Syllabi: Medicine and Society

INSTITUTION: University of Illinois College of Medicine at Urbana-Chanpaign

COURSE DIRECTORS:

Paula A. Treichler, Ph.D.

Medicine/Communications

(email: ptreich@ux1.cso.uiuc.edu)

Daniel K. Bloomfield, M.D.

Medicine

ENROLLMENT: 4th year; elective

SEMESTER: Spring 1995

January 30-February 24, 1995

(This syllabus, though revised annually, remains substantially the same from year to year. For further information, contact Paula A. Treichler, Ph.D.)

COURSE DESCRIPTION:

This course, now in its second decade, is designed for advanced medical students (generally fourth-year) and for resident physicians training in a primary care specialty. The course offers a multidisciplinary approach to social aspects of medicine and health care, and draws upon faculty from the social sciences, the humanities, law, medicine, and other fields to present such topics as the evolution of human disease, cultural and social aspects of illness, ethical issues in health care delivery, communication in medical settings, the history of medicine, medical economics, health care organization, health care policy, and the study of medicine as a profession. Each week of the four-week course is (1) structured around a specific clinical case study and (2) emphasizes selected areas of sociomedical content. All medical students (including Medical Scholars) must satisfactorily complete the course as a requirement for graduation.

OBJECTIVES

The course is designed to familiarize students with major social issues in medicine, and with the concepts, theoretical approaches, terminology, and methods of the dominant sociomedical disciplines; to sensitize students to the social dimensions and complexity of medicine and health care problems; to expose students to contrasting theoretical arguments and the empirical evidence supporting them; to encourage students to recognize and tolerate the fact that clinical decisions must often be made in the presence of uncertainty and ambiguity, and with empirical data that are incomplete, limited, or contradictory; to demonstrate an interdisciplinary approach to health care in terms of topics, faculty, and students; to encourage students to analyze and reflect upon their own professionalization process; and to demonstrate the applicability of sociomedical theory and research to the realities of the disease and treatment. In the long run, the course should enable you to better understand the social context in which medicine is practiced and which partially determines what medicine is to become.

Theory, Research, and Practice

"Theory" means the body of principles and commitments upon which a field of inquiry is based. This course is designed to help students understand and integrate theory, research, and practice. The course requires conceptual thinking as well as work on the part of the students to identify similarities, differences, and clinical relationships across disciplines. In many cases, unambiguous results and practical recommendations will not be available. Learning to appreciate and apply work in progress is a skill students should develop.

Case Study Format

Each Monday is devoted to the case study for that week (except in Week One, where Monday is used for a general introduction to social issues in medicine). The case is presented in the morning (10 am-noon); after significant medical and sociomedical issues have been identified, the class breaks into assigned small groups for discussion of different disciplinary perspectives. In the afternoon, a panel explores the case in greater depth and detail, again drawing on social as well as medical knowledge. In general, the other morning sessions are used to present panels, films, and speakers directly relevant to the case; broader issues and topics raised by the case; and student presentations on projects suggested by the case study. In general, the other afternoon sessions are devoted to presentations by faculty of major sociomedical content areas. This material is to some degree organized to elucidate the case study, but perfect correspondence is not intended. Rather, the afternoon lecture-discussion sessions are the primary vehicle for presenting the principles of a field, major debates, specific bodies of empirical evidence, and so on. The material will generally be applicable to all four cases. Student research projects (carried out in assigned small groups) are intended to relate sociomedical theory and research to clinical disease and treatment and to encourage students to become familiar with a range of interdisciplinary perspectives and topics.

Meeting Times

The class meets MTWThF 10-12 noon (morning) and 1:30-3:30 p.m. (afternoon) for four weeks. Some class sessions are at different times to accommodate the individual schedules of faculty and guest speakers.

Small Groups

Students meet each week in assigned small groups with core faculty members to discuss the case from one of the following broad disciplinary perspectives: Medical History and Law; Health Care Economics and Organization; Health Policy, Research & Education; and Health Communication, Culture, and Ethics. Faculty members rotate from one small group to the next so that students are encouraged to think about all four broad areas.

On Friday mornings, each small group will make a 20-25 minute presentation to the class. Lunch on Fridays (pizza or brown bag as dictated by budget constraints) will provide a time for informal faculty-student discussions--of the presentations, the case, disciplinary material, preparation for exams, or topics in the news. To research and prepare the Friday morning presentations, each small group will need to make its own arrangements, as necessary, for getting together outside of class. More on the presentations below.

REQUIREMENTS

All medical students (including Medical Scholars) are expected to prepare for, attend, and actively participate in the morning and afternoon sessions (see detailed schedule), take all examinations (see below), attend and actively participate in small group activities, and participate in course evaluation during the last day of class. Individual and group presentations are periodically required. Internal medicine residents (primary care track) are expected to prepare for, attend, and participate in both morning and afternoon class sessions, read the weekly case studies and readings, and (unless an alternative is negotiated) take the exams; their participation in Friday morning presentations is welcome but not required.

REQUIRED READINGS

Case Studies will be distributed weekly in class. Packets of required readings for the first case will be distributed in class; readings for the others will be available at Notes & Quotes copy shop in Johnstown Center under the course number Medical Studies 303. Additional material will occasionally be distributed in class. Also required is a short book, Power and Illness by Daniel M. Fox, available soon at Horizon Book store, 1115_ W. Oregon, Urbana. Many of the books and articles listed in the case study packets are on reserve in the Library of the Health Sciences in the Medical Sciences Building.

Highly recommended

The following books provide greater depth on the issues covered in the course, particularly the social and historical formation of the U.S. health care system and proposals for changing it. Many other references are listed in the bibliographies for each case study.

_ George Rosen, Preventive Medicine in the United States

_ George Rosen, Structure of American Medical Practice

_ Lee and Estes, ed., The Nation's Health

_ Paul Starr, Social Transformation of American Medicine

_ Erik Eckholm, ed. Solving America's Health Care Crisis

_ Rosemary Stevens, In Sickness and in Wealth

_ Melhado, Feinberg, and Swartz, Money, Power, and Health Care

_ Paul Starr, The Social Transformation of American Medicine: The Rise of Sovereign Profession and the Making of a Vast Industry

_ Howard Waitzkein, Doctor-Patient Communication: Clinical Implications of Social Scientific Research

Attendance

Students are expected to attend class regularly; attendance and class participation will count toward the final grade. Students are also expected to be on time for class. Students who need to miss a given class or classes should inform Dr. Treichler (333-0738).

Examinations

There will be a two-hour midterm examination on the afternoon of Friday, February 10 (1:30-3:30 pm) and a two- hour final examination on Friday, February 24 (1:30-3:30 pm). The examinations will be closed-book, and will consist primarily of short answer and/or short essay questions. Study questions, on which exam questions will be based, are included in each case study.

Student Presentations

Each Friday morning, the entire class session will consist of presentations by student groups on projects selected from the syllabus. Objectives of the presentations include:

-to illuminate the sociomedical dimensions of the case studies with some depth and complexity;

-to learn more about the arguments and evidence in some of the sociomedical disciplines--particularly those covered in the afternoon sessions--by researching them and applying them in the context of the case study;

-to obtain a greater appreciation of complexity by synthesizing arguments from different disciplines and perspectives and/or by pursuing them in depth in one discipline;

-to apply and critically evaluate the relevance of sociomedical arguments and insights as they relate to medical socialization, research, and practice, and to your own professional development;

-to explore the resources available in selected sociomedical areas;

-to share resources, ideas, and results with other students.

Each presentation will be evaluated by core faculty for content, relevance, sociomedical emphasis, analytic brilliance, and organization.

Guidelines for Project Presentations

Each group's presentations should be 20-25 minutes long, should represent the perspective of the broad disciplinary area you are working on for the week, and should concentrate on one or two of the issues suggested in each case study. All members of each small group will select and research the topic; they should select a format for presentation that will fit within the allotted time. If information is to be presented or a reading or video presentation analyzed, one or two students should probably make the actual presentation. A role play, on the other hand, might involve all group members. In any case, each student should contribute to the overall project by selecting a sub-topic and preparing a one-page summary of the issues, including sources as relevant. Each group should appoint someone as a time-keeper so you don't run over.

Each group should prepare a handout for the presentation to be distributed to faculty and class members. It should include a title, your names/group number, and an outline or overview of issues covered in the presentation itself. In addition, it might include the individual outlines, articles or illustrative material, and references for your presentation. These handouts are useful as study notes for the students and interesting to the faculty as well--

often helpful in updating the cases or otherwise incorporating into next year's material. If you have additional relevant material that is not necessary to copy for the whole class, please make a copy for us to keep on file for future reference. Again, include your NAME(S) and TOPIC/TITLE on the handout and cite relevant references.

Faculty Resources

The core faculty will help you with format, topic, resources, etc., and will be responsible for guiding and grading your presentation. In addition, you are free to consult other faculty and other campus resources.

Overall Grade for the Course

Grading will be based on a point system, with the following weightings (exams will cover both morning and afternoon material):

30% midterm

30% final

40% classroom participation (small groups, discussion, & project presentations)

TOTAL 100%

01/24/95

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