also impart knowledge of and skills in addressing the effects of general medical illnesses on mental health and comorbid mental illnesses and on social needs. While the biopsychosocial model of health care has long been advocated (Engel, 1977), the extent to which this model is adequately implemented in educational curricula is unclear. Licensing and continuing education requirements and credentialing standards pertaining to psychosocial factors also are unclear and appear to be limited, with variations across professions.


Education, training, and licensing requirements to practice medicine in the United States typically include graduating from college with an undergraduate degree; receiving an additional 4 years of undergraduate education at a medical school; passing a licensing examination; and completing up to 8 years of residency training, depending on a physician’s chosen specialty (BLS, 2006b).

Undergraduate Medical Education

The IOM committee that authored the 2004 IOM report Improving Medical Education: Enhancing the Behavioral and Social Science Content of Medical School Curricula found that “existing national databases provide inadequate information on behavioral and social science content, teaching techniques, and assessment methodologies. This lack of data impedes the ability to reach conclusions about the current state and adequacy of behavioral and social science instruction in U.S. medical schools.” The committee recommended that the “National Institutes of Health’s Office of Behavioral and Social Sciences Research should contract with the Association of American Medical Colleges to develop and maintain a database on behavioral and social science curricular content, teaching techniques, and assessment methodologies in U.S. medical schools. This database should be updated on a regular basis” (IOM, 2004a:7). This recommendation has not been implemented.3

Accreditation of medical schools is conducted by the Liaison Committee on Medical Education (LCME), sponsored jointly by the Association of American Medical Colleges (AAMC) and the American Medical Association. Although LCME accreditation is “voluntary,” it is required for “schools to receive federal grants for medical education and to participate in federal loan programs” (LCME, 2006b). Box 7-1 displays LCME accreditation standards that address psychosocial health services. The stan-


Personal communication, M. Brownell Anderson, AAMC, November 9, 2006.

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