Element 7.1 – Biomedical, Behavioral, Social Sciences

The faculty of a medical school ensure that the medical curriculum includes content from the biomedical, behavioral, and socioeconomic sciences to support medical students’ mastery of contemporary medical science knowledge and concepts and the methods fundamental to applying them to the health of individuals and populations.

Hidden Curriculum

This element has recently become one that is frequently cited as discussed at the June 2024 LCME Secretariat Webinar.  They mentioned that student dissatisfaction with Element 7.1 might be because many curricula are now more integrated. This means content from various disciplines is combined and taught together, rather than separately. As a result, students may not easily recognize which specific discipline the information belongs to, even though it is covered in an integrated manner.

The integration of biomedical, behavioral, and socioeconomic sciences not only enriches students’ understanding of medical science but also cultivates an approach to patient care. The curriculum committee plays a crucial role in deciding how to effectively prepare students for their clerkships, ensuring they acquire the interdisciplinary knowledge and skills essential for medical practice. Make NO MISTAKE – if you have courses that are performing poorly – it is EXPECTED that you will make changes once that trend is noted. Failing to take decisive action will just cause the LCME to take decisive action – so ACT! Yes – it is the Curriculum Committee’s job to recommend course director changes etc. and if they don’t bring it up – your Curriculum Dean best do so.

Best Practice

To address the issue of students not recognizing which specific discipline the information belongs to, ensure that each integrated lesson or module clearly identifies the contributing disciplines. Provide context and explicitly state how different scientific perspectives are being combined. This can be achieved through clear labeling in course materials and offering overviews at the beginning and summaries at the end of each module to reinforce the interdisciplinary nature of the content. Make sure disciplines (helpful if they correspond to the AAMC GQ and the Tables listed in 7.1) are tagged for your Curriculum map and also tagged for exam questions.

To put into practice, for example:

1. At the start of each new phase/block etc., hold an orientation session that reviews the key topics (corresponding to titles in 7.1) to be covered in that phase/block.  Even better, also remind them of where this topic has already been taught – and where it will show up again in the future. This helps students understand the progression and context of their learning. To assist in this, you can create a visual map or timeline that shows when and where each topic area will be covered/assessed and keep this in your learning management system that students use (e.g. Blackboard).
2. Each course overview document (COD) should explicitly list the topics that will be covered and assessed. This can include formative assessments (quizzes, midterms) and summative assessments (final exams, standardized tests).
3. Regularly review and update the curriculum outline and COD to reflect any changes.
4. Communicate these updates clearly to students to ensure they have the most current information. This will not only enhance their learning experience but also helps them to see the interconnectedness of various medical disciplines throughout their education.

The only other thing this element asks for other than listing where you teach certain topics is how you address issues that come up with any of the topics.  Let me translate this for you – This means have EXAMPLES ready with MINUTES in your Curriculum Committee to back them up. Have an example for each category brought up in Narrative Response “a:” Gaps, Performance Problems and Student Dissatisfaction!

How do you know you have a problem? You are looking at outcomes in your phase reviews and overall whole curriculum reviews!  This will identify gaps and performance problems easily.  For student dissatisfaction, establish robust feedback mechanisms where students can share their concerns and experiences about the curriculum. End-of-course evaluations and end-of-course student meetings with faculty/deans etc. are all good ways to capture this. In addition, tagging content areas on quiz/exam questions, can be used to identify how students are performing in those areas in order to adjust the curriculum if needed. There is also the AAMC Graduation Questionnaire (GQ), year-end surveys, course/clerkship annual reviews, and USMLE Step Exam results!

Now that you have the information – YOU MUST ACT ON IT which leads us to…

Continuous Quality Improvement

The curriculum committee must actively participate in the CQI process and respond to the feedback collected about the curriculum. If you have a specific CQI committee, ensure they monitor this feedback and determine if actions are required to address any issues. Their findings and recommendations should be communicated to the curriculum committee. Specific Action Items with Due Dates for Deliverables and Who is Responsible should be clearly delineated.