Doctors take a lesson in caring

March 14, 1997

STUDENTS at a top medical school in the United States are having to master more than basic science and anatomy. To graduate, they now will have to prove they have compassion.

Brown University has changed its curriculum to measure a student's ability to be a good doctor and not just his or her command of scientific facts.

Other medical schools are already copying or following this departure from tradition.

Stephen Smith, associate dean for medical education and the new curriculum's chief architect, said: "We realised that we were asking them to memorise lists of facts and be able to answer multiple choice questions, but not really to perform in the way the public was asking its doctors to perform.

"We need to give physicians of the future the ability to recognise the importance of not only the biological issues, but the patient's psychology and cultural anthropology and spiritual and religious beliefs," he said.

The curriculum, seven years in the planning, is called MD2000, after the first graduating class that will complete it. That class began its studies in the autumn.

Lay volunteers, including other students, retirees and young actors from a local children's theatre, undergo treatment by Brown Medical School students and judge them on the humanity of their care.

Making a positive impression is a requirement for graduation. Stephen Abrahamson, professor emeritus of medical education at the University of Southern California and a medical school consultant, said: "MD2000 is what a medical school curriculum should look like. Facts are important, but what people do with them is more important."

The universities of Missouri and East Tennessee have already copied the Brown curriculum and the University of Indiana plans to adopt it.

The US health care system has been criticised for a bottom-line mentality imposed by private insurance companies and health maintenance organisations, which parcel out care in exchange for monthly payments. Some HMOs are pressing doctors to cut costs.

"Physicians need now more than ever to recognise ethical conflicts they may find themselves in and be able to do some problem-solving," Dr Smith said.

"The new structure of medicine, I think, creates a much greater hazard for that and it really requires physicians to reason through it."

The US Board of Licensing uses a 720-question multiple-choice examination to test prospective doctors, and US medical schools have come to focus on instilling basic scientific knowledge.

But Brown now asks its students to show they have also mastered nine abilities ranging from moral reasoning to problem-solving. "Human illness is more than just biological malfunction," Dr Smith said.

"That may be the end point, but the trigger may be psychological problems. And certainly the approach to that patient means understanding the social and cultural and spiritual context in which they interpret disease and illness."

Brown's nine areas of medical competency

Effective communication. Basic clinical skills. Using basic science in the practice of medicine. Diagnosis, management and prevention. Lifelong learning. Self-awareness, self-care and personal growth. Social and community contexts of medical care. Moral reasoning and ethical judgment. Problem-solving

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