UB Medical School One of 10 Selected by AMA to Develop Curricula on Medical Professionalism

BUFFALO, N.Y. -- The University at Buffalo School of Medicine and Biomedical Sciences is one of 10 medical schools nationwide selected by the American Medical Association (AMA) to participate in a new initiative aimed at integrating medical professionalism issues into the medical-school curriculum.

The initiative is called Strategies for Teaching and Evaluating Professionalism, or STEP. Nancy H. Nielsen, M.D., clinical professor of medicine and senior associate dean for medical education, developed UB medical school's proposal and will direct the project.

"We're delighted and honored to participate in this important undertaking," said Nielsen. "There's nothing more critical in the education of a physician than developing an understanding of professionalism."

Issues of professionalism unrelated to specific clinical proficiencies currently are addressed by each institution individually. Through the STEP project, the AMA aims to develop a set of educational tools that can be used by all medical educators and would establish consistency across U.S. medical education.

Today's physicians confront increasingly difficult ethical and professional challenges, given the scientific advances of modern medicine and the need to address issues such as end-of-life care, rationing of expensive medical technologies, potential conflicts of interest, and disclosure of medical errors, the AMA noted in announcing the selections. The 10 institutions taking part in the initiative will develop educational programs to incorporate these issues and others into a medical school curriculum.

UB's contribution will be to develop a model four-year self-directed course in

professionalism. The plan involves Web-based and printed readings, case studies, standardized patient encounters, student journal-keeping and on-site experiences.

"There is a body of material that needs to be imparted," said Nielsen, "but the students also need to combine earlier knowledge with later experiences, and to make the concept of 'professional' meaningful in their daily lives. Students need to reflect, to experience, and to interact with faculty mentors who can serve as guides and sounding boards for uncomfortable emotions and difficult situations.

"The integration we are planning combines a reflective look at the art and literature of medicine with their own daily encounters on the wards and a variety of experiences that we think are key to developing professionalism," she added.

The readings, case studies and Web-based learning assignments will be based on specific study topics geared to each medical-school year. The "Professionalism" course will begin with the White Coat Ceremony that initiates each student into the medical world. First-year issues to be addressed include medical codes and oaths, privacy and confidentiality, federal health-insurance regulations, paternalism in medicine, ethical disparities in medical care and impairment in health professionals.

Issues that will be studied during the second, third and fourth years of medical school include cultural competence, health literacy, domestic violence, homelessness, sexuality, end-of-life care, organ donation, complementary medicine, spirituality in health care, ethics of managed care, and malevolent and benevolent uses of medical science.

Students will spend time at a refugee shelter, clinic for the homeless, hospice, organ procurement agency and other sites as necessary. They will meet quarterly with faculty mentors to review their progress and evaluate their understanding of the principles of professionalism studied. Standardized patient cases, exams and essays will be used to assess students' competency.

"We've begun planning activities already," Nielsen said, "and we'll join with the other schools chosen in a fall meeting. Elements of the project will be implemented with the incoming first-year class."

Core faculty for the STEP program, in addition to Nielsen, are Margaret Paroski, M.D., professor of neurology, interim vice president for health affairs and interim dean of the medical school; Jack Freer, M.D., clinical associate professor of medicine; Charles Severin, M.D., Ph.D.,

associate professor of pathology and anatomical sciences and associate dean for medical education; David Milling, M.D., clinical assistant professor of medicine and assistant dean for multicultural affairs; Robert Milch, M.D., clinical assistant professor of surgery and director of Hospice Buffalo, and Jack Coyne, M.D., clinical assistant professor of pediatrics.

David Block, incoming fourth-year medical student who spent a year at the AMA Institute of Ethics before coming to medical school, will serve as the core's student advisor.

Also selected as STEP program participants were medical schools at Indiana University, Loyola University Chicago, McGill University, Michigan State University, New York University, University of Minnesota, University of North Dakota, University of Pennsylvania and University of Texas-Houston.