A Report on Instruction in Medical Ethics, Humanities, and Jurisprudence Provided by Texas Medical Schools

Transcription

1 A Report on Instruction in Medical Ethics, Humanities, and Jurisprudence Provided by Texas Medical Schools Texas Higher Education Coordinating Board Division of Universities and Health-Related Institutions October

2 Executive Summary Legislative Directive The General Appropriations Act of the 76th Legislature (1999) included the following language on page III-51, section 18 (4): Medical Ethics, Humanities, and Jurisprudence at Medical Schools. All academic health centers with medical schools and that receive a state appropriation are authorized to review the current curriculum content and requirements for medical ethics, humanities, and jurisprudence for medical students at their institution, including current instruction and integration into the basic sciences, clinic clerkships, and elective experiences. The review shall consider current testable material in these areas as might appear on each part of the United States Medical Licensure Examination. Institutions shall report this information to the Texas Higher Education Coordinating Board by September 1, 2000 in a format prescribed by the board. Background -- Medical Education Medical education provided by Texas eight medical schools -- public and private, allopathic and osteopathic -- is similar to medical education offered nationally. However, medical education in the U.S. is diverse and no two schools construct their curriculum or conduct education and training in exactly the same manner. National accreditation assures the public that all U.S. medical schools require students to complete training within a prescribed period of time, and with education and training in specific areas. Prior to entering medical practice, medical students must pass a three-part national licensing exam, the United States Medical Licensing Exam (USMLE). While medical students may take two of the three parts of the exam during medical school, the third part of the exam may not be taken until at least one year after medical school, when the first year of residency training is completed. Standardized national testing helps to ensure that newly educated physicians have acquired a minimum set of competencies, including understanding complex ethical challenges. Finally, prior to receiving a Texas medical license, a physician must pass a state-required jurisprudence exam. Study Methodology Coordinating Board staff surveyed the eight medical schools (seven public and one independent) in August 2000 to understand how Texas medical schools incorporated medical ethics, humanities, and jurisprudence into their current curricula. A map illustrating the location of Texas medical schools is provided as Appendix A. The survey asked institutional representatives, primarily academic deans, to report the courses and clinical experiences required and available to students in the areas of medical ethics, humanities, and jurisprudence. Humanities courses include offerings such as the study of the history of medicine, medicine and culture, and medical Spanish. A copy of the survey instrument used to assemble data for the study is included as Appendix B. Institutional responses to the survey are included in Appendix C and reflect the medical schools curricula for the academic year. i

3 Findings and Recommendations The following are the principal findings of an analysis of the institutional survey responses: Texas medical schools are well-positioned to offer medical students educational experiences that will ensure that the next generation of physicians is appropriately educated in the areas of medical ethics, humanities, and jurisprudence. Based on the responses to the institutional survey, national accreditation requirements, and high pass rates students on the state s licensing exams, the Coordinating Board staff finds that Texas medical schools require an adequate and appropriate amount of education and training in medical ethics, humanities, and jurisprudence. Education and training in medical ethics, humanities, and jurisprudence have evolved over the past decade to encompass issues related to all aspects of the life cycle. Texas medical school include the study of medical ethics, humanities, and jurisprudence within their current curricula through required course work, clinical rotations, and elective opportunities. Most Texas medical schools require completion of a medical ethics course, usually in the fourth year of study. Many Texas medical schools devote a separate course or a component of a clinical rotation to the study of jurisprudence. The study of medical humanities is most commonly available to Texas medical students within the elective portion of their studies. All Texas medical schools reported that the clinical rotation experiences, required of all third- and fourth-year medical students, contain considerable opportunities for students and faculty to explore together issues which encompass medical ethics, humanities, and jurisprudence. Technological advances bring new and complex ethical and legal issues to the forefront. To deal with this, Texas medical schools continually review, revise, and update educational curricula to incorporate technological advances and the ethical issues they raise. The Coordinating Board staff recommends that Texas medical schools continue to adhere to the rigorous standards currently in place and continue to incorporate into their curricula the use of new technologies and the study of the ethical issues these new technologies raise. ii

4 Table of Contents Executive Summary...i Table of Contents... iii Legislative Directive... 1 Background... 1 National Definition, Accreditation, and Examples... 1 Texas Medical Schools -- Recent Curricular Changes... 2 Computer Simulation... 3 Testing and Licensure... 3 Findings... 3 Medical Ethics... 3 Humanities... 4 Jurisprudence... 4 History and Methodology of the Study... 4 References... 6 Other Web Sites and Recent Articles... 6 Resources... 7 Institutional Contacts

5 Appendix A: Map of Texas= Medical Schools... 9 Appendix B: Institutional Survey Form Appendix C: Institutional Responses Baylor College of Medicine Texas A&M University Health Science Center College of Medicine Texas Tech University Health Sciences Center School of Medicine University of North Texas Health Science Center at Fort Worth Texas College of Osteopathic Medicine The University of Texas Health Science Center at Houston School of Medicine The University of Texas Health Science Center at San Antonio School of Medicine The University of Texas Medical Branch at Galveston School of Medicine The University of Texas Southwestern Medical Center at Dallas Medical School

6 Legislative Directive In accordance with Rider 18 of the General Appropriations Act of the 76th Legislature (1999), the Texas Higher Education Coordinating Board conducted an interim study regarding: Medical Ethics, Humanities, and Jurisprudence at Medical Schools. All academic health centers with medical schools and that receive a state appropriation are authorized to review the current curriculum content and requirements for medical ethics, humanities, and jurisprudence for medical students at their institution, including current instruction and integration into the basic sciences, clinic clerkships, and elective experiences. The review shall consider current testable material in these areas as might appear on each part of the United States Medical Licensure Examination. Institutions shall report this information to the Texas Higher Education Coordinating Board by September 1, 2000 in a format prescribed by the board. Background A physician=s ability to address and manage the array of ethical issues found in today=s health care environment results in some measure from the educational experiences and opportunities the physician encountered as a medical student. Texas medical students regularly deal with complex issues, such as Aend of life@ decisions, pain management, and insurance limitations on reimbursement for necessary or beneficial treatments. These issues, along with countless others, present Texas medical students with challenging and often difficult ethical and legal dilemmas. Ensuring that medical students are prepared to face the ever-changing means of providing health care is a fundamental part of the mission of each of Texas= medical schools. Since ethical issues are complex and continue to change over time, medical students must be prepared to consider both the technical and ethical implications of a patient=s condition when faced with an ethical dilemma. How a physician delivers medical information communicates to the patient and family members an underlying message of hope or despair. Ultimately, Texas medical schools must ensure that the next generation of physicians is adequately and ably prepared to respond to ethical and legal issues as they arise, with compassion and concern for patients and their families. National Definition, Accreditation, and Examples The Association of American Medical Colleges (AAMC), a national non-profit association of the nation=s 125 doctor of medicine (MD) medical schools and 400 associated teaching hospitals, states its purpose as Athe improvement of the nation=s health through the advancement of academic medicine.@ The AAMC has defined medical ethics as Athe study of moral issues in the fields of medical treatment and research. Ethical issues are most often posted by conflicts between what benefits society and what benefits the individual. Religious and personal beliefs, scarce medical resources, and advances in biotechnology are factors that most often lead to ethical dilemmas.@ 1 The nation=s accredited 125 MD and 16 Doctor of Osteopathic Medicine (DO) medical schools must adhere to well-developed standards in their provision of medical education. The medical schools are required to offer experiences in basic sciences and clinical disciplines, as well as ethical, behavioral, and socioeconomic areas related to medicine. 2 The national accrediting 1

7 body for the majority of the nation=s medical schools is the Liaison Committee for Medical Education (LCME), which is a joint effort of the AAMC and the American Medical Association. The LCME sets the standards for educational programs leading to the MD degree. Included in these standards are the duration instruction (currently set at 130 weeks delivered over a minimum of four years), design and management of the curriculum, and curricular content. The AAMC web site is highlighting particular medical schools= efforts to incorporate education and training in medical ethics. Currently featured are the curricular changes implemented by the University of Michigan Medical School and the State University of New York, Upstate Medical University. Both schools incorporate medical ethics as an essential element in the curriculum. At the University of Michigan, first-year medical students learn to be mindful of patients= emotional states and how to communicate bad news to patients. At the State University of New York, medical students participate over a two-year period in both large and small group forums to study how differences in culture, race, and gender affect ethical issues and professional development. The AAMC=s journal Academic Medicine recently published a supplement, Snapshot of Medical Students= Education at the Beginning of the 21st Century: Reports from 130 Schools. The supplement presents an overview of 130 (118 U.S. and 12 Canadian) medical schools= curricula. In analyzing the changes occurring within medical schools and the resulting curricular revisions, the editor of the supplement reports that the greatest changes within medical education are found in how education is conducted. 3 U.S. medical schools now place greater importance on teaching students in small group settings, increasing student access to faculty, incorporating problem-based learning, and encouraging students to become more effective communicators. Those changes affect the way in which education and training in medical ethics, humanities, and jurisprudence are provided. Texas Medical Schools -- Recent Curricular Changes Texas medical schools have revised their curricula and incorporated new and innovative teaching methods to ensure that their students are prepared to address the technical, ethical, and legal changes they will face in their future practices. As advances in knowledge and understanding of disease processes are made, Texas medical schools are continually implementing these advances into the medical schools= curricula. These advances also have implications for educating students in ethical and legal issues, which is the subject of this report. Mastering technical skills, as well as understanding and addressing the ethical issues new technologies may bring, is included in the course work required of Texas medical students. During the last decade, curricula in Texas= medical schools have been revised to place a greater importance on increasing medical students= analytical skills and encouraging their pursuit of lifelong learning. Several Texas medical schools reported using smaller learning groups to foster communication skills and increase team work. Real-life patient cases or problem-based learning (PBL) teaching methods have been implemented by many of the medical schools, and students have been moved out of the lecture halls into smaller groups much earlier in their medical education than in the past. This approach lends itself well to discussions of ethical dilemmas, which seldom have clearly prescribed solutions. Several studies have been published on the use of PBL as a teaching method within the medical school setting. While there is no clear agreement that PBL as a teaching method is advantageous, some evidence suggests that the PBL model enhances medical students= critical assessment abilities. 3-6 While not all Texas medical schools have incorporated PBL into the curricula, most Texas medical schools have incorporated the use of 2

8 smaller groups, focused on case studies. Computer Simulation Over the past decade, Texas medical schools have incorporated the use of computer simulation to a greater degree than before. The medical schools rely on computer simulations to illustrate examples of human development, diagnosis of diseases, and treatment options. Computer simulations allow medical students to actively consider and experiment with a wide range of patient concerns and manipulate disease complications for varying effects. Medical student accessibility to computer simulations can efficiently enhance understanding of disease processes and the simulations may be modified with subtle or dramatic changes to highlight diseases or human development. The use of this technology greatly enhances students= accessibility to ethical issues, as students can manipulate the simulation to raise or diminish these challenges. Consistent and thoughtful exposure to ethical dilemmas helps ensure that medical students will be ably equipped to address them as they enter and begin practicing medicine. Testing and Licensure Physicians must pass several tests prior to treating patients. In order to obtain a Texas medical license, Texas physicians must pass a three-part national licensing examination -- the United States Medical License Exam (USMLE). Included on parts 1 and 2 of the USMLE are questions related to ethical behaviors, and psychosocial norms. Medical students are eligible to take two of the three parts of the licensure exam while they are enrolled in an accredited medical school. However, physicians are only eligible to sit for the third part of the exam following completion of the first-year of residency training. Additionally, to practice medicine in Texas, a physician must pass a state-required test on jurisprudence. The education and training of physicians in Texas, as in the United States, requires medical students to have a broad understanding of human development, disease, and the ethical issues these issues raise. National testing and state licensure serve to help ensure that physicians are appropriately prepared to enter medical practice. Medical Ethics Findings Texas= medical schools require their medical students to complete course work and clinical training in medical ethics and offer their students several opportunities to pursue additional study in ethics, humanities, and jurisprudence. Some courses clearly contain material related to medical ethics, while other courses include medical ethics as a component or section of a broader-based course. Six of the eight Texas medical schools require students to complete medical ethics as a separate course, usually in the fourth year of study. Four Texas medical schools offer students the opportunity to pursue additional study in medical ethics during the elective portion of their studies. Humanities 3

9 All eight Texas medical schools offer students the opportunity to study humanities in the elective portion of the curricula. Most of the medical schools offer students a selection or range of courses in the area of humanities. For example, students enrolled at Texas A&M University System Health Science Center, College of Medicine may select from among the following humanities course offerings during the elective portion of their education: medical humanities, history of medicine, literature and medicine, medical ethics, medicine and culture, or medical Spanish. Medical students at Baylor College of Medicine have the opportunity to study compassion and the art of medicine, history of medicine, literature and medicine, and four distinct medical ethics courses. Jurisprudence The study of jurisprudence is available to medical students in the elective portion of the curricula, and in the clinical training. Medical students gain a general understanding of the issues related to medical jurisprudence, including areas such structure and workings of the legal system, laws related to the practice of medicine, and issues of liability. To obtain a Texas medical license, a physician must pass a state-regulated jurisprudence exam. The exam tests physicians= knowledge of hospital law, drug law, conviction of crime that involves moral turpitude, withdrawal of treatment from terminally ill patients, Medicaid reporting requirements, aiding suicide, anatomical gifts, medical malpractice liability, and other issues. The study of medical ethics, humanities, and jurisprudence in Texas= medical schools partially fulfills national accreditation requirements, prepares students to sit for parts 1 and 2 of the national licensing exam (USMLE), and assures the public that next generation of physicians will be adequately prepared to handle the challenging ethical dilemmas they will encounter. History and Methodology of the Study In 1998, at the request of State Representative Dianne Delisi of Temple, Coordinating Board staff surveyed the eight Texas medical schools to assess the amount of instruction required of and available to Texas medical students in the areas of medical ethics and humanities. The 1998 survey did not request information about the instruction required or available in the area of jurisprudence. Institutional responses to the 1998 survey indicated that all Texas medical schools required medical students to complete some course work in medical ethics and humanities, and that additional course work was available for those students with greater interest in those areas. In August 2000, Coordinating Board staff surveyed Texas= eight medical schools to assess the amount of course work, required clinical experiences, and opportunities for electives the schools offered in the areas of medical ethics, humanities, and jurisprudence. The survey was similar to the one conducted in 1998, with an additional request for the institutions to provide information related to the study of jurisprudence and updates to an internal staff review of course catalogs. Completed survey responses were collected in August Institutional representatives were provided copies of reviewed survey responses and given opportunities to make revisions prior to publication. The institutional survey responses included in Appendix C of this report present an overview by institution of the instruction the medical schools offer and require in the areas of medical ethics, humanities, and jurisprudence. The responses present information in three sections: required 4

10 course work, required clinical training, and optional educational experiences. The survey also requested information about the number of full-time faculty and the amount of time allocated for these topics and means of study. Responses confirmed that, while each institution gives significant attention to medical ethics, humanities and jurisprudence in its curriculum, they do so in strikingly different ways, making direct comparisons between institutions difficult. The institutional surveys serve as a snapshot of Texas medical schools= curricula for the academic year. 5

11 References 1 AAMC. (June 2000). Doctoring 101: Connecting you to the education of tomorrow=s doctors. ( 2 AAMC and AMA. (1997). Functions and structure of a medical school, accreditation and the Liaison Committee on Medical Education, and standards for accreditation of Medical Education Programs leading to the MD degree. 3 Academic Medicine Supplement. (September 2000). A snapshot of medical students= education at the beginning of the 21st century: reports from 130 schools. M. Brownell Anderson, editor. Volume 75, Number Nine (p.sxii). 4 Shimoda, Todd, A and Takayesu, James Kimo. (March 1997). Individual roles and group dynamics in Problem-Based Learning classroom: Generating and evaluating skill-oriented learning objectives. Paper presented to Annual Meeting of the American Educational Research Association, Chicago, Illinois. 5 Shue, Laura L, and Lacroix, Celeste. (November 1998). The problem with Problem- Based Learning: Organizational members make sense of pedagogical change in medical school curriculum. Paper presented to Annual Meeting of the National Communication Association, New York, New York. 6 Schmidt, Henk G., et al. (April 1995). The development of diagnostic competence: A comparison between Problem-Based, an Integrated, and a Conventional Medical Curriculum. Paper presented to Annual Meeting of the American Educational Research Association, San Francisco, California. Other Web Sites and Recent Articles Langone, schools discover value in dispensing compassion.@ The New York Times on the Web. (August 22, 2000). Web search and article site: Medical ethics forum: where do you draw the line? Web search October Snyder, L. AMedical ethics.@ Annals of Internal Medicine. Web site: or American College of Physicians, Independence Mall West, Sixth Street at Race, Philadelphia, PA Wang, J. AIntroduction to research ethics.@ (Spring 2000). Health Law News. University of Houston, Health Law and Policy Institute; p.3. Yarborough, M., et al. AInterprofessional education in ethics at an Academic Health Center.@ Academic Medicine. (August 2000); 75:

12 Resources Texas Health-Related Institutions Baylor College of Medicine Texas A&M University System Health Science Center Texas Tech University Health Sciences Center University of North Texas Health Science Center at Fort Worth The University of Texas Medical Branch at Galveston Web Sites: The University of Texas Health Science Center at Houston The University of Texas Health Science Center at San Antonio The University of Texas Southwestern Medical Center at Dallas Medical Organizations Association of American Medical Colleges Texas Academy of Family Physicians Texas Medical Association Texas Osteopathic Medical Association Texas State Board of Medical Examiners

13 Institutional Contacts Baylor College of Medicine Houston (years 1 through 4) One Baylor Plaza Texas Medical Center Houston, Texas Rebecca T. Kirkland, MD, MPH Associate Dean for Curriculum Phone: (713) Fax: (713) kmoritz@bcm.tmc.edu Texas A&M University System Health Science Center College of Medicine College Station (years 1 and 2) and Temple (years 3 and 4) John B. Connolly Building 301 Tarrow, 3rd Floor College Station, Texas R. Kelly Hester, PhD Associate Dean for Academic Affairs Phone: (979) Fax: (979) khester@tamu.edu Texas Tech University Health Sciences Center School of Medicine Lubbock (years 1 through 4) Amarillo (years 3 and 4) and El Paso (years 3 and 4) th Street Lubbock, Texas Terry McMahon, MD Associate Dean for Educational Programs Phone: (806) Fax: (806) somtcm@ttuhsc.edu The University of North Texas Health Science Center at Fort Worth Texas College of Osteopathic Medicine Fort Worth (years 1 through 4) 3500 Camp Bowie Boulevard Fort Worth, Texas Jay Shores, PhD Phone: (817) Fax: (817) j_shores@hsc.unt.edu The University of Texas Medical Branch at Galveston School of Medicine Galveston (years 1 through 4) and Austin (cohort of 10 third-year students) 301 University Blvd., Ste. 604 Galveston, Texas Walter Meyer, III, MD Vice Dean, School of Medicine Phone: (409) Fax: ( wmeyer@utmb.edu The University of Texas Health Science Center at Houston School of Medicine Houston (years 1 through 4) P.O. Box Houston, Texas Patricia Butler, MD Associate Dean for Educational Programs Phone: (713) Fax: (713) butler@uth.tmc.edu The University of Texas Health Science Center at San Antonio School of Medicine San Antonio (years 1 through 4) 7703 Floyd Curl Drive San Antonio, Texas Nanette Clare, MD Senior Associate Dean and Associate Dean for Academic Affairs Phone: (210) Fax: (210) clare@uthscsa.edu The University of Texas Southwestern Medical Center at Dallas Medical School Dallas (years 1 through 4) 5525 Harry Hines Boulevard, Dallas Jennifer Cuthbert, MD Associate Dean for Undergraduate Medical Education Phone: (214) Fax: (214) jennifer.cuthbert@utsouthwestern.edu Note: The Coordinating Board staff extends its appreciation and thanks to the institutional representatives for their assistance in this report. 8

14 Appendix A Map of Texas= Medical Schools 9

15 Texas Medical Schools Lubbock Fort Worth Dallas College Station San Antonio Houston Galveston College Station Texas A&M University System Health Science Center College of Medicine College Station (years 1 and 2) and Temple (years 3 and 4) Dallas The University of Texas Southwestern Medical Center at Dallas Medical School Dallas (years 1 through 4) Fort Worth The University of North Texas Health Science Center at Fort Worth Texas College of Osteopathic Medicine Fort Worth (years 1 through 4) Galveston The University of Texas Medical Branch at Galveston School of Medicine Galveston (years 1 through 4) and Austin (cohort of 10 third-year students) Houston Baylor College of Medicine Houston (years 1 through 4) The University of Texas Health Science Center at Houston School of Medicine Houston (years 1 through 4) Lubbock Texas Tech University Health Sciences Center School of Medicine Lubbock (years 1 through 4) Amarillo (years 3 and 4) and El Paso (years 3 and 4) San Antonio The University of Texas Health Science Center at San Antonio School of Medicine San Antonio (years 1 through 4) 10

16 Appendix B Institutional Survey Form 11

17 Institutional Survey Name of Medical School Person Completing Form: Address One City, State Zip Phone: Name of School Official Phone Number FAX: Medical School Curriculum Content and Course Offerings in the areas of Ethics, Humanities, and Jurisprudence FTE Faculty per course Required Courses that Contain Ethics, Humanities, and Jurisprudence Total Course Hours Number of Hours for Ethics, Humanities, and Jurisprudence Number of Students per Required Course FTE Faculty per Rotation Required Rotations that Contain Ethics, Humanities, and Jurisprudence Total Rotation Weeks Number of Weeks for Ethics, Humanities, and Jurisprudence Total Number of Students per Rotation FTE Faculty per Course or Rotation Elective or Selective Courses or Rotations that Contain Ethics, Humanities, and Jurisprudence Total Course Hours or Rotation Weeks Number of Hours/Weeks for Ethics, Humanities, and Jurisprudence Total Number of Students per Elective or Selective Course or Rotation Total (CB staff use only) Initial course/rotation data reported by institution in April Text in italics added based on the Medical School Catalog. Please update/revise table to reflect academic year

18 Appendix C Institutional Survey Responses 13

19 Baylor College of Medicine Houston (years 1 through 4) Required Courses that Contain Instruction in Ethics, Humanities, and Jurisprudence Total Course Hours Required Course 1. Integrated Problem Solving Patient, Physician, and Society Medical Ethics Required conferences and lectures during core rotations (3rd and 4th years) hours Required Clinical Rotations that Contain Instruction in Ethics, Humanities, and Jurisprudence *** Total Rotation Weeks Rotation 1. Medicine Pediatrics Surgery 8 50 Elective or Selective Courses or Rotations that Contain Instruction in Ethics, Humanities, and Jurisprudence 28 weeks Total Course Weeks Elective or Selective Course 1. Compassion and the Art of Medicine.4 wks History of Medicine 1.0 wks Literature and Medicine 1.2 wks Readings in the Foundation of Bioethics 2.0 wks Introduction to Clinical Medical Ethics 4.0 wks Research in Clinical Medical Ethics 4.0 wks 8 7. Integrative Clinical Experience 2.0 wks Institutional response to CB survey reflects curriculum for Academic Year *** The amount of medical ethics in the required clerkships other than the amount above varies, depending on the patients/cases that students see. 14

20 Texas A&M University System Health Science Center College of Medicine College Station (years 1 and 2) and Temple (years 3 and 4) Required Courses that Contain Instruction in Ethics, Humanities, and Jurisprudence Total Course Hours Required Course 1. Humanities in Medicine (1st year) Leadership in Medicine (1st year) Biochemistry and Genetics (1st year) Humanities in Medicine (2nd year) Ethics (4th year) Jurisprudence (4th year) Required Clinical Rotations that Contain Instruction in Ethics, Humanities, and Jurisprudence hours Total Rotation Weeks Rotation 1. Family Medicine (3rd year) Pediatrics Clerkship (3rd year) Psychiatry Clerkship (3rd year) Obstetrics/Gynecology Clerkship (3rd year) Surgery Clerkship (3rd year) Medicine Clerkship (3rd year) Drug and Alcohol Dependence (4th year) 2 64 Elective or Selective Courses or Rotations that Contain Instruction in Ethics, Humanities, and Jurisprudence 50 weeks Total Course Weeks Elective or Selective Course 1. Medical Humanities 17 wks History of Medicine 17 wks Literature and Medicine 17 wks Medical Ethics 17 wks Medicine and Culture 17 wks Medical Spanish 17 wks Institutional response to CB survey reflects curriculum for Academic Year

21 Texas Tech University Health Sciences Center School of Medicine Lubbock (years 1 through 4), Amarillo (years 3 and 4), and El Paso (years 3 and 4) Required Courses that Contain Instruction in Ethics, Humanities, and Jurisprudence Total Course Hours Required Course 1. Concepts in Community and Ambulatory Medicine (Includes professionalism and clinical bio-ethics) (1st year) (all 1st year) 2. Patient Care: An Integrated Approach (2nd year) (all 2nd year) 3. Introduction to Medicine (all 2nd year) 4. Introduction to Psychiatry (all 2nd year) Required Clinical Rotations that Contain Instruction in Ethics, Humanities, and Jurisprudence 371 hours Total Rotation Weeks Rotation 1. Psychiatry Clerkship 6 weeks Clinical Bioethics Seminar 48 weeks 125 (all 3rd year) 3. Medical Jurisprudence 48 weeks 125 (all 3rd year) Elective or Selective Courses or Rotations that Contain Instruction in Ethics, Humanities, and Jurisprudence 102 weeks Total Course Weeks Elective or Selective Course 1. Health Care Ethics/Humanities Forum periodically 2. Health Care Ethics Grand Rounds continually 3. Health Care Ethics Conference periodically Institutional response to CB survey reflects curriculum for Academic Year

22 University of North Texas Health Science Center at Fort Worth Texas College of Osteopathic Medicine Fort Worth (years 1 through 4) Required Courses that Contain Instruction in Ethics, Humanities, and Jurisprudence Total Course Hours Required Course 1. Medical Ethics Manipulative Medicine Medical Interviewing hours Required Clinical Rotations that Contain Instruction in Ethics, Humanities, and Jurisprudence Total Rotation Weeks Rotation 1. Core Rotations (3rd and 4th years) 60 weeks all 3rd and 4th year students Elective or Selective Courses or Rotations that Contain Instruction in Ethics, Humanities, and Jurisprudence 60 weeks Total Course Weeks Elective or Selective Course 1. Literature and Medicine Child Abuse and Neglect Concepts in Long Term Care Perspectives on Aging Osteopathic Reading Group ~ White Coat Ceremony Christian Medical Dental Society (CMDS) CMDS Mexican Mission Trip CMDS Euthanasia Program Institutional response to CB survey reflects curriculum for Academic Year

23 The University of Texas Health Science Center at Houston School of Medicine Houston (years 1 through 4) Required Courses that Contain Instruction in Ethics, Humanities, and Jurisprudence Total Course Hours Required Course 1. Medical Ethics (4th year) Fundamentals of Clinical Medicine (Problem-Based Learning) (2nd year) Developmental Anatomy (1st year) Behavioral Science (2nd year) Genetics (2nd year) Required Clinical Rotations that Contain Instruction in Ethics, Humanities, and Jurisprudence 364 hours Total Rotation Weeks Rotation 1. Surgery Clerkship All Clerkships Medical Jurisprudence 10 hours 200 Elective or Selective Courses or Rotations that Contain Instruction in Ethics, Humanities, and Jurisprudence Total Course Weeks Elective or Selective Course 1. Medical Ethics (elective rotation) (4th year) 4 wks 15 (per period) 2. Ethics in Medicine 10 hours Health Care and the Arts 8 hours 125 Institutional response to CB survey reflects curriculum for Academic Year

24 The University of Texas Health Science Center at San Antonio School of Medicine San Antonio (years 1 through 4) Required Courses that Contain Instruction in Ethics, Humanities, and Jurisprudence Total Course Hours Required Course 1. Medical Jurisprudence Behavioral Science Psychopathology Epidemiology Clinical Integration Required Clinical Rotations that Contain Instruction in Ethics, Humanities, and Jurisprudence 168 hours Total Rotation Weeks Rotation 1. Medical Ethics 4 weeks 0-6 Elective or Selective Courses or Rotations that Contain Instruction in Ethics, Humanities, and Jurisprudence 4 weeks Total Course Weeks Elective or Selective Course 1. Dying Patients and their Caregivers Economics of Health Care the Medical Practice History of the Doctor-Patient Relationship Environmental Medicine and Border Health Interdisciplinary Approaches and Issues in Death and Dying Institutional response to CB survey reflects curriculum for Academic Year

25 The University of Texas Medical Branch at Galveston School of Medicine Galveston (years 1 through 4) and Austin (10 third year students) Required Courses that Contain Instruction in Ethics, Humanities, and Jurisprudence Total Course Hours Required Course 1. Medical Ethics (Part of POM) Ethics Case Conference (Internal Medicine) Required conference and lectures on core rotations (3rd and 4th years) hours Required Clinical Rotations that Contain Instruction in Ethics, Humanities, and Jurisprudence Total Rotation Weeks Rotation 1. Pediatric Rounds Infectious Diseases -- Rounds Psychiatry and Behavioral Science Elective or Selective Courses or Rotations that Contain Instruction in Ethics, Humanities, and Jurisprudence 14 weeks Total Course Weeks Elective or Selective Course 1. History of Medicine Literature and Medicine Medicine and Religion Art and Medicine Law Ethics/Practice 4 20 Institutional response to CB survey reflects curriculum for Academic Year

26 The University of Texas Southwestern Medical Center at Dallas Medical School Dallas (years 1 through 4) Required Courses that Contain Instruction in Ethics, Humanities, and Jurisprudence Total Course Hours Required Course 1. Medical Genetics Human Behavior and Psychopathology Clinical Ethics in Medicine Clinical Medicine: Principles and Practices Required Clinical Rotations that Contain Instruction in Ethics, Humanities, and Jurisprudence 485 hours Total Rotation Weeks Rotation 1. Psychiatry Clerkship (3rd year)* 6 wks Internal Medicine Clerkship (3rd year)* 12 wks Pediatrics Clerkship (3rd year)* 8 wks Family Practice Clerkship * 4 wks 20 Fourth-Year Elective or Selective Rotations that Contain Instruction in Ethics, Humanities, and Jurisprudence 30 wks Total Weeks Elective or Selective 1. Medicine and Spirituality 34 hrs 6 2. Law, Medicine, and Literature (reading class) 14 wks 9 3. Geriatric Medicine 4 wks 4 4. Supervised Internship in Internal Medicine 4 wks 2 5. Infectious Diseases 4 wks 2 6. Intensive Care Unit 4 wks 1 7. Pulmonary 4 wks 2 8. GI B St. Paul Hospital (Dallas) 4 wks 1 9. GI B Baylor University Medical Center(Dallas) 4 wks Nephrology 4 wks Hematology/Oncology 4 wks Gynecology/Oncology 4 wks Child Psychiatry 4 wks Inpatient Psychiatry 8 North 4 wks 2 21

27 The University of Texas Southwestern Medical Center at Dallas Medical School Dallas (years 1 through 4) Table Continued Fourth-Year Elective or Selective Rotations that Contain Instruction in Ethics, Humanities, and Jurisprudence Total Weeks Elective or Selective 15. Externship in Pain Management 4 wks Emergency Psychiatry & Crisis 4 wks Outpatient Evaluation and Treatment of Psychiatric Patients 18. Advanced Psychiatric Diagnosis and Assessments 4 wks 2 4 wks Biological Research in Schizophrenia 4-8 wks Directed Reading/Research in Mood Disorders 4-8 wks Geriatric Psychiatry 4 wks Supervised Internship in Community Psychiatry & Severely Disturbed Patients 4-8 wks Special Topics in Psychiatry 4 wks Chemical Dependency/Addictive Disorders 4 wks Outpatient Child/Adolescent & Emergency Psychiatry 4 wks General Adult Outpatient Psychiatry 1-6 months Psychiatric Preceptorship Elective 4-8 wks Outpatient Bipolar Disorder Clinical/Research 4 wks Elective in Sleep & Psychiatry 4 wks 1 Institutional response to CB survey reflects curriculum for Academic Year

28 Related reports available from the Texas Higher Education Coordinating Board, Division of Universities and Health-Related Institutions: Texas-Mexico Border Health Education Needs Study, October 2000 Task Force on Health Professions Education, July 2000 This document is available on the Texas Higher Education Coordinating Board World Wide Web site For further information about this study, please contact: Stacey Silverman Division of Universities and Health-Related Institutions Texas Higher Education Coordinating Board P.O. Box Austin, Texas (512) FAX (512) The Texas Higher Education Coordinating Board does not discriminate on the basis of race, color, national origin, gender, religion, age or disability in employment or the provision of services. 23