Teaching an integrated approach to health care: lessons from five schools

Medical education has excelled in bringing a sound biomedical base to the practice of medicine; however, there is now growing interest in helping students and residents learn an integrated approach to health care that addresses the complex interaction of many factors influencing health and illness. The authors' purpose was to learn about how some medical schools teach students a more integrated approach to health care. They used a qualitative, multiple-case-study design and collected data through document review and interviews with faculty, administrators, students, and residents at five U.S. and Canadian medical schools, chosen for their reputed excellence in addressing an integrated approach to care. Visits to the schools were made in the spring of 1993. Data analysis focussed on the institutional factors associated with teaching such an approach and the ways in which the schools help students and residents learn about this approach. The interviewees described the strong presence of an institutional mission or philosophy that is unique to each school but that generally has a service-oriented, patient-centered perspective. They reported that the primary means for learning about an integrated approach was the attention, woven into the curriculum, to four relationships; physician-patient, physician-community, physician-other practitioners, and faculty-student. A broad-based shared mission or philosophy was important in focusing attention on the integration of biomedical and non-biomedical concerns and promoting a perspective that focuses outward toward the community and its people. The pervasive attention to the four relationships suggests that such attention is intimately related to each school's underlying mission or philosophy.(ABSTRACT TRUNCATED AT 250 WORDS)