graduates.

The competency-based curriculum requires that, in addition to technical excellence, students demonstrate nine core skills and behaviors essential to being a good doctor. In the past, physicians acquired these characteristics haphazardly through experience; now students will be taught, tested and scored on their mastery of all nine areas.

As part of the present curriculum, only two of these areas are tested: basic clinical skills (like starting IVs and doing histories and physicals) and using science as a guide to diagnosis (basic and clinical medical science). The new curriculum adds seven more: communication; lifelong learning; social and community contexts of health care; self-awareness, self-care and personal growth; problem solving; moral and ethical judgment, and professionalism.

What will be the outcome of this curricular experiment? Our intent is to assure that future patients are treated by the best IU-trained doctor possible. This means a doctor who knows and cares about your home life, health beliefs and personal values. . . a doctor you trust more and with whom you can develop the kind of caring and healing alliance that has been shown to be essential to high quality medical care.

There may be some secondary positive consequences as well. At a time when thirty-one percent of physicians say that they would choose another profession if they had a chance, and more and more physicians are unable to cope with the stress of modern medical practice, a curriculum that acknowledges the importance of self-awareness can help physicians too.

As common sense as this approach may seem, it is late in coming. In fact, only Brown University (which first established the competency-based curriculum upon which IUSM's is based), IUSM, and one other U.S. medical school have adopted this type of curriculum.

This kind of curricular change, while especially important in medical school, could also make colleges and even high schools better. It requires faculty to certify that students are competent in written and spoken communication, that students can analyze and solve a problem, and that they can find and judge the value of sources of information. In addition, it requires that students receive instruction and be tested to show ability in ethics, professionalism, modern society and self-analysis.

So obvious is the value of demonstrating such abilities that you might be left wondering: "Why didn't we do a competency-based curriculum before 1999?"

Patrick Bankston, PhD is a professor of anatomy and pathology at the IU Northwest Center for Medical Education in Gary.