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After each surgery, the surgeon I worked with fully takes off his mask and hair bonnet prior to speaking with the patient's family. Although it only takes seconds to do this, I believe it helps the family feel more at ease and allows them to see the surgeon as a true human not hiding behind anything. Third-year medical student, IUSM 2006

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Our team and the ICU team were rounding and we all entered a patient's room. There were at least 15 of us in the room. Our teams spoke about the patient, examined him, adjusted the ventilator setting, and then left—all oblivious to the family member who was in the room the entire time. After we had all left, I noticed that the intern—who had just started the service that morning—kneeled down beside the patient's wife and began explaining what the team had just done. No one else noticed what she had done, but I was very impressed by her behavior. Third-year medical student, IUSM 2006

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Across the country, medical training institutions are enhancing traditional formal curricula to develop and assess trainees' competency in a wide range of abilities, including competencies in the social and behavior sciences such as communication, self-awareness, professionalism, and moral reasoning. "Competency" is a complex notion that refers to the capacity, in varying circumstances, to use knowledge, skills, and values in actions that serve a purpose (e.g., promoting or regaining health or various intermediate outcomes on the way to health). The lowest-order competency is the ability to take certain actions successfully without much self-awareness, capacity to reflect, or adaptability. The highest-order competency is to interact with others with mindfulness, awareness, and adaptability, that is, to be what Donald Schön has called a "reflective practitioner." The acquisition of competencies in the social and behavioral sciences (SBS) in undergraduate medical education, indeed throughout the long career in medicine, is a staged process that combines learning of several different types (cognitive, behavioral, and social). Throughout their professional life cycle, physicians learn from formal and informal sources that are both didactic and experiential. The most powerful learning aligns both formal and informal sources while providing opportunities for reflection and feedback.

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A useful framework for integrating trainees' formal and informal experiences in the SBS is to focus on their competency. Educators must attend both to the formal curriculum, as well as trainees' learning environment, which comprises the institution's informal or "hidden" curriculum. Using current theories of learning, this chapter illustrates innovative educational methods that integrate formal and informal curricula in teaching and assessing competency in the SBS.

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The 2004 Institute of Medicine (IOM) report, Improving Medical Education: Enhancing the Behavioral and Social Science Content of Medical School Curricula, identifies 26 topics in six SBS domains that are important to the education of future physicians (see Table 38–1). The need for such training in the behavioral and ...

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