Health, Society, and the Physician: problem-based learning of the social sciences and humanities. Eight years of experience.

We describe a required course for fourth-year medical students focusing on the application of the social sciences and the humanities to critical decisions in the practice of medicine. During 160 hours (70 with faculty contact) in a 7-week period, active, patient-centered, problem-based learning takes place in small collaborating groups, is facilitated by trained tutors, and uses computerized access to library materials plus reference files and resource persons. Major issues identified in the cases are clarified in complementary lectures and symposia. Formative evaluation is ongoing within tutorial groups. Summative evaluation is determined by the individual student's performance in a final complex management problem using a simulated patient. Evaluation of the course, and the basis for its ongoing revision, are provided by participating students and faculty, whose evaluations of the course have been favorable in 80% to 90% of cases.

Irritable bowel syndrome: classification and pathogenesis.

The irritable bowel syndrome (IBS), a chronic disorder of gut motility with a variable but continuous spectrum of clinical features, affects 15% of the population of developed countries. Its intestinal and extraintestinal symptoms arise principally from the global physiological changes that accompany emotional tension; but the advancing knowledge of neurohumoral control of gut motility has not yet revealed any features pathognomonic for IBS. Persons having IBS exhibit psychoneurotic traits in varying degree; and IBS patients (a minority of the whole) differ from nonpatients in having more severe life changes and in their learned illness behavior.

Health experience learning program (HELP).

Since 1976, The Burke Rehabilitation Center has employed undergraduate university and college students as nurses' aides. This experience has enabled many students to make a decision or firm up their decision to go on to medical school. It has also been extremely valuable to the institution to have available for employment this intelligent and highly motivated group of individuals. The program has been mutually beneficial for both parties and could easily be adapted for other health care institutions.

Health-related experimental learning for college undergraduates.

Guided service experience commonly enriches medical education at the doctoral and postdoctoral levels but rarely has been offered to premedical students. Internships in health agencies were individually arranged for 198 self-selected college undergraduates in 101 different settings which emphasized the social, economic, and interpersonal factors in health care. Students served as nursing aides, clinical assistants, and health educators and in other nontechnical roles; each wrote an analytical report based upon a study plan and firsthand observations. The expectations of both students and host institutions were usually exceeded. Benefits included help in career decisions, exercise in self-directed learning, and demonstration of noncognitive qualities desired in professional work. The authors conclude that undergraduate students are competent to deal with sensitive ethical and social issues in patient care and to provide needed health services of high quality.