UC San Diego

Drawing upon 90 in-depth interviews with medical educators and students from humanities, social sciences, and biomedical backgrounds at 37 medical schools, curricular and institutional data from an exhaustive set of all 137 MD-granting institutions, and observational data from national pedagogical meetings on medical education, I present findings on four different strategies that educators employ for incorporating the humanities and social sciences. I call the first strategy of incorporation the foundational curriculum, where educators require all medical students to learn how the critical and interpretive concepts, theories, and methods that the humanities and social sciences offer are fundamental for their future clinical practice. In contrast, the second strategy of incorporation is what I call the therapeutic curriculum, where educators give students the option of taking a humanities elective or extracurricular enrichment activity, while billing the humanities as a stress-reducing mechanism. The third curricular practice is the symbolic curriculum, where educators only integrate the social sciences in a bare minimum manner, like a week-long intersession on positivistic social science facts or exercises in the clinical skills course, the Practice of Medicine. The final strategy of incorporation emerges from the Practice of Medicine course, which I call the conscripted curriculum, and entails educators relying on students to teach each other the social science content by sharing their personal experiences as members of particular social groups. These strategies of incorporation are enabled and constrained by field-wide pressures facing the medical profession: the problem of health and health care disparities, the crisis of student burnout, the need to respect the individual patient, the appeal of clinical relevance, and the social pressure to emulate other institutions. While most schools are heavily influenced by these cultural structures of opportunity and constraint, the few schools that resist these field-wide epistemic pressures have built up the organizational resources—or what I call the intellectual infrastructure—to sustain a foundational curricular practice. By having the funding, embracing the prestige, and hiring personnel adept at working across disciplines, these schools cultivate students who envision the humanities and social sciences as critical for their observational and interpretive decision-making processes as future physicians.