Introducing comprehensive medical education

No physician's education would be complete without an understanding of the role played by behavioural and social factors in human health and disease, knowledge of the ways in which these factors can be modified, and an appreciation of how personal life experiences influence physician-patient relationships.  Behavioural and social sciences instruction in medical school should build on pre-medical educational foundation. Behavioural and social sciences may be included in the undergraduate and graduate medical school phases of the medical education continuum, which may include meticulously organised compulsory residency and fellowship training in Bangladesh. The importance of continuing behavioural and social science education throughout a physician's career cannot be overemphasised.

Human health and illness are influenced by multiple interacting biological, psychological, social, cultural, behavioural, and economic factors. The behavioural and social sciences have contributed a great deal of research-based knowledge in each of these areas that can inform physicians' approaches to prevention, diagnosis, and patient care. Within the clinical encounter, certain interactional competencies are critically related to the effectiveness and subsequent outcomes of health care. These competencies include the taking of the medical history, communication, counselling, and behavioural management. Medical professionals should demonstrate competency in the following domains: mind-body interactions in health and disease, patient behaviour, physician role and behaviour, physician-patient interactions, social and cultural issues in health care, health policy, health economics, professional and social norms and ethics.

A quote, 'The eye cannot see what the mind does not know', (snonymous) is familiar to most students without internalising its significance. Classroom theoretical teaching builds the knowledge base, while hospital bedside practice during clinical attachment synchronises that knowledge with what the eyes see, which leads to internalisation of knowledge. Another quote by Rudolf Virchow 'Medicine is a social science in its very bone and marrow', draws attention to integrating the technical and social aspects of medicine in all stages of medical education and professionalism, an area that has not received sufficient importance in the medical curriculum of undergraduate and graduate teaching. Hence, in the process of preparation/updating the curriculum, in addition to experts in different medical subjects, inclusion of behavioural and social sciences, management sciences, and other inter-professional experts may also be included. Behavioural and social sciences, taught by experts in the field (not by psychiatrists), may be included throughout the duration of any medical-related course. To decrease dependency on experts from external source (e.g., other universities) and to develop behavioural sciences experts within health system, a graduate course on Behavioural Sciences may be introduced. A graduate course on Forensic Sciences (not medical jurisprudence or forensic medicine) may also be introduced to supplement the knowledge on behavioural and social sciences by setting up of a national-level institute. These activities will require creation of job opportunities in the health sector of the country. This is expected to open avenues for research in health behavioural sciences. The Government is contemplating extension of internship for students completing undergraduate medical course. If the course and internship (one year) period are brought under total quality management (TQM) practice in its true sense, this in itself will bring about positive effects. Moreover, co-supervision by behavioural and social experts may be done during internship within the hospitals attached to the teaching institutes. 

Md. Shafiqur Rahman, PhD is Consultant, Directorate General of Health Services (DGHS), Dhaka

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