LCME Element 7.5 – Societal Problems

The faculty of a medical school ensure that the medical curriculum includes instruction in the diagnosis, prevention, appropriate reporting, and treatment of the medical consequences of common societal problems.

Hidden Curriculum

Element 7.5 is one of those elements that can get lost in the shuffle of Standards 7 and 8, with schools grafting societal problems onto existing curricula after the fact.  However, if embraced with forethought and intention, the element’s primary goal is to expand students’ understanding of common challenges that patients face by providing context and knowledge.  It is especially practical for developing physicians, giving them perspective on the complexity of health issues they will encounter.  Element 7.5 also allows schools to customize their curricula to the local setting, which further prepares students for core clinical training and beyond. 

The LCME specifically has a table for the Full DCI 2023-24 that says:

For five common societal problems identified by the school, list each of the courses/clerkships where the teaching occurs; categorize the learning objectives for that course or clerkship according to whether they address: (a) the diagnosis; (b) prevention; (c) appropriate reporting (if relevant); and (d) treatment of the medical consequences of the societal problem; and assessment method(s) for each objective.

Many schools incorporate four to five woven throughout the entire curriculum to create a logical sequence of skill-building.  In other words, a single lecture in a single course on a topic will not suffice.  Courses that are home to the content for societal problems must have well-articulated learning objectives, and programs must be prepared to specify in the Data Collection Instrument (DCI) table every specific item above. One issue we frequently see missing is that the school must also indicate the assessment method(s) for each learning objective associated with the adopted societal problems.  Sometimes, these are a little, well – sketchy.

Best Practices

A school’s curriculum committee must formally review and adopt societal problems, and it would be prudent to do so at least four years prior to a site visit.  This timeframe allows a program to fully implement and monitor new content across the entire curriculum.  Prior to formal approval, identifying potential societal problems is the biggest step involved with the element.  While there is no hard and fast methodology, it may be best to triangulate by using a few sources to generate a short list of options.  Possible resources include national, state, and local health assessments; evaluation of existing curricular content; and feedback from key stakeholders like faculty, partner health systems, or public health experts. 

Make every effort to maintain a connection between the curriculum committee’s final decision and the work of the subcommittees.  Subcommittees are ultimately responsible for designing and delivering relevant content, and their support is vital to compliance.  As such, design an inclusive communication and decision-making process when adopting societal problems.  Additionally, subcommittee chairs should take the initiative to orient new course directors to the purpose and importance of Element 7.5’s content, lest they try to modify or discard inherited curricula. 

Continuous Quality Improvement

Remember Element 8.3?  You know, the one that inquires about a school’s curriculum database?  Well, Element 7.5 is one of many elements that demonstrates the value of having a reliable system to map a program’s curriculum.  A disciplined approach to maintaining a curricular database is key to compliance, and schools should tag content with the name of the societal problem to yield accurate queries.  Note: the DCI requires schools to select a single societal problem and elaborate on where and how it is delivered and assessed.  Early efforts to map the curriculum will alleviate pain down the road.  While an annual evaluation of this element may not be feasible, regularly scheduled reviews every two years will ensure consistent delivery throughout all phases of the curriculum, particularly as new course directors assume their roles.