Dr Stephen Hargarten discusses broadening the curriculum of medical education at the Medical College of Wisconsin
Medical education has for over many decades, across three centuries, beginning in the late 1800’s and more intently in the 1900’s, devoted itself to the advancement of the biomedical sciences, such as anatomy, physiology, biochemistry, and others. Medical school curriculum, especially in the United States was transformed with the publication of the Flexner Report (1910), calling for medical schools to have a strong science base. It has been successful and remains the dominant structure of medical education. Our patients have benefited with quality and continuously improved biomedical care and health care systems have benefited from physician leaders trained in delivering the biomedical model.
However, medical professional education is poised to broaden its curriculum and become more wholistic for patients and the communities that are served.
Since the 1800’s, there has been a steady stream of physician leaders (and others) speaking and writing that the biomedical model isn’t enough for our patients, beginning with Rudolf Virchow who stated:
“Medicine is a social science, and politics is nothing else but medicine on a large scale. Medicine, as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution: the politician, the practical anthropologist, must find the means for their actual solution…
-Rudolf Virchow, MD (1821 – 1902)
These social conditions, housing, food security, that Virchow was addressing are still with us today, yet medical school education has stayed firmly established just like Flexner wanted medical schools to be: based on basic biomedical sciences such as physiology, histology, and biochemistry.
Yet Flexer wrote:
“…the physician’s function is fast becoming social and preventive, rather than individual and curative”. The physician practitioner should “not forget that directly or indirectly, disease has been found to depend largely on unpropitious environments”. These conditions…”a bad water supply, defective drainage, impure food, unfavorable occupational surroundings” are matters for “social regulation”, and doctors have the duty “to promote social conditions that conduce to physical well-being”.
Abraham Flexner, 1910
We need to do more and broaden our curriculum with other sciences.
This article and a series to follow, seeks to advance what is now called the biopsychosocial model and use gun violence as a example of its application
Gun violence is a global public health pandemic, with over half of all of the estimated 250,000 deaths, occurring in the Americas. By framing gun violence as a biopsychosocial disease, medical schools can integrate the biologic/pathological changes from bullets penetrating a human body, with the necessary other disciplines, such as the psychology and social sciences to inform a wholistic treatment approach to this disease and inform prevention strategies, just like other diseases that are addressed in Medical School curriculum such as Cancer and Heart Disease