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Poor patient compliance is common in clinical practice but difficult to demonstrate to medical students in a convincing manner. To accomplish this, the authors asked medical students who preregistered for a conference on patient compliance to adopt the role of "patient" and to take "medication" (Vitamin C) for one week, to observe certain dietary restrictions, and to complete an attitude and health beliefs questionnaire. The educational impact was intensified by making prior predictions about outcome which were almost exactly confirmed. The predictions concerned failure to fill the prescription, extent and type of noncompliance, and significant differences in attitudes between compliant and noncompliant students. The attitudes of the students resembled those of noncompliant patients asked to take medication for nonsymptomatic disorders (such as hypertension). Those students who participated in the drug-taking experience rated the educational impact of the conference more highly than did those students who attended the conference but did not take part in the drug project.

There is a need to add a humanistic component to scientific aspects of medical education. It must be adequately organized and evaluated to compete successfully in an already overcrowded curriculum. This study reports an educational experiment involving three consecutive freshmen classes in a new community-based medical school. A specialist in literature and a psychiatrist teach a two-week course to first-year students in which themes and topics relevant to medical practice are explored through selected readings and patient interviews that are integrated into daily experiential groups. The outcome of the course and similarities and differences between years are explored in relation to group sessions, class composition, reading assignments, and patient interviews.

Over 300 patients have been treated on an inpatient psychosomatic service employing a learning model of chronic illness behavior. This model stresses social reinforcement and avoidance of occupational and social activities in the development of a syndrome characterized by somatic complaints and care-eliciting interpersonal behaviors. Preliminary studies showed that patients reinforced others for care-giving responses but showed improved tolerance of experimental pain and lower rates of drug use when care-taking responses were minimized and self-control encouraged. Treatment was designed to involve the patient in his own care, including behavior modification techniques to reduce symptomatology, social skills training, and family therapy. One-year follow-up shows that most patients achieve self-set goals, with generalization of beneficial treatment effects. Patients who return to an intact family show continuing decreases in somatic complaints and increases in achievement orientation. Treatment failures are characterized by lack of an intact family and return to the medical care system.