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Chapter 1 181 Has there been any change in the last 50 years? Has there been none?Those of you in this room should know. And, if so, what caused that change to occur? —Nicholas Christakis, Interim Report of the Acadia Institute on Undergraduate Medical Education Is it possible to integrate humanistic attributes and actions in a more encompassing framework—a new curriculum—without contaminating an activity that, through participants ’ enthusiasm, has kept the service ethic alive? There are two major dilemmas that restrict any proposed reforms based on RCSIP. First, how can programs be required and voluntary at the same time? Second, can medical school faculty who are deeply invested in the model of the traditional curriculum be persuaded to change without causing serious resentment? What I am proposing is, on the surface, both well-nigh impossible and extremely controversial. My reference in what follows is Rush, but my model, if feasible, applies to American medical education in general. The very thought of an intellectual and experiential widening of the curriculum brings shivers down the spines of the basic scientists who hang on tenaciously to every course hour they feel they have won through bloody scrimmages with their clinical counterparts. The myth of the traditional curriculum as the only way to educate must be debunked slowly but firmly. What the “traditionalists” actually believe, without realizing it, is that the culture of medical education is unalterable. But culture is fluid, not static, and that means the culture of medical school can change, but it will take serious effort by those committed to reform. When I have cautiously raised the idea of integrating our voluntary service programs into the existing curriculum, a typical response has been “The dean has the power to do it, and, if he or she says so, it will happen.” I presume that this notion is not uncommon, because the academic health center is perceived as a powerful hierarchy, with orders and assignments following a chain of authority that goes from the top to the bottom. Nonetheless, Appendix D The Social Medicine, Community Health, and Human Rights Curriculum 182 Appendices there have been some innovative curricular changes at major medical schools in recent times, for example, the integration of problem-based learning throughout all four years at New Mexico, the double-helix curriculum at Rochester based on the biopsychosocial model, and the population health and social medicine inner-city programs at the Sophie Davis State University of New York Medical School, to mention a few. I build my curricular design on the model created by Wear and Castellani (2000). Professionalism , they argue, “is fostered by students’ engagement with significant, integrated experiences with certain kinds of content” (602). They make it clear that professionalism cannot flourish without a sound anchoring of knowledge, skills, and methods. They emphasize “the need for an intellectual widening of the medical curriculum” if professional development is to be enhanced and sustained, and they address, in a straightforward and clear manner, the essential tension between the biomedical paradigm and the “humanistic dimensions of medical practice” (603). If professionalism and its six elements—altruism, accountability, excellence, duty, honor and integrity, and respect for others—are the moral underpinning of medicine, then those must be systematically and thoroughly intertwined throughout the medical school curriculum. In a strict pedagogical sense, Wear and Castellani are talking about content. They take heed of the dichotomy of medicine as science and medicine as service that I have tried to confront throughout this thesis. “To ask students to develop compassion, communication skills, and social responsibility within the confines of a biomedical discourse is unrealistic, if not unfair, given the evaluative criteria of success and competency in contemporary medical education.” They assert that for learning to be humane, culturally astute, and socially committed, a structure is needed in the form of a curricular innovation that is initiated by the medical school administration, acknowledged by the faculty, and embraced by the students. Such a proposition is a task that is far from easy. Those in charge of teaching medical students have been thoroughly socialized in a biomedical environment in which anything that doesn’t fit—sociocultural, economic, and political—is outside scientific scrutiny and based on value judgments. Their observations highlight the resistance to change by medical school faculty that has been emboldened by a firm belief that medicine, grounded in the basic sciences and learned through practicing in major hospitals that care for the seriously sick, has resulted in...

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