Innovative curriculum: Integrating the bio-behavioral and social science principles across the LifeStages in basic science years.

Behavioral and social science integration in clinical practice improves health outcomes across the life stages. The medical school curriculum requires an integration of the behavioral and social science principles in early medical education. We developed and delivered a four-week course entitled "LifeStages" to the first year medical students. The learning objectives of the bio-behavioral and social science principles along with the cultural, economic, political, and ethical parameters were integrated across the lifespan in the curriculum matrix. We focused on the following major domains: Growth and Brain Development; Sexuality, Hormones and Gender; Sleep; Cognitive and Emotional Development; Mobility, Exercise, Injury and Safety; Nutrition, Diet and Lifestyle; Stress and coping skills, Domestic Violence; Substance Use Disorders; Pain, Illness and Suffering; End of Life, Ethics and Death along with Intergenerational issues and Family Dynamics. Collaboration from the clinical and biomedical science departments led to the dynamic delivery of the course learning objectives and content. The faculty developed and led a scholarly discussion, using the case of a multi-racial, multi-generational family during Active Learning Group (ALG) sessions. The assessment in the LifeStages course involved multiple assessment tools: including the holistic assessment by the faculty facilitator inside ALGs, a Team-Based Learning (TBL) exercise, multiple choice questions and Team Work Assessment during which the students had to create a clinical case on a LifeStages domain along with the facilitators guide and learning objectives.

The Evolution of Psychology as a Basic Bio-behavioral Science in Healthcare Education.

For over a century, researchers and educators have called for the integration of psychological science into medical school curricula, but such efforts have been impeded by barriers within medicine and psychology. In addressing these barriers, Psychology has re-examined its relationship to Medicine, incorporated psychological practices into health care, and redefined its parameters as a science. In response to interdisciplinary research into the mechanisms of bio-behavioral interaction, Psychology evolved from an ancillary social science to a bio-behavioral science that is fundamental to medicine and health care. However, in recent medical school curriculum innovations, psychological science is being reduced to a set of "clinical skills," and once again viewed as an ancillary social science. These developments warrant concern and consideration of new approaches to integrating psychological science in medical education.

An innovative behavioral science curriculum at the University of Tennessee College of Dentistry.

Communication skills have long been associated with practice success in dentistry. The Commission on Dental Accreditation's standards state that "Graduates must be competent in the application of the fundamental principles of behavioral sciences" and that "Graduates must be competent in managing a diverse patient population and have...interpersonal and communications skills." A recent survey of U.S. dentists found an underutilization of communication skills by general dentists. The University of Tennessee College of Dentistry strives for continuous improvement and has implemented an innovative behavioral science curriculum to improve students' communication skills, consistent with the College's "patient-centered, comprehensive care" philosophy. We describe the design and implementation of our "Patient-Centered Dentistry" course, in which third-year dental students practice communication skills with simulated patients in the Kaplan Clinical Skills Center on the UTHSC campus. The clinical simulations involve the following scenarios: The Initial Interview with a Patient, Presenting a Treatment Plan, Treating Patients with Fear and Anxiety, Interviewing Considerations for Difficult Patients, Delivering Distressing News to Patients, and Coping with a Drug-Seeking Patient. Student simulations were videotaped and assessed by course instructors as well as clinical faculty, and students received immediate feedback by instructors and clinical faculty after their simulations. Students were provided with the opportunity to view their simulation performance and to reflect on their performance in order to recognize their communication strengths as well as areas for improvement. The use of simulation experiences is becoming a widespread and expected practice in health care education. The Patient-Centered Dentistry course provides students with the opportunity to experience the kinds of real-life situations that they would experience in dental practice, without risks to patients. It provides students with the opportunity to assess their communication skills, make mistakes and improve.

Teaching dental students how to deliver bad news: S-P-I-K-E-S model.

Delivering bad news has traditionally been associated with life-threatening illness, the imminence of death, or communicating about the death of a loved one to a family member. The delivery of bad news in dentistry is rarely about life-threatening circumstances. However, the impact of the bad news such as the loss of an anterior tooth can be devastating for the patient. This article outlines the S-P-I-K-E-S protocol and discusses the teaching aims and methodology in applying the model in an undergraduate dental program in Ireland.

[The nursing profession and its interest in the human sciences]. / La profession infirmière et son intérêt pour les sciences humaines.

This research work's purpose is to study the question of nurses' interest for the human sciences. Indeed the development of human sciences' learning since the global diploma of 1992, should allow them to appropriate theorical concepts of the human sciences. These along with other teachings, enable a holistic medical approach. However, it has been noticed that many nurses do not pay any interest at these thought subjects like sociology, psychology and anthropology. The sociological way taken by this research work, made us put work on the following hypothesis: "If nurses don't pay any attention to these subjects, maybe has something to do with their social condition, in the way Bourdieu conceptualised it". The field research consisted in the statistical exploitation panel of 152 tests, trying to measure the interest for the human sciences and to mix the results obtained with sex, age, social origins, year of diploma and the speciality.

An interdisciplinary approach to case-based teaching: does it create patient-centered and culturally sensitive providers?

This investigation explored whether teaching a case-based seminar influenced dental students' perceptions of the importance of various factors for diagnosis and treatment planning. In addition, the effects of an interdisciplinary approach to case-based teaching were analyzed. During the winter semesters 2004 and 2005, 204 second-year dental students participated in a case-based comprehensive care seminar. The students were randomly assigned either to a section with a behavioral science instructor present or to a section without a behavioral science instructor. At the beginning and end of each semester, the students evaluated the importance of various factors for diagnosis and treatment planning in self-administered questionnaires. This seminar increased students' importance ratings of subjective oral health-related factors (such as dental fear) and diversity-related factors (such as the patient's ethnicity/race) from the beginning to the end of the semester. Students in the section with a behavioral science instructor rated the importance of behavioral and diversity-related factors higher than students in the section without the behavioral science instructor. These findings suggest that interdisciplinary, case-based teaching increased students' appreciation of the complexity of patient care and of a patient-centered, culturally sensitive approach to diagnosis and treatment planning.

Evaluation by dental students of a communication skills course using professional role-players in a UK school of dentistry.

This paper reports student (n = 180) feedback on the role-play teaching methodology used in behavioural sciences teaching at The School of Dentistry in Birmingham (UK). The feedback received on this well-established (since 1995) educational programme was collected via questionnaire (100% response rate), requiring Likert scale and free text responses. Generally students reported that they had enjoyed and valued the session. Over two-thirds (69.7%) of students rated the role-players as 'very real' and over three-quarters (78.9%) rated their feedback as 'very fair'. The data collected from this study will inform future curriculum development. Student feedback was very positive and demonstrated that the cohort (86% of all students studying in years 1, 2 and 3) found the use of professional role-players involved in behavioural sciences teaching to be both acceptable and valuable.

Paradigm shifts in medical and dental education: behavioural sciences and behavioural medicine.

Psychosomatic and behavioural medicine have a long tradition in Hungary. In this paper, we highlight the possibilities of teaching behavioural medicine and behavioural science in the medical and dental curricula, particularly in the field of health promotion and prevention. There are a number of possibilities for dentists in the fields of behavioural science in both research and health policy. There is a need for closer integration of teaching, research and health policy in both general medicine and dentistry, and both doctors and dentists must approach their patients in a holistic way.

Effects of training in management of child behavior for dental hygiene students.

The reliability and validity of a Confidence of Dental Hygienist in Child Management Scale were examined. Forty-eight dental hygiene students, nine dental staff, and thirty-one dentists were subjects for the reliability and validity scale. The acceptable level of the reliability on the Scale was shown by internal consistency and stability. The confidence scores of the clinician's group were significantly higher than the confidence scores of the students. The reliability and validity of the Confidence Scale were established. Next, we evaluated the effect of behavioral science training, using videotape feedback and role playing on twelve dental hygiene students. Six students received the training, the other six students, the controls, had no training. The confidence scores of the training group were significantly higher than those of the control group, demonstrating that the training was effective for dental hygiene students.

The place of behavioral science in medical education and practice.

Medicine and medical practice have undergone dramatic changes in the recent past. Technological advances have exceeded the norms of social thought (e.g., frozen embryos, surrogate motherhood, assisted suicide, and the right to die), and there has been a loss of professional control of the provision of medical services because of an inability to control the costs of technology and the patterns of practice. These and related changes find the profession of medicine, including medical education, without the necessary theory and content to adapt. The author explains why this situation makes it more necessary than ever to develop and upgrade the teaching of behavioral sciences in the medical curriculum, even though these disciplines' breadth and comparative lack of definition create special problems for the teaching and learning of behavioral concepts and their application to medical practice. The behavioral sciences are needed in medicine because their role is not that of a technologically defined knowledge area but rather that of a process or functional area that mediates between the patient as a person and the delivery of medical care. The author presents concepts, a diagram, and teaching examples that explain the characteristics of behavioral sciences and illustrate the necessity for including them in the curriculum. He concludes by urging the leaders of academic medicine to find practical ways to transmit an awareness of behavioral sciences' crucial role in patient care so that tomorrow's physicians can function more fully in the complex arena of clinical reality.

The role of family physicians in the management of cancer patients.

Eight functions of health care--identifying and monitoring risk factors, early disease screening, diagnosis, staging, treatment, shared care (between referring physicians and cancer specialist), follow-up monitoring, and advanced disease management--are applied to the management by family physicians of the spectrum of cancer. Family practice training programs emphasize competencies necessary to identify serious disease in the undifferentiated patient, continuity of care, comprehensive care, human behavior, preventive medicine, community medicine, and integration and management skills. Consequently, family physicians maintain overall patient management. The competencies acquired in family practice residency training prepare graduates for roles in the management of every stage of the natural history of a chronic disease such as cancer. The author describes the roles that family physicians are prepared to assume in the management of cancer patients at the eight stages of disease management: 1) monitoring risk factors--establish cancer risks for every patient and provide appropriate periodic review of each risk; 2) early disease screening--utilize the screening recommendations of the American Cancer Society and develop an office procedure to maintain the continuity of this effort; 3) diagnosis--follow up on positive screening results and pursue causes of presenting symptoms; 4) staging--use the results of staging procedures to guide patient choice of alternative treatments; 5) treatment--although some family physicians choose to administer chemotherapy under the direction of cancer specialists, all will find themselves involved in counseling patients and their families, in providing family support, and in arranging for utilization of community resources; 6) shared care (comanagement)--share the monitoring of treatment progress and side-effects; this entails support of the patient and family throughout all stages of the disease; 7) follow-up monitoring--continued follow-up of patients once they are considered "cured" (e.g., monitor for recurrence or second primary disease); and 8) advanced disease management--manage symptoms, pain, and quality of life when cure is no longer an option.

Training osteopathic medical students in behavioral medicine and psychiatry.

Medical students need more comprehensive training in behavioral sciences to cope with the increasing acuity of patients seen in an ambulatory-care setting. Present-day psychiatry teaching and clinical rotations emphasize severe psychopathologic disorders and inpatient care. Colleges of osteopathic medicine should integrate behavioral sciences into the preclinical curriculum and clinical training. Clinical psychiatry training should prepare students to care for patients with the kinds of behavioral difficulties seen in primary care settings in an integrated manner.

Description of a faculty-student group practice.

Dental schools are facing budgetary constraints, decreasing clinic patient populations, and increasing competition. At the same time, there is a need to provide students a realistic educational environment. The Dental Practice Systems (DPS) Program is a partially self-supported student-faculty group practice designed to address these issues. All individuals appearing for care are accepted into the program. Services are delivered by vertical teams of faculty preceptors, in-house specialty consultants, dental and dental hygiene students, and appropriate auxiliaries. All third- and fourth-year students rotate through the program providing clinical services. In addition, fourth-year students are assigned specific managerial responsibilities. The DPS Program maximizes the use of auxiliaries and students, allowing each to function as autonomously as is consistent with good patient care.

The involvement of the behavioral sciences in American medicine: a historical perspective.

This paper discusses the medical profession's underlying motivations in initiating recent changes in medical education in the United States. The first part briefly examines the transition from a holistic to a scientific theory and practice in American medicine. The second part of the paper analyzes and interprets the increasing incorporation of behavioral scientists into medical education in recent decades. A review of the debate on reforms in medical education, appearing in The Journal of the American Medical Association since the 1940s, indicates that the primary function of these behavioral scientists is to provide future physicians with techniques for managing problems in the physician-patient relationship. The concluding interpretation is that behavioral science expertise is actually used to strengthen and legitimize the traditional status of the medical profession in the existing structure of health care delivery.