Training U.S. Medical Students to Care for the Chronically Ill

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Abstract
Purpose The growing prevalence of chronic illness has important implications for the training of all physicians. The authors assessed the degree to which undergraduate medical curricula explicitly address chronic care competencies selected through literature and expert review. Method In 2001, trained student assistants interviewed directors of required medical school courses (internal medicine, pediatrics, family practice, and ambulatory care clerkships; longitudinal care; and other relevant courses) at 16 representative U.S. medical schools sampled by geography, curriculum reform activity, and primary care orientation of graduates. Course directors were asked whether chronic care competencies were addressed using specific curricular methods (written objectives, course materials, observational evaluations, written/oral examinations, other required course activities), and to rate the importance (1 = not important; 5 = essential) of each competency for their course and for the overall undergraduate curriculum. Results All 70 eligible course directors responded. Of 49 chronic care competencies, 29 (59%) received mean importance ratings for a course of ≥ 3, but only 14 (29%) were addressed using two or more specific curricular methods. Course directors gave highest importance ratings (mean > 3.9) to screening for abuse, awareness of patients’ sociocultural perspectives, and protecting patients’ confidentiality. They gave lowest importance ratings (mean ≤ 2.6) to knowing strategies to maximize patients’ potential, ability to discuss alternative information sources, and ability to assess equipment needs. Their importance ratings correlated only moderately with the number of curricular methods used to address each competency (r2 = 0.27–0.80, p < .05). Conclusion Course directors agreed about the importance of many competencies in chronic care but reported considerable variation in how they addressed competencies in their courses. Medical schools can improve training in chronic care by paying greater attention to specific methods for addressing important chronic care competencies.