Viewpoint: the importance of worldviews for medical education

The culture of academic medicine holds implicit and explicit assumptions about what is important in life, including assumptions about health and the practice of medicine. This philosophy of life constitutes a worldview from which medicine is practiced. Medical educators should introduce medical students to the benefits and limitations of this worldview, and to important alternative worldviews, early in medical school. The authors describe the concept of worldview, discuss the biomedical worldview that is dominant in Western medicine, compare it with other life philosophies (including non-Western and spiritual perspectives), and propose teaching about biomedical and other worldviews within the existing structure of preclinical medical education. The authors propose beginning medical school with a Foundations of Healing course that would introduce students to the concept of worldviews, place the biomedical worldview in a larger context with other worldviews, and explore the beneficial and adverse elements of the biomedical worldview. To maintain the awareness of worldviews after the course described above, the authors propose humanistic "horizontal strands." These would be structural elements of a longitudinal curriculum that intentionally interweave patient vignettes and case discussions into basic science lectures to highlight the variety of worldviews operating in healthcare contexts. By exposing students to the concept of worldview early in their training, educators can better meet professionalism mandates related to bias and self-awareness, immunize students against the adverse effects of the hidden curriculum, and bolster the status of the social and behavioral sciences in medical education.