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Teaching Psychosomatic (Biopsychosocial) Medicine in United States Medical Schools: Survey Findings

From the Department of Psychology, University of Maryland, Baltimore County; Division of Gerontology, Department of Medicine, University of Maryland School of Medicine; and Geriatrics Research Education and Clinical Center, Baltimore Veterans Affairs Medical Center (S.R.W., S.A.N.), Baltimore, Maryland; the Division of Digestive Diseases and Nutrition, University of North Carolina (D.A.D.), Chapel Hill, North Carolina; and the Office of Educational Affairs, MCP Hahnemann School of Medicine (D.H.N.), Philadelphia, Pennsylvania.

Address reprint requests to: Shari R. Waldstein, PhD, Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250. Email: waldstei{at}umbc.edu

OBJECTIVE: A survey of US medical schools regarding the incorporation of psychosomatic (biopsychosocial) medicine topics into medical school curriculum was conducted. The perceived importance and success of this curriculum, barriers to teaching psychosomatic medicine, and curricular needs were also assessed.

METHODS: From August 1997 to August 1999, representatives of US medical schools were contacted to complete a survey instrument either by telephone interview or by written questionnaire.

RESULTS: Survey responses were received from 54 of the 118 US medical schools contacted (46%). Responses were obtained from representatives of both public (57%) and private (43%) institutions. Only 20% of respondents indicated that their schools used the term "psychosomatic medicine"; the terms "behavioral medicine" (63%) and "biopsychosocial medicine" (41%) were used more frequently. Coverage of various health habits (eg, substance use and exercise) ranged from 52% to 96%. The conceptualization and/or measurement of psychosocial factors (eg, stress and social support) was taught by 80% to 93% of schools. Teaching about the role of psychosocial factors in specific disease states or syndromes ranged from 33% (renal disease) to 83% (cardiovascular disease). Coverage of treatment-related issues ranged from 44% (relaxation/biofeedback) to 98% (doctor-patient communication). Topics in psychosomatic medicine were estimated to comprise approximately 10% (median response) of the medical school curriculum. On a scale of 1 (lowest) to 10 (highest), ratings of the relative importance of this curriculum averaged 7 (SD = 2.5; range = 2–10). Student response to the curriculum varied from positive to mixed to negative. Perceived barriers to teaching psychosomatic medicine included limited resources (eg, time, money, and faculty), student and faculty resistance, and a lack of continuity among courses. Sixty-three percent of respondents expressed an interest in receiving information about further incorporation of topics in psychosomatic medicine into their school’s curriculum.

CONCLUSIONS: Results of this survey reveal variable coverage of specific psychosomatic medicine topics in the medical school curriculum and differential use of nomenclature to refer to this field. There is a need for further curricular development in psychosomatic medicine in US medical schools.

Key Words: psychosomatic medicine • biopsychosocial medicine • biopsychosocial model • medical education • medical curriculum • survey.

Abbreviations: APS = American Psychosomatic Society; HIV = human immunodeficiency virus.

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