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Teaching about communication between doctors and terminal cancer patients is problematic. A practical model that requires individual student problem-solving and group discussion with minimal staff involvement has been described. An evaluation showed that this model was effective in exposing students to different points of view, could result in changes in behaviour and was found to be interesting by the majority of students.

The behavioral sciences have much to offer medical research and practice, and they are likely to play an increasingly important role in medical education. The need for researchers and teachers trained in both medicine and behavioral sciences has been addressed at Johns Hopkins by the establishment of a joint degree program. Concurrent, as opposed to consecutive, training in both fields shortens the duration of study and fosters interdisciplinary research early in the trainee's career.

This study sought to explore the following questions: (1) Do residents perceive training focused on infancy and early childhood care issues as more clinically applicable than training focused on care of older children and adolescents? (2) Do residents at different training levels differ in their evaluation of behavioural paediatrics instruction? (3) What is the strength of the association between instructional style and clinical impact dimensions? and (4) Compared to the instruction provided by instructors from other medical and academic disciplines, do paediatric residents perceive differences in the teaching efficacy and clinical relevance of instruction provided by paediatricians? Data were drawn from 1341 residents' evaluations of 116 required behavioural paediatrics sessions over 3 years. The data demonstrated that house officers recognize the value of acquiring knowledge in behavioural paediatrics, regardless of the level of the house officers' training, or whether the focus concerned infants or older children. However, residents were more likely to perceive the presentations provided by paediatricians as providing instruction that was slightly more applicable to their practice needs than instruction that other faculty presented. The study results further demonstrated that the clarity and organization of instruction influences, but does not supercede, the residents' perception of the merit of instruction. The findings suggest that international recommendations for greater inclusion and acceptance of behavioural paediatric instruction can be achieved in programmes that, by requiring participation, confer equal status to behavioural paediatrics and traditional residency training. The results support residents' acceptance of a health team approach to behavioural paediatric instruction.(ABSTRACT TRUNCATED AT 250 WORDS)

The two-year preclinical course in Behavioural Sciences in Medicine at the University of Sydney is described. A brief history of the development of the department is followed by a description of the course objectives, and the way that these objectives are translated into course content. The supervision of assignment work in the community is considered to be an essential part of the department's work. Ongoing evaluation of the course contributes to its development and refinement.

Although behavioral science training is an essential component of family practice residency education, there have been few evaluations of its effects. In this study, selected behaviors of senior residents and their patients in two different family practice residency programs were compared. One program emphasized behavioral science, the other did not. Residents in the more behaviorally oriented program had more positive attitudes toward both social factors in illness and the importance of a warm physician-patient relationship. In addition, these residents claimed to know more about non-pharmacologic treatments for depression and anxiety and felt more confident in their ability to handle them than their less behaviorally trained counterparts. In regard to patient care, patients of residents in the program which emphasized behavioral science were more likely to receive a psychosocial diagnosis and resident counseling or mental health referral than patients of residents in the program which did not. On a patient satisfaction questionnaire, patients of the two programs differed on only one subscale which concerned convenience of care. Although these early results are encouraging, behavioral science training needs continuing clarification and evaluation of its goals and accomplishments.

The paper reports on a survey into the present state of medical sociology in Great Britain, describing the developments which have occurred following upon the recommendations in the Todd Report on the teaching of behavioural sciences to undergraduates. Details of existing and proposed courses at each school are given; they reveal the wide variations which exist, in respect of precise specification of educational objectives, course content, affiliation and qualifications of teachers, teaching methods, and curricular time. However, most schools are consciously trying to incorporate this discipline into the syllabus at an early stage. At present several of the provincial schools have more experience of teaching medical sociology than do the London schools, but this difference may soon be lessened. In most cases the subject is taught in close association with social or community medicine, but connexions with psychology and psychiatry are often close. The prospects for this relatively untried subject are good, with new medical schools demonstrating new ways of applying sociology to medicine.

An 8-hour training programme in basic communication skills was carried out for an entire behavioural science class. Students participated in small-group practical workshops which focused on attending and primary accurate empathy (Egan, 1975). The latter was assessed objectively be written responses to short trigger statements, and in matched pre- and post-training measures showed a significant overall increase in empathetic responding. Student evaluations of the project were positive and allowed suggestions for increasing the impact of similar training efforts in the future.

A survey of members of the Society of Teachers of Family Medicine provided information about roles, relationships, and rewards for teachers involved in family medicine residency behavioral science education. Family physicians and behavioral scientists perceive their own roles in behavioral teaching and patient care as greater than is perceived by the other group. All groups of respondents see a continued need for collaborative behavioral teaching, patient care, and research. Interpersonal rewards reported emphasize family physicians learning from behavioral scientists. Frustrations reflect personal style, use of jargon, and a sense that the other group does not understand important aspects of one's work. Income is markedly greater for family physicians than behavioral scientists. Most behavioral scientists responding plan to remain in family medicine teaching.

This paper explores the collaborative research relationships between clinical dentists and behavioral scientists in dental education. The emergence of behavioral sciences in dentistry is discussed and attention is given to the nature of professional roles in collaborative clinical research. Components for a model for collaborative clinical research are specified based on the research experiences of behavioral scientists with colleagues in prosthodontics and orthodontics.

Fifty-six family practice residents representing programs in 23 different states were surveyed concerning their training experience in behavioral science. Questions covered three basic areas of concern: experiential content, subsequent relevance to family practice, and suggestions for curriculum improvement at the residency level. The results point out definite knowledge of medical psychology, psychiatric consultation to medical patients, and practical intervention skills. Suggestions are made concerning curriculum development in behavioral science which (1) emphasize some new areas of concern raised by the residents, (2) recommend a more practical, integrated approach beginning in the medical school training, and (3) emphasize a dual approach requiring skills in medical psychology and skills more traditionally subsumed under the "mental health" field.

Patients' concerns have too infrequently been considered by curriculum developers in the design of the behavioral science curriculum for family practice physicians. With these concerns in mind, the authors in this study examined by questionnaires patient attitudes regarding the level of involvement desired of family physicians for each of 45 psychosocial problems. The choices of responses offered were: Level 1, no help; Level 2, referral; Level 3, compassion, concern, and minor advice; and Level 4, expert, therapeutic help. The results demonstrated that for a majority of the problems, the patients expected their family physician to be caring and to show concern but not to be an expert (Level 3). Certain problems appeared in predictable categories, such as religion/church concerns in Level 1 and pregnancy, where expert advice was desired, in Level 4; pediatric problems dominated Level 2. Discrepancies between patient expectations and current curricular emphases were noted (for example, in counseling). Statistically significant differences were found between rural and urban populations as well as across low, middle, and upper socioeconomic classes. Educational implications derived from the data are discussed.

During 1976-77 the authors studied psychiatric education in Western Europe, visiting university centers in 10 countries. Medical education in various European countries has developed out of different traditions. The significance of these for the present educational systems are discussed and the differences from the U.S. curriculum clarified. Psychiatry until recently in Europe has been dominated by a phenomenological approach. It has not assumed the same importance in the curriculum as in the United States. However, since the student revolts of 1968, there have been major reforms in teaching, including changes in the role of psychiatry in medical education and increased attention to social and psychological factors in health and disease.

Assessment and treatment of the varied psychosocial problems which affect patient health often present primary care physicians with their most difficult and frustating problems. This paper outlines criteria which can be used to select a model of psychosocial treatment compatible with an active family practice clinic. It also describes one treatment model which fits the criteria and can be used to assess and treat a wide range of psychosocial problems common to family practice.

Little difference was found in the extent to which psychosocial data were recorded in two samples of general hospital case-notes written 10 years apart, in spite of a significant increase of apparently relevant material in the undergraduate medical curriculum. Although the house physicians responsible acknowledge the importance of the data, their estimate of recording frequency was much higher than was actually the case. Impediments to such recording were identified. The apparent lack of generalization of learning is presented as an important problem relevant to psychiatrists who have a major responsibility for teaching in these areas. Suggestions are made of ways in which generalization might be facilitated.

To tailor a behavioral science curriculum to family practice needs, less importance should be given to inpatient psychiatry, and more emphasis to the common outpatient problems seen in the primary care setting. The experience of co-leading a short-term couples therapy group during residency training can assist the family physician in becoming more comfortable with marital counseling. Each couples group was co-led by a resident and a behavioral scientist, with couples who had requested marital treatment from the mental health service of a health maintenance organization. After couples were initially evaluated with a pregroup questionnaire, a number of group therapy sessions were co-led, using specific communications techniques and exercises. Benefits to the resident included development of skills in handling small groups, learning behavioral tools for assisting couples, and developing increased comfort in approaching psychosocial issues.

Basic science education of physicians has been almost exclusively in the biological fields. Although in recent years many schools have added behavioral sciences to the preclinical curriculum, there has been no agreement as to content or method in this area. An understanding of human behavior is essential for all physicians and is the goal of the course described here. This course, entitled "Introduction to Patient Care," utilizes readings, group presentations, site visits, small-group seminars, and specifically stated educational objectives to present the following topics: health problems of the United States, physicians and other healers, humanistic values--the sick role, and the doctor-patient relationship. The small-group seminars, with behavioral science and clinical faculty, help to guide the student's learning experience toward a scientific analysis of the art of medicine.