Behavioral medicine in medical education: report of a survey.
TL;DR: It is concluded that medical education must include behavioral medicine in order to improve the health of the public and to meet the demands of a changing health care system.
Abstract: SUMMARY Behavioral medicine has become increasingly important in medical education over the past two decades, but adoption of its principles and methods has been slow. Behavioral medicine stresses the effects of human behavior on health and illness using a biopsychosocial approach. It also focuses on the use of the doctor-patient relationship, which, if developed using appropriate communication skills, can result in greater patient satisfaction and increased compliance. The authors surveyed all 124 American medical schools to assess both national trends and specific efforts in the teaching of behavioral medicine principles and methods. A review of the types of behavioral medicine programs offered reveals that eight percent of U.S. medical schools had integrated programs of behavioral medicine. Several successful and effective programs were identified, as were a number of specific curricular components. There are several options available to medical schools to integrate behavioral medicine into medical edu...
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30 Sep 2015
TL;DR: The explicit utility of the BPS model in medical school is limited and can stimulate educational processes and research endeavors to advance medical education and medical practice to ensure that future doctors can meet the challenge of rising lifestyle and environmental associated illnesses.
Abstract: Background
Current medical practice is grounded in a biomedical model that fails to effectively address multifaceted lifestyle and morbidogenic environmental components that are the root causes of contemporary chronic diseases. Utilizing the biopsychosocial (BPS) model in medical school training may produce competent healthcare providers to meet the challenge of rising chronic illnesses that are a result of these factors. This study explored the current trend of research on the utility of the BPS model in medical education and examined medical school curricula that have explicitly adopted the BPS model.
28 citations
Cites background from "Behavioral medicine in medical educ..."
...medical schools that responded to a survey about their curricula reported that they had integrated programs of behavioral medicine using a BPS model [38]....
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TL;DR: E eliminating health disparities will require a multifaceted approach, including increasing research into health disparities, biologic, sociologic, and health services research, transforming the health care system into a culturally sensitive system, eliminating unequal treatment provided to minority populations, and assuring that health care providers provide culturally competent health care are needed.
28 citations
Journal Article•
TL;DR: The skill of doctor-patient communication can be developed and improved by the application of the principles of the patient-centered approach, the utilization of patient-oriented evidence that matters, and its inclusion in the undergraduate curriculum in the first few years of medical school.
Abstract: Doctor-patient communication is a skill essential for the satisfaction of the patients' needs and expectations. It involves an art that every practicing physician should have. The situations in health care delivery that demands good doctor-patient communication are many. Diabetes care, the management of hypertension, explaining serious disease diagnoses, prognosis, and investigative procedures are some of the common situations where good doctor-patient communication is very essential. Doctor-patient communication assumes a special status in Saudi Arabia where as a result of mixed ethnicity of the manpower in the health service and the expatriate community, there is a vast diversity of languages, health traditions and beliefs. The skill of doctor-patient communication can be developed and improved by the application of the principles of the patient-centered approach, the utilization of patient-oriented evidence that matters, and its inclusion in the undergraduate curriculum in the first few years of medical school. There should be continuous medical education programs for practicing doctors on the skills of doctor-patient communication through seminars and workshops. This would be a further step towards the improvement of the consumer's well-being.
16 citations
TL;DR: Analysis of quantitative and qualitative data collected at course start and completion showed student satisfaction with the curriculum, increases in self-reported skill and confidence to apply IH principles to practice and an expanded perception of the role of professional social workers in IH.
Abstract: Integrated healthcare (IH), the systematic coordination of physical and behavioral health needs, is instrumental to the emerging healthcare landscape under the Patient Protection and Affordable Care Act. To ensure social work students are prepared to practice as part of IH transdisciplinary teams, a 15-week advanced practice course was piloted and evaluated at two universities for 58 master's-level students. Analysis of quantitative and qualitative data collected at course start and completion showed student satisfaction with the curriculum, increases in self-reported skill and confidence to apply IH principles to practice and an expanded perception of the role of professional social workers in IH.
12 citations
TL;DR: The basis of the Community Attachment Scheme has been self-directed problem-based learning in small groups with continuous assessment, and these principles have now extended to the rest of the medical curriculum in Sheffield, of which the community attachment scheme is an integral part.
Abstract: This paper describes the development over 14 years of a Community Attachment Scheme for First Year Medical Students in Sheffield, together with feedback from tutors and students. The scheme involves pairs of students visiting families expecting a baby or experiencing an illness. The families are identified by general practitioners who act as tutors together with a behavioural scientist for groups of eight to 10 students. The scheme provides first-year students with practical experience of sociology and psychology in terms of family dynamics and illness behaviour. Assessment is part of the degree examination, and involves a written assignment on the family, together with tutors' assessments. The development of the attachment scheme took place in three phases, which are described together with feedback from tutors and students, as well as changes in methods of assessment. The basis of the Community Attachment Scheme has been self-directed problem-based learning in small groups with continuous assessment, and these principles have now extended to the rest of the medical curriculum in Sheffield, of which the Community Attachment Scheme is an integral part.
7 citations
Cites background from "Behavioral medicine in medical educ..."
...…awareness of the need to integrate behavioural science in the medical curriculum (Tait, 1973; Otite, 1987; Kelly, 1990; Strate et al., 1998; Brook et al., 2000) with early clinical experience (Hampshire, 1998; Matson et al., 1999; Cohen et al., 2000), and an emphasis on community-based…...
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References
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TL;DR: A biopsychosocial model is proposed that provides a blueprint for research, a framework for teaching, and a design for action in the real world of health care.
Abstract: The dominant model of disease today is biomedical, and it leaves no room within tis framework for the social, psychological, and behavioral dimensions of illness. A biopsychosocial model is proposed that provides a blueprint for research, a framework for teaching, and a design for action in the real world of health care.
8,359 citations
01 Jan 1992
TL;DR: Frequent reeducation, reinforcement, and encouragement, as well as training in self-management and self-monitoring, will at the very least maximize the patient's comprehension of the illness and his or her motivation for adherence--an especially important requisite for living with a chronic condition.
Abstract: Clinicians face nonadherence as the norm in everyday medical practice. The literature suggests a number of techniques that are likely to increase adherence when incorporated into regular clinical practices and routines. Central to these guidelines appears to be the doctor-patient relationship. For instance, the physician who uses understandable language, encourages open doctor-patient exchange, fosters participation by patients in their own medical care, and creates a friendly and efficient environment should increase the likelihood of adherence. Clinicians can also check adherence to medication regimens by requesting patients to bring in their pill bottles (or other prescription containers) for a discussion on how the medication appears to be working for them. This should elicit information from the patient about problems related to medication adherence. Since patient variables and social support affect adherence behaviors, eliciting information from patients about their understanding and beliefs regarding their particular illness and treatment, as well as enlisting the support of family and friends, may encourage adherence. Identifying what individual patients perceive as obstacles in following treatment regimens decreases their likelihood of nonadherence; these are difficulties that can be negotiated during the medical interview. Individualizing the treatment and minimizing its complexity may provide the solution that encourages adherent behavior. Frequent reeducation, reinforcement, and encouragement, as well as training in self-management and self-monitoring, will at the very least maximize the patient's comprehension of the illness and his or her motivation for adherence--an especially important requisite for living with a chronic condition. Some patients may even wish to openly solicit family and friends for help in the management and monitoring of their illness and treatment, and to structure their environment to support adherence. Education programs for the patient featuring handouts and pamphlets that provide information about the illness in written and illustrated form have been used successfully. Education programs such as patient-oriented package inserts to accompany the medications and brief written summaries of complex treatment plans may also be useful. The purpose of such patient education adjuncts to illness and treatment lie in the hope that they will enhance the likelihood of following treatment recommendations. Through their use, the reason for the treatment and its potential effectiveness will, it is hoped, be better understood (Ley 1988). Overall, significant advances have been made in adherence research. Measurement systems have become more finely tuned, and the definitions and criteria for adherent behaviors are more clear and precise.(ABSTRACT TRUNCATED AT 400 WORDS)
202 citations
TL;DR: Physicians need to increase their efforts in counseling smokers to quit before smoking-related diseases result, especially for smokers with additional risk factors for cardiovascular disease.
Abstract: Physicians can play an important role in smoking cessation because they have frequent contact with smokers and because most smokers believe that a physician's advice is important in the decision to quit. Therefore, to determine smokers' perceptions of physician involvement in smoking cessation, we analyzed aggregate data from two random statewide surveys of 5875 Michigan adults. Of smokers who had seen a physician in the previous year, only 44% reported that they had ever been told to quit smoking by a physician. Young male smokers were the least likely (30%) to have been told to quit. Smokers who were hypertensive, obese, diabetic, sedentary, or users of oral contraceptives were no more likely to have been told to quit than smokers without these additional cardiovascular risks. Conversely, smokers who had survived a myocardial infarction or stroke were more likely to have been told to quit than smokers who had not suffered these events (73% vs 43%). Most smokers do not perceive physicians to be even minimally involved in their efforts to quit. Physicians need to increase their efforts in counseling smokers to quit before smoking-related diseases result, especially for smokers with additional risk factors for cardiovascular disease. ( JAMA 1987;257:1916-1919)
189 citations
"Behavioral medicine in medical educ..." refers result in this paper
...Although this may seem like common sense, studies have shown that doctors do not always give good prevention advice: one study revealed that only 44% of smokers’ physicians suggested they quit smoking (Anda et al., 1987)....
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Journal Article•
TL;DR: The authors conclude that, when appropriate, spiritual issues should be addressed in patient care since they may have a positive impact on patient health and behavior, and recommend that the medical model be expanded to a biopsychosocial-spiritual one.
Abstract: Spirituality is an important aspect of health care that is not often addressed in modern day primary medical practice. Controversy surrounds the role of spiritual issues in medical practice. Some of this stems from confusing spirituality with religion. This paper distinguishes between spiritual and religious issues and reviews the history of these issues in medicine, the growing medical literature in this area, and some practical guidelines for the practicing physician. The authors conclude that, when appropriate, spiritual issues should be addressed in patient care since they may have a positive impact on patient health and behavior, and recommend that the medical model be expanded to a biopsychosocial-spiritual one. The guidelines developed by the American Psychiatric Association provide a useful model for the practicing physician to follow. More research is needed in this area, but the authors conclude that enough is already known to support the inclusion of spiritual issues in medical education.
168 citations
TL;DR: Results indicate a statistically significant increase in the level of moral reasoning of students exposed to the medical ethics course, regardless of format, and that the case‐study method was significantly more effective than the lecture method in increasing students' level ofmoral reasoning.
Abstract: A study assessed the effect of incorporating medical ethics into the medical curriculum and the relative effects of two methods of implementing that curriculum, namely, lecture and case-study discussions. Results indicate a statistically significant increase (p less than or equal to .0001) in the level of moral reasoning of students exposed to the medical ethics course, regardless of format. Moreover, the unadjusted posttest scores indicated that the case-study method was significantly (p less than or equal to .03) more effective than the lecture method in increasing students' level of moral reasoning. When adjustment were made for the pretest scores, however, this difference was not statistically significant (p less than or equal to .18). Regression analysis by linear panel techniques revealed that age, gender, undergraduate grade-point average, and scores on the Medical College Admission Test were not related to the changes in moral-reasoning scores. All of the variance that could be explained was due to the students' being in one of the two experimental groups. In comparison with the control group, the change associated with each experimental format was statistically significant (lecture, p less than or equal to .004; case study, p less than or equal to .0001). Various explanations for these findings and their implications are given.
166 citations