META-CURRICULUM IN MEDICAL EDUCATION, THE

Medicine and Health Rhode Island, Aug 2004 by Smith, Stephen R

ABILITY V-LIFELONG LEARNING

The elective nature of the fourth year of medical school has enabled Brown medical students to pursue independent study at a rate twice that of the national average. Planning for the new Doctoring course envisions an additional half-day each month free for elective activity. Students will be able to choose from a list of faculty-organized electives or design their own.

Brown Medical School maintains a very liberal policy regaarding academic leaves. Essentially, all a student has to do is ask. Among the 64 graduates in the MD Class of 2004 (excluding Brown/Dartmouth and advanced transfer students), 20 took more than four years to complete medical school. Many of those 20 students used the additional time to pursue scholarly interests.

ABILITY VI-PXOFESSIONAL DEVELOPMENT AND PERSONAL GROWTH

Professional development will be yet another component of the Doctoring course. In addition to the half-day a week continuity practice, students will spend an additional half-day a week either developing their skills in historytaking and physical diagnosis or in professional development or their elective activity.

At the start of medical school, students receive a professional development portfolio, consisting of four sections: the socially responsible physician, the ethical physician, the healthy physician, and the informed physician. Students choose artifacts to place in the portfolio relating to those four sections. These artifacts form the basis of reflective discussions that students have with their faculty advisors. In the fourth year of medical school, two faculty members other than their advisor will review students' portfolios to certify their attainment of the professional development competency.

Rituals represent a powerful way that the institution conveys its values to the student body. The medical school convocation ceremony features as the keynote speaker one of the Fleet Community Fellows-a graduate who exemplifies the altruistic characteristics of the socially responsible physician. The human morphology course includes a memorial service to honor those who donated their bodies for the education of medical students. The Ceremony of Commitment, in which first-year students receive their white coats, emphasizes the loftiest goals of the profession of medicine. Fleet Fellows are again featured in the transition ceremony that marks the beginning of the clinical years for students. And, of course, the commencement ceremonies reach their climax when the students recite the Physician's Oath, written by the charter graduates of 1975.

ABILIIY VII- THE SOCIALAND COMMUNITY CONTEXTS OF HEALTH CARE

The faculty expressed the high value they place on this ability by both making it a formal part of the curriculum and letting students achieve competency through service learning. The result has been a sharp increase in the level of student participation in community service and involvement in more than one community service activity.

Students have also expressed stronger agreement with the statement that they feel supported in their efforts to serve as advocates for their patients. (Table 1).