Social responsibility: a missing ingredient

A crucial component of medical education As academic medicine enters the 21st century, some educators are concerned that the profession is in danger of losing sight of its fundamental purposes and values.1 There has also been a call for more attention to be paid to the moral development and character of medical students.^{2 3} It seems that the fiscal, legal, and political realities of the new healthcare era may easily distract from the true purpose of medical education. The American Association of Medical Colleges (AAMC) has recognised the vital importance of understanding and nurturing the social contract that exists between medical schools and the public. The best way to fulfill this contract is to educate medical students "in a manner that instills appropriate professional attitudes, values, and skills."4 If the AAMC is correct, and I believe it is, then it also follows that part of the social contract for medical schools is a duty to educate their students to be socially responsible doctors.

The first question to logically follow from this discussion is, "What is a socially responsible doctor?" McCurdy and I have examined this question in some detail elsewhere, and we have suggested that a socially responsible doctor is an individual who takes part in activities that contribute to the happiness, health, and prosperity of a community and its members.⁵ We have argued that if doctors are to be expected to take part in these types of activities then they must be trained to do so in medical school. Socrates is reported to have said that "the shortest and surest way to live with honour in the world is to be in reality what we would appear to be; all human virtues increase and strengthen themselves by the practice and experience of them."⁶

If those of us who are leaders of modern medical education and mentors to the next generation of the world's doctors wish young doctors to practise their craft not only with competence but also with honour, then we must pay careful attention to both the content and the process of our educational programmes. We must take all the necessary steps to ensure that medical students complete the types of curricular experiences that will enable them to practise in a competent and sensitive manner and to show abiding concern for their patients and the communities in which they live. In short, we must specifically prepare the doctors of the future to be not only excellent clinicians but socially responsible practitioners as well.

If incorporating the teaching of social responsibility into medical education curriculums is a worthwhile goal, how should it be done? I believe that this difficult task should be approached like any other component of a curriculum. The faculty should identify specific educational objectives-that is, define the knowledge, skills, and attitudes that the faculty believe all medical students should possess in order to become socially responsible doctors. Next, the faculty should identify how medical students will achieve these objectives. The required combination of didactics, learning experiences, and faculty supervision that will teach the medical students to become socially responsible doctors needs to be thought out. Finally, the faculty must decide how the students and the curricular components will be evaluated to determine if the educational objectives have been achieved. While the outline of this recommended curriculum is very specific, its individual components provide enough latitude to be adapted to any medical education system.

Teaching social responsibility to medical students in this way might seem too formal and structured. Some say that medical students should be encouraged to do this on their own or as an elective experience. I do not share this opinion. Students learn best not by merely passively listening to their teachers, but by participating in well structured educational programmes. Students also quickly learn how important a specific topic is by how much attention it is given in their curriculum. Until the teaching of social responsibility is given equal standing with other important components of medical education curriculums, it will not be incorporated into the personas of doctors. If medical educators really believe that it is important for doctors to be socially responsible then they must match their words with deeds. If not, then let us stop talking about it and turn our attention to what we really believe to be crucial in medical education.

Larry R Faulkner, vice president for medical affairs and dean, School of Medicine, University of South Carolina, Columbia, SC 29208, USA
Email: shaw@dcsmerver.med.sc.edu


studentBMJ 2001;09:171-216 June ISSN 0966-6494

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