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.

Use of an interpractice medical information system to develop a data-based clinical cost-consciousness curriculum in Primary Care settings.

A data-based cost-consciousness curriculum was developed that stresses teaching by community physician preceptors in their own practice settings, using an educational packet that incorporates the teaching practice's own data. The cost awareness program represents an educational application of an interpractice medical information system developed by the Primary Care Cooperative Information Project (COOP Project). This system allows patients to be tracked longitudinally within a practice and enables cross-practice comparisons of process, outcomes, and costs for similar cohorts of patients. Initial experiences during the pilot year suggest that the use of practice-based data by physician preceptors is a sound strategy, giving the preceptors flexibility in tailoring their approach to specific teaching/learning situations. Student and preceptor reaction was generally positive. Cost issues are threatening to physicians and it is appropriate to design educational strategies which allow physician preceptors to articulate their perspectives. As role models for medical students, preceptors are in an excellent position to influence physicians in training to be more cost conscious as physicians.