Is the primary mission of medical school departments to teach students about the disciplines? Not long ago, the answer would have been obvious. Each clinical department was engaged in an unending war for curriculum turf, with success measured by weeks and classes gained and by the numbers of students going into each discipline. For faculty in several disciplines, including family medicine, psychiatry, and pediatrics, the turf wars held special significance, as faculty felt (and still feel) a mission to ensure that an adequate number of students enter disciplines where there is unmet need.
Such considerations are being supplanted by a growing concern that the turf fights have diverted attention and resources from the fundamental responsibility of providing medical students with a broad training in the profession of medicine. As each discipline has focused on providing training within its domain, there has been less attention paid to professionalism, ethics, and communication skills, which transcend departments.
Although no “cease-fire” is in sight, especially with the declining number of students going into family medicine and psychiatry, broader educational strategies are starting to emerge. In many schools control of curriculum time and funding is shifting from the departments to the dean’s office and is being allocated based on an overarching curricular plan. Increasing numbers of family medicine faculty, who once taught primarily within their own clerkships, are teaching courses in interviewing skills, physical examination, medical decision making, medical ethics, and reading the medical literature. Programs to teach research skills, once the sole province of bench researchers, now include faculty who conduct qualitative studies, epidemiologic studies, and survey research. Even faculty development programs, once within the purview of family medicine programs, are now found within dean’s offices with the same departmental faculty teaching a wider and more diverse audience.
For instance, at Michigan State University, faculty develop and implement courses in information management, physician-patient relations, communication/interviewing, physical diagnosis, international health, underserved medical needs, nutrition, and geriatrics.
Faculty at the University of Utah lead required courses in social medicine, patient in the community, and a fourth-year public health rotation. The dean’s office is now directly hiring and firing faculty from courses rather than working through the department.
At the University of North Carolina, faculty have led an institutional initiative to develop the role of professional service in medical student education. The cornerstone is a student-run clinic, which has expanded to include a mobile clinic, an outreach dental clinic, and a women’s shelter. The initiative includes clinical rotations and research opportunities.
An Ohio State family medicine faculty member is director of the “Patient-Centered Medicine” course, which teaches students about communication, domestic violence, human sexuality, and ethics. Department faculty also teach the professionalism course, direct the physician development program, and direct the 3-month ambulatory clerkship.
At Brown Medical School, the Associate Dean for Education is a family physician, and 4 other family physicians have joined the dean’s office as associate deans. The generalist skills and broad approach of family medicine training and experience and the ability to collaborate and work across disciplines were defining advantages in their selection.
At the University of Texas at San Antonio, a faculty member directs the first-year “Clinical Integration” course. In the third and fourth year, 3 faculty play leading roles in the medical school’s Regional Academic Health Center.
Finally, at Duke, the assistant dean and director of the 3-year training program in physician-patient relationships is a family physician, as is the faculty member who is the lead writer of the new curriculum, while the past family medicine residency program director is now the associate director of graduate medical education. The department faculty development program has also had a rebirth as an institutional training program.
Faculty continue to have their primary appointments (and often their primary loyalties) within their disciplines and departments. Departments are still charged with ensuring that students are well trained in the disciplines and can safely practice as interns after graduation. But the previously strident tones of interdisciplinary fighting are starting to mute, as faculty recall that the primary obligation of medical school faculty is to the students. Whether this new focus will translate into more students going into areas of need remains to be seen. We will be training students to be members not just of a discipline, but of a profession.
Lloyd Michener, MD
- © 2003 Annals of Family Medicine, Inc.
