Photo by Chris T. Anderson (copyright 2004)

"The best way for a student to become a fantastic doctor may not be to go straight through medical school getting straight A's and doing nothing else," says Helen Loeser, Associate Dean for Curricular Affairs at the UCSF School of Medicine. "A physician will likely remain healthier if more of her background, intellect, and heart can be engaged and developed along with her physicianship."

To that end, the School of Medicine has introduced an innovative new program to the medical school curriculum. The Area of Concentration (AoC) program enables fourth-year students to select elective coursework in one of six interdisciplinary themes that cuts across traditional clinical fields and career paths. Comparable to a college minor, the six AoC themes are:

• Community Health and Social Advocacy
• Global and Public Health
• Humanities and Medicine
• Medical Education
• The Health Care System and the Physician-Leader
• The Science of Medicine and the Physician-Investigator

In the last few years, such specialty programs have sprung up at other medical schools across the country, including Stanford, Pittsburgh, UCLA, and Columbia. Yet it is the "home-grown" nature of UCSF's program, says Loeser, that distinguishes it from the rest.

"The key was looking at what UCSF students already do with their time and energy in their fourth year, over and above getting ready for internships and residencies," says Loeser, "rather than creating a 'UCSF product.' The result was a program designed to enhance and reinforce what UCSF students do best."

After starting foundational AoC coursework, students identify a project and work with faculty advisors to focus their inquiry, then follow a three-step "know, show, do" process to acquire the necessary knowledge, demonstrate an ability to use that knowledge, and apply it to practical use. Prior to graduation, students complete final presentations or a "legacy" of their own design, which may range in format from a scientific paper or web-based curriculum module to a patient registry or, as one student demonstrated, a photography exhibit.

Interested in the disproportionately high asthma rates among children in one of San Francisco's low-income neighborhoods, fourth-year student Rachel Agrin created a photo essay to "bring to life" the faces and stories of the neighborhood children affected by this illness. The exhibit was displayed outside the Dean's Office for nearly four months, to great effect.

"She not only developed a far richer understanding of asthma's effect on children and disenfranchised communities," says Ramu Nagappan, who heads up the Medical Humanities AoC, "but she was also able to have a powerful impact on physicians and physicians-to-be that is rarely possible within the confines of a traditional scientific paper. It's a perfect illustration of what we're shooting for with the humanities AoC."

UCSF piloted the AoC program in 2003-04 with a full launch in all six areas expected to roll out during the coming year. So far the student response has been enthusiastic, and the first "AoC Bazaar" in April featuring student project posters and presentations drew an enthusiastic audience. As the program continues to evolve, Loeser envisions creating communities of faculty and students from divergent careers engaged in intellectual inquiry in AoC themes that will serve to "inspire, educate, and energize" the next generation of physicians.

"The AoC program validates that being a physician isn't your whole identity," says Loeser. "This is so important for students as individuals, and also for society as a whole."

This overview is the first in a series about the Areas of Concentration program.


Source: Lisa Zimmerman