Suggestions for comprehensive medical education in Bangladesh

No physician’s education would be complete without an understanding of the role played by behavioral and social factors in human health and disease, knowledge of the ways in which these factors can be modified, and an appreciation of how personal life experiences influence physician–patient relationships. Behavioral and social sciences instruction in medical school should build on pre-medical educational foundation. Behavioral and social sciences may be included in the undergraduate and graduate medical school phases of the medical education continuum, which may include meticulously organized compulsory residency and fellowship training in Bangladesh. The importance of continuing behavioral and social science education throughout a physician’s career cannot be overemphasized.

Human health and illness are influenced by multiple interacting biological, psychological, social, cultural, behavioral, and economic factors. The behavioral and social sciences have contributed a great deal of research-based knowledge in each of these areas that can inform physicians’ approaches to prevention, diagnosis, and patient care. Within the clinical encounter, certain interactional competencies are critically related to the effectiveness and subsequent outcomes of healthcare. These competencies include the taking of the medical history, communication, counseling, and behavioral management. Medical professionals should demonstrate competency in the following domains: mind–body interactions in health and disease, patient behavior, physician role and behavior, physician–patient interactions, social and cultural issues in health care, health policy, health economics, professional and social norms and ethics.

A quote, ‘The eye cannot see what the mind does not know’, (Anonymous)is familiar to most students without internalizing its significance. Classroom theoretical teaching builds the knowledge base, while hospital bedside practice during clinical attachment synchronizes that knowledge with what the eyes see, which leads to internalization of knowledge. Another quote by Rudolf Virchow ‘Medicine is a social science in its very bone and marrow’, draws attention to integrating the technical and social aspects of medicine in all stages of medical education and professionalism, an area that has not received sufficient importance in the medical curriculum of undergraduate and graduate teaching. Hence, in the process of preparation/updating the curriculum, in addition to experts in different medical subjects, inclusion of behavioral and social sciences, management sciences, and other inter-professional experts may also be included.

Behavioral and social sciences, taught by experts in the field (not by psychiatrists), may be included throughout the duration of any medical related course. To decrease dependency on experts from external source (e.g. other universities) and to develop behavioral sciences experts within health system, a graduate course on Behavioral Sciences may be introduced.

A graduate course on Forensic Sciences (not medical jurisprudence or forensic medicine) may also be introduced to supplement the knowledge on behavioral and social sciences by setting up of a national level institute. These activities will require creation of job opportunities in the health sector of the country. This is expected to open venues for research in health behavioral sciences. The Government is contemplating extension of internship for students completing undergraduate medical course. If the course and internship (one year) period is brought under total quality management (TQM) practice in its true sense, this in itself will bring about positive effects. Moreover, co-supervision by behavioral and social experts may be done during internship within the hospitals attached to the teaching institutes.

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