Doctors Serving People: Restoring Humanism to Medicine through Student Community Service

By Edward J. Eckenfels | Go to book overview

Appendix D
The Social Medicine, Community Health,
and Human Rights Curriculum

Has there been any change in the last 50 years?
Has there been none? Those of you in this room
should know. And, if so, what caused that
change to occur?

—Nicholas Christakis, Interim Report of the Acadia
Institute on Undergraduate Medical Education

Is it possible to integrate humanistic attributes and actions in a more encompassing framework—a new curriculum—without contaminating an activity that, through participants’ enthusiasm, has kept the service ethic alive? There are two major dilemmas that restrict any proposed reforms based on RCSIP. First, how can programs be required and voluntary at the same time? Second, can medical school faculty who are deeply invested in the model of the traditional curriculum be persuaded to change without causing serious resentment? What I am proposing is, on the surface, both well-nigh impossible and extremely controversial.

My reference in what follows is Rush, but my model, if feasible, applies to American medical education in general. The very thought of an intellectual and experiential widening of the curriculum brings shivers down the spines of the basic scientists who hang on tenaciously to every course hour they feel they have won through bloody scrimmages with their clinical counterparts. The myth of the traditional curriculum as the only way to educate must be debunked slowly but firmly. What the “traditionalists” actually believe, without realizing it, is that the culture of medical education is unalterable. But culture is fluid, not static, and that means the culture of medical school can change, but it will take serious effort by those committed to reform.

When I have cautiously raised the idea of integrating our voluntary service programs into the existing curriculum, a typical response has been “The dean has the power to do it, and, if he or she says so, it will happen.” I presume that this notion is not uncommon, because the academic health center is perceived as a powerful hierarchy, with orders and assignments following a chain of authority that goes from the top to the bottom. Nonetheless,

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