Risky health behaviors and social factors are linked to half of all causes of morbidity and mortality in the United States. Physicians report lack of training as one of the barriers to providing behavior change counseling. Formal behavior change curricula are infrequent in medical schools, and where they are available, they are often isolated from clinical experiences or presented through a limited approach. The authors developed the Health Beliefs and Behavior (HBB) course at University of Medicine and Dentistry-New Jersey Medical School (UMDNJ-NJMS) to teach the impact of unhealthy behaviors on health and wellness, to broaden students' understanding of the many factors that affect behavior, and to give medical students tools to facilitate health behavior change in patients. To the authors' knowledge, this is the only comprehensive, clinically integrated course on health behavior change in a U.S. medical school.The authors intercalated the 60-hour HBB course in the four-week, third-year internal medicine clerkship ambulatory block. Thus, students practice learned techniques in both the ambulatory and classroom settings, and they gain insight into health behavior by applying learned health models to patients and engaging in experiential exercises. Course components stress the biopsychosocial and patient-centered approach. The authors measure the impact of the course through student surveys. Third-year medical students at UMDNJ-NJMS who have completed the HBB course report enhanced understanding of the principles of behavior change and improved ability to perform behavior change counseling.
In the face of a fragmented and poorly performing health care delivery system, medical education in the United States is poised for disruption. Despite broad-based recommendations to better align physician training with societal needs, adaptive change has been slow. Traditionally, medical education has focused on the basic and clinical sciences, largely removed from the newer systems sciences such as population health, policy, financing, health care delivery, and teamwork. In this article, authors examine the current state of medical education with respect to systems sciences and propose a new framework for educating physicians in adapting to and practicing in systems-based environments. Specifically, the authors propose an educational shift from a two-pillar framework to a three-pillar framework where basic, clinical, and systems sciences are interdependent. In this new three-pillar framework, students not only learn the interconnectivity in the basic, clinical, and systems sciences but also uncover relevance and meaning in their education through authentic, value-added, and patient-centered roles as navigators within the health care system. Authors describe the Systems Navigation Curriculum, currently implemented for all students at the Penn State College of Medicine, as an example of this three-pillar educational model. Simple adjustments, such as including occasional systems topics in medical curriculum, will not foster graduates prepared to practice in the 21st-century health care system. Adequate preparation requires an explicit focus on the systems sciences as a vital and equal component of physician education.
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