only 37 percent had a written curriculum on these topics. Student interest in and appreciation of the subject was mixed. About 50 percent of medical schools endorsed less than 40 hours of total instruction in psychosomatic/ behavioral medicine out of the 7,000–8,000 hours in the average medical school curriculum. The researchers concluded that the degree of coverage of the subject in undergraduate medical education appeared variable, but generally was unknown and difficult to assess (Waldstein et al., 2001). AAMC’s online Curriculum Management and Information Tool (CurrMIT) currently serves as the database for tracking teaching techniques and assessment methodologies for these topics.6 Although CurrMIT aids in analyzing curricular content, it is a voluntary system. About one-third of accredited U.S. medical schools are not actively entering data into the system. Further, medical schools that participate have flexibility in data entry, and as a result, the data submitted vary in detail from school to school.7 As reported above, a 2004 IOM report found that existing national databases provide inadequate information on behavioral and social science content, teaching techniques, and assessment methodologies in U.S. medical schools.
Medical students’ clerkship experiences and opinions reflect some satisfaction with current education and training in psychosocial health services (Yuen et al., 2006). In the 2006 Medical School Graduation Questionnaire, 86.5 percent of students reported receiving “appropriate” instruction in behavioral sciences (AAMC, 2006b).8 Yet some medical students, residents, and practicing physicians have reported inadequate medical education on the role of psychosocial factors in health (Astin et al., 2005, 2006), which is related to clinicians’ attention to psychosocial issues in their practices (Astin et al., 2006).
To practice legally as a physician, medical students must pass the three-step U.S. Medical Licensing Examination (USMLE). Step 1 of the exam (usually taken after the second year in medical school) assesses basic science knowledge according to general principles and individual organ systems. Approximately 10–20 percent of Step 1 addresses “behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational and environmental” (USMLE, 2006:7). Box 7-2 shows the subtopics in the Step 1 exam that address psychosocial
6Personal communication, M. Brownell Anderson, AAMC, November 9, 2006.
7Personal communication, Robby Reynolds, AAMC, October, 23, 2006.
8In the 2006 All Schools Report, the question was, “Do you believe that the time devoted to your instruction in the following areas was inadequate, appropriate, or excessive?” (n= 11,417); 9.2 and 4.4 percent, respectively, rated the time as “inadequate” or “excessive” (AAMC, 2006b).