The courses for the first two years--the preclinical period of the students' education--are classified under the general heading "medical humanities" and have the following goals:
The first year course has 20 contact hours; the second year course has 24 contact hours. Topics that have been covered in these courses include professionalism, ethics codes and oaths, paternalism, informed consent, competency, truthfulness, confidentiality, abortion, maternal-fetal issues, treatment for incompetent patients, end-of-life decisions, death and dying, physician-assisted suicide, research on human subjects, objectivity and bias in medical research, animal research, genetic testing, managed care, health care reform, social justice and health care, organ donation and procurement, health care regulation, ethics committees, and medical futility. Grading in these courses is based on exams, class participation, and short papers.
The topics introduced in the first two years are further discussed in small groups for one or two sessions of two hours each, as part of the regular pediatrics, internal medicine, obstetrics/gynecology, surgery, and family medicine clerkships.
The third-year courses provide 8-10 contact hours. Although the formats and times differ somewhat among instructors and departments, we team-teach with clinicians and the students usually identify the issue for discussion. Typically, they are concerned about issues of death and dying, uncooperative patients, unfair aspects of "the system," pain control, and "hot" topics. With our two courses behind them, they are comfortable discussing moral and social issues, they know how to address such problems, and we can make progress because we share a common language. It is an exciting time for us as faculty to see how much they have developed. The sharp contrast between our students and those who have no such program is obvious when residents participate in these and other discussions. For example, in the face of difficult problems, our students know how to structure the issues and do not retreat into dogmatism, situation ethics, extreme relativism, defensive postures, or other untenable approaches.
The fourth-year medical students have the opportunity to take a variety of month-long courses in the medical humanities including History of Medicine, Literature and Medicine, Law and Medicine, War and Medicine, Death and Dying, Electives in Medical Ethics and Humanities (Independent Projects), and Osler, The Man and His Writings. Enrollment has ranged from 38% to 66% of graduating students. Some students take more than one humanities selective. In addition to the month-long selectives, there is also a three-hour required portion of the fourth-year curriculum for medical humanities that is taught in the classroom during the Dean's Month.
We offered an ethics course for the students receiving Ph.D.s in medical science for the first time in the spring of 1993. It has 14 sessions and is team-taught with members of the basic science faculty. The objectives of the course are to:
Ongoing scheduled meetings with the residents and fellows in pediatrics, family medicine, emergency medicine, and internal medicine have resulted in the drafting of medical humanities curricula for some of these specialties. We also participate in rounds, grand rounds, and conferences, and serve on several hospital ethics committees.