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PRINCIPLES REGARDING MEDICAL EDUCATION—

CURRICULUM DESIGN AND CONTENT

The American Medical Student Association:

1.  In regards to Curriculum Design:

a.             ENCOURAGES substantive participation of medical student representatives on curriculum committees and other advisory bodies involved in curricular oversight. (2005)

b.             SUPPORTS using a framework of competencies and objectives to guide curricular design and development. (2005)

c.             SUPPORTS the use of pass/fail grading in the preclinical years of medical school. (2001)

d.             SUPPORTS any effort to increase meaningful patient contact in the preclinical years. (2005)

e.             DISCOURAGES the excessive use of passive learning (i.e., lectures) in medical schools and URGES that active educational techniques (e.g., problem-solving, small group discussions, computer aided instruction) be more widely utilized. (1988)

f.              BELIEVES that hands-on training opportunities in undergraduate medical education are necessary to achieve a level of proficiency in medical procedures, and thus the earlier that this is begun, the greater the level of proficiency that is attained. (1988)  

g.             SUPPORTS the development of federal and state grants and contracts with medical schools to meet the costs of curriculum development projects to improve the teaching of medical students on subjects of emerging national concern, such as preventive medicine, nutrition, occupational health and the health needs of the aged;

h.             SUPPORTS a medical school curriculum that provides appropriate faculty training in the areas of curriculum design and communication techniques, the adequacy of which to be reviewed through student evaluations and the accreditation process;

i.              SUPPORTS development of clinical rotations that devote a fair portion of time to teaching patient communication and health promotion skills. (1992)

j.              ENCOURAGES the formation of student/faculty groups to address the evaluation and formulation of curriculum, to clearly define curricula objectives, and to improve indices of student performance;

2.             In regard to Preventive and Community Medicine in the curriculum:

a.             URGES that every medical school have required preclinical and clinical curricula in Preventive and Community Medicine, that content to include, at the minimum, Epidemiology, Biostatistics, Clinical Preventive Medicine, Community Medicine and Emergency Medicine; that this curricula:

b.             In regard to Preventive and Community Medicine, Epidemiology and Biostatistics:

1.             emphasizes prevention and health maintenance with holistic medicine as its core;

2.             provides instruction in health care economics and, in particular, increases students’ awareness of the cost of the care they provide;

3.             addresses the issues and relevancy of occupational disease by incorporating instruction in such areas as occupation, history-taking, common occupational illnesses and fundamentals of industrial toxicology, including field projects that introduce students to these issues;

4.             provides, in the core curriculum, a structured practical nutrition course, including diet counseling centered around the patient/student educational aspect of nutrition in health and disease;

5.             recognizes the relevancy of applying preventive and community medicine principles to the medical problems of Third World countries;

6.             offers quality experiences in the areas of medical ethics, cultural and linguistics barriers to health care, medical jurisprudence, health-care economics and health-care planning, organization and management;

c.             In regard to Emergency Medicine:

1.             provides, in the core curriculum, training in Basic and Advanced Cardiac Life Support, management of life threatening emergencies, basic first aid, awareness of Poison Control or other available references regarding toxic and psychosocial emergencies;

2.             SUPPORTS a medical school curriculum that provides instruction in emergency medical techniques and basic first aid during the first year, so that the medical student may be prepared to provide a service needed in the event of a medical emergency occurring inside or outside the hospital facilities.

3.             SUPPORTS development of Emergency Medicine curriculum (per American College of Emergency Physicians guidelines) to be available at all medical schools on at least an elective basis.

d.             In regard to Violence:

1.             provides, in the core curriculum, information regarding violence as a public health issue. (1992)

2.             stresses:

a.             the physician’s unique position of and, thus, responsibility for recognition and initial intervention in cases of child and spouse abuse;

b.             education in the prevalence, incidence and interrelatedness of these problems, in presenting signs and symptoms, and in counseling skills for use in conjunction with available social services.

e.             URGES that at least 5 percent (or 250 hours) of the curriculum be allotted specifically to teach Preventive and Community Medicine;

f.              URGES that all medical schools have a department of Preventive and Community Medicine, or its equivalent, with a sufficient number of qualified faculty and adequate financial support to effectively teach the material;

g.             SUPPORTS efforts to increase the teaching of clinical medicine in ambulatory settings, and encourages the linkage of such efforts with programs to provide care to the underserved populations and the medically indigent. (1986)

h.             SUPPORTS the introduction of cost awareness into undergraduate and graduate medical education only if it is integrated with formal instruction on the physician’s ethical responsibilities to the patient and the community. (1986)

3.             SUPPORTS a medical school curriculum that:

a.             In regard to educational experience:

1.             develops and supports the interdisciplinary approach through interdisciplinary courses and experiences, so that members of the various health disciplines can develop habits of cooperation and mutual respect and understanding with regard to roles, training, education, and expertise;

2.             provides, as part of the curriculum, information and statistics on relative specialty and geographical needs for physicians;

3.             allows, but does not require, individuals to pursue areas of special interest including nontraditional educational experiences that demonstrate definite educational value;

4.             incorporates formal and effective interpersonal skills training as an integral part of the preclinical and clinical instruction of medical students and residents;

b.             In regard to medical school curriculum and aging:

1.             SUPPORTS efforts by American Medical Schools (Allopathic and Osteopathic) to make substantial improvements in preparing future physicians to serve the needs of this country’s older population by: (1989)

a.             Offer a general, interdisciplinary introduction to Geriatrics and Gerontology during the preclinical years of medical school, including the cultural and sociobehavioral aspects of normal aging, (1986)

b.             subsequently highlight pertinent information regarding the older (both normal and ill) person with specific lectures in existing courses, (1986)

c.             include active teaching components devoted to the acute and chronically ill elderly patient during the clinical clerkships, as well as post-geriatric training, (1986)

d.             offer elective(s) in clinical Geriatrics, (1986)

e.             include Geriatrics as a part of CME courses in practicing physicians. (1986)

2.             incorporates information about aging and health care for the elderly;

c.             incorporates training in the special health-care needs of the terminally ill, including concerns for psychosocial issues and symptom control;

d.             In regard to medical school curriculum and the disabled and rehabilitation;

1.             incorporates training of health care professionals in the special needs of the disabled, including skills required to care for the disabled patient;

2.             RECOGNIZES that the physical medicine and rehabilitation is a specialty with a shortage of physicians; and therefore, URGES: (1986)

a.             all medical schools to teach students medical and psychosocial problems of the disabled. (1986)

b.             all medical schools to consider establishing a department of physical medicine and rehabilitation. (1986)

c.             federal funding for the training of physiatrists and for research in physical medicine and rehabilitation. (1986)

e.             includes relevant information on the association between cancer, genetic damage and radiation—including exposure from x-rays, the uranium mining and waste disposal, nuclear fallout and general background radiation;

f.              In regard to human sexuality and reproduction:

1.             teaches in third or fourth year rotations in OB/GYN the abortion procedure to medical students, with exemption on the basis of personal principles, in the same manner as other surgical procedures within that field. (1994)

2.             incorporates the use of female and male Professional Teaching Associates during the initial instruction of medical students in pelvic, breast, rectogenital, testicular and prostate examinations; (1995)

3.             incorporates, in the core curriculum, a comprehensive human sexuality course that:

a.             provides facts about human sexuality, sexual problems and options for treatment;

b.             equips the student with adequate diagnostic and therapeutic skills, including the ability to assess the degree of severity of a patient’s sexual problems;

c.             enables the student to take a sensitive and appropriate sexual history, and talk comfortably about specific sexual behavior;

d.             clarifies the student’s own values regarding sexual behavior, enabling the student to be comfortable with value differences in patients.

4.             URGES the LCME to accredit only those medical schools, which offer the following:

a.             Didactic training, which excludes observation or participation, in reproductive health including, but not limited to abortion, in Ob/Gyn clerkships and in preclinical years; (1995)

b.             Experience in the surgical procedure of abortion, including observation of the procedure itself and the pre-abortion and post-abortion counseling, with exemptions for students based on personal principle; (1995)

c.             The aforementioned training can be received either on or off campus. (1995)

5.             URGES the USMLE to include items regarding abortion in the Ob/Gyn “shelf” examinations, and in the USMLE Step II and Step III examination. (1995)

g.             In regard to mental health:

1.             incorporates in the core curriculum training which:

a.             emphasizes the influence of patients' lifestyle and behavior on widely prevalent chronic conditions such as obesity, hypertension, atherosclerotic heart disease, non-insulin dependent diabetes mellitus, and violent trauma and the importance of this interrelationship in providing comprehensive, quality medical care to all patients; (1997)

b.             emphasizes the centrality of patients' lifestyle and behavior in the treatment and recovery from widely prevalent chronic conditions such as those named above;

c.             emphasizes instruction in how to discuss with patients the role of behavior in recovery from medical illness including improving diet, reducing stress, maintaining medication compliance, and avoiding high-risk behaviors such as unprotected sex and gang membership; (1997)

d.             instructs students during the Physical Diagnosis course in the proper techniques of obtaining a psychiatric history, including a psychosocial review of systems and performing a complete mental status examination. (1987)

2.             informs students of the markedly increased incidence of depression among medical students at the end of the second year and the beginning of the third year and the generally high risk for medical students, house officers, and practicing physicians of mental illness and its consequences, e.g., alcoholism, drug abuse, divorce and suicide, and provides elective small-group experiences to offer interested students peer group support and instruction in stress reduction techniques. (1997)

3.             recognizes that the third year psychiatry clerkship has been shown to have the greatest impact on career choice but that the second year course plays a critical role in educating medical students about the behavioral aspects of medicine as described above. (1997)

h.             In regard to palliative care and pain management:

1.             URGES the eventual establishment of palliative medicine and pain management programs and departments at US accredited academic medical institutions that currently do not have such programs; (2003)

2.             ENCOURAGES the active recruitment of specialists in palliative care to the faculty; (2003)

3.             INCORPORATES concepts of palliative care (which include good communication skills, and sensitivity to patients’ pain and symptoms) into all courses; (2003)

4.             SUPPORTS a practical, case-based training in end of life issues; (2003)

5.             ENCOURAGES medical students to consider palliative medicine as a career specialty. (2003)

4.             BELIEVES that cost-of-living stipends for clerkships and other experiences away from a student’s home medical center are not inconsistent with sound educational principles and should be provided for students engaging in such experiences;

5.             Regarding medical education and the pharmaceutical industry and pharmacy, SUPPORTS a medical school curriculum that:

a.             provides formal instruction about the pharmaceutical and medical products industry, including critical evaluation of the issues of drug development incentives, research quality and independence, regulation, and communication;

b.             provides full disclosure about commercial sources of sponsorship of any medical education program, whether Grand Rounds or CME;

c.             establishes pharmacy and therapeutics committees in all teaching hospitals to encourage the following:

1.             active team practice (joint bedside rounds, pharmacy chart reviews, etc.) involving clinical pharmacists and physicians in drug use decision-making;

2.             establishment of oversight and evaluation mechanisms for prescribing practices of students, housestaff, and physicians; these mechanisms to include guidelines for interaction with industry representatives in teaching institutions;

3.             establishment of hospital formularies which specify drugs, their indications, mode and cost of administration, and complications;

d.             PROHIBITS pharmaceutical industry representatives from marketing to medical students, including, but not limited to, distributing paraphernalia advertising pharmaceuticals or pharmaceutical companies to students, detailing students about a particular prescription drug, and inviting students to pharmaceutical industry-sponsored meals. (2005)

6.             SUPPORTS a medical school curriculum that:

a.             allows advance placement in the basic sciences;

b.             allows advancement at the student’s own rate, based on learning and achievement rather than on time spent in a particular area;

7.             Regarding the National Board Examinations:

a.             URGES the National Board of Medical Examiners (NBME) to report student performance as simply Pass/Fail to both students and state licensing boards, and provide medical schools with only a Pass/Fail statistical evaluation of the performance of their student population as a whole, with no documentation of individual student scores;

b.             URGES each medical schools’ faculty to develop its own internal evaluation process, other than exclusive use of National Board examinations, utilizing a variety of testing devices to assess both the cognitive and noncognitive aspects of student performance and curriculum quality;

c.             OPPOSES the use of National Board Examinations for medical school accreditation, residency selection, student promotion, and as the exclusive mode of curriculum evaluation;

d.             BELIEVES that the NBME must guarantee student representation in decisions regarding present and future USMLE examinations and future proposed licensing exams. (2005)

e.             OPPOSES the addition of the Clinical Skills Examination (CSE) to the United States Medical Licensing Exam (USMLE). Recognizing the existence of the CSE requirement for licensure despite our opposition, AMSA:  (2005)

1.             strongly SUPPORTS pass/fail grading of the CSE;  (2005)

2.             strongly SUPPORTS making the CSE available free or at a nominal cost to all medical students at U.S. medical schools;  (2005)

3.             strongly SUPPORTS making CSE testing locations available in every U.S. city with a medical school;  (2005)

 4.            strongly SUPPORTS the creation of national standards for clinical skills examinations to be implemented at all US medical schools;  (2000)

5.             strongly SUPPORTS the requirement for constructive feedback to students regarding their performance.  (2000)

8.             Regarding research in health professions education:

a.             SUPPORTS the creation and federal funding of a National Center for Health Professions Education Research; (1992)

b.             BELIEVES that physicians-in-training and other health professions-in-training should play an active role in the planning and execution of all initiatives for research in health professions education; (1992)

c.             SUPPORTS a national research agenda for health professions education that includes research on specialty choice and primary care, the impact of student indebtedness on education and careers, the recruitment and retention of under represented minority students and those of low-income backgrounds, and the impact of community-responsive training on eventual career choices. (1992)

9.             SUPPORTS requiring every medical school to include rotational exposure to community service and practice in an underserved community in their curriculum. (1994)

10.           In regard to primary care:

a.             ENCOURAGES every medical school to include in their mission statement a commitment to primary care. (1994)

b.             SUPPORTS improving and strengthening primary education through having an appropriate number of primary care physician faculty in every medical school. (1994)

c.             offers and encourages a variety of quality primary care experiences, including educational programs and preceptorships in regional medical centers or other primary care settings outside of large teaching institutions, preferably in shortage areas;

d.             provides primary care educational experiences in the classroom and community setting taught by community-based physicians to supplement the existing curricula, which are often limited to the academic setting. (1991)

11.           SUPPORTS the development of interdisciplinary education programs in the undergraduate, graduate and continuing education training of health-care professionals where appropriate. (1995)

12.           SUPPORTS and PROMOTES the inclusion of medicolegal topics such as medical malpractice and tort processes in medical school and continuing education curricula. (1996)

13.           SUPPORTS the integration of public health into undergraduate and graduate medical education by:

                  a.             Encouraging state and federal funding of public health education and practice, particularly in an era of market-driven health care; (1996)

                        b.             Reframing public health as a basic science in the personal and clinical health sciences by incorporating the knowledge, skills and competencies related to the analysis of health care as a system into medical education; (1996)

                         c.             Creating programs at the federal, state and managed-care organizational levels to continue and enlarge the support base for a broad range of psychosocial-behavioral research and training; 

                         d.             Developing research, service and training partnerships to apply population-based health management skills to the problems now faced by highly managed and integrated systems of care;

                         e.             Creating, in conjunction with federal, state and local government, managed-care organizations, and other nonacademic institutions, new public health programs that bring together the traditional public health disciplines with the clinical professions. (1996)

14.           In regard to managed care:

a.             SUPPORTS and ENCOURAGES medical schools and residency programs to form arrangements with managed care organizations such that schools may offer numerous clinical clerkships and other opportunities in managed care settings, not limited to clinical rotations in managed-care clinics, staff-model health maintenance organizations, etc.; (1997)

b.             SUPPORTS and ENCOURAGES managed care organizations to participate actively in medical education by forming arrangements with medical schools and academic health centers such that medical students and residents may participate in numerous clinical clerkships and other opportunities in managed care settings, not limited to clinical rotations in managed-care clinics, staff-model health maintenance organizations, etc.; (1997)

c.             SUPPORTS requiring managed care organizations to contribute financially to academic health centers for the education and training of physicians in medical school and in residency programs.  Medical schools must retain autonomy over their curriculum and training programs. (1997)

15.           In regard to complementary medicine:

a.             SUPPORTS the establishment of elective courses in medical school curricula that educate physicians-in-training about complementary and alternative medical modalities so that physicians can more effectively guide the healing process. (1998)

16.           In regard to medical student work hours:

a.             STRONGLY SUPPORTS the same limits on medical student work hours that it does for resident work hours as stated the Principles Regarding Resident and Student Work Hours. (2005)

17.           In regard to LGBTI health in medical school curricula:

a.             RECOGNIZES that culturally competent medical students and medical residents improve the healthcare environment experienced by LGBT patients. (2006)

b.             BELIEVES that learning the specific healthcare needs of LGBT patients during undergraduate medical education is a critical component of professional development as a physician. (2006)

c.             URGES Medical Schools to seamlessly integrate LGBT Health into their core curricula as part of mandatory coursework, and not sequester LGBT Health as a subject disconnected from other essential cultural topics in medicine. (2006)

d.             FURTHER RECOGNIZES that by working to ensure LGBTI patients feel less threatened in healthcare settings, LGBTI medical students, residents, and physicians will also feel more comfortable to draw on their own experiences to advocate on behalf of all their patients. (2006)

18.           In regard to medical errors and patient safety:

a.             URGES the LCME to require all medical schools to include curriculum about medical errors and patient safety, including but not limited to:

1.             disclosure of risks, medical errors and poor outcomes to patients and families (2007)

2.             understanding the science that underlies patient safety, including the multifactorial nature of errors, high-risk situations, root cause analysis and appropriate reporting of mistakes and near misses (2007)

3.             teamwork including interaction with non-physician members of the medical team (2007)

4.             communication and conflict resolution skills between health professionals, including what to do if an error goes unreported or is suppressed and how to disclose to supervisors if the student does not feel competent to perform a procedure or duty (2007)

5.             appropriate medical record keeping, informed consent, defensive medicine, appropriate standards of care, and what constitutes malpractice including examples of each.  (2007)

6.             Identifying mistakes, learning how to analyze mistakes, identifying potential ways to reduce risk, and exploring how to implement risk reduction strategies. (2007)