Essentials of the Profession: Evidence, Ethics, Policy, and Social Medicine

Required for first year medical students at HMS.

Overview Essentials of the Profession brings together the social and population science relevant to the practice of medicine. It covers and integrates key concepts and methods of clinical epidemiology, population health, health care policy, social medicine, medical ethics and professionalism.  The course is taught in two components, the first in the January block of Year 1 and the second in a month after the Principal Clinical Experience. 

Relationship to other new courses: The faculty of Essentials of the Profession and the Practice of Medicine course have worked together closely on how best to teach material that is relevant to both courses.  EoP will draw from students’ encounters with patients and their clinical experiences during POM. Selected topics from EoP will also be woven throughout the four-year curriculum, including Introduction to the Profession, the Transition to the Principal Clinical Experience (PCE), the PCE, and the Capstone Course.

Major topics to be covered during EoP (Year 1):

Clinical Epidemiology and Population Health: continuum of individual patient care and population health approaches; study design; critical reading; introduction to inference and biostatistics; diagnostic testing and clinical decisions (sensitivity, specificity, etc.); summarizing and integrating evidence; introduction to paradigmatic population health issues/interventions; and translation of evidence-based medicine to clinical care.

Health Policy: key characteristics of the U.S. health care system and recent reforms; private insurance; Medicare and Medicaid; payment of health care providers; measurement of quality of care; improving quality; how other countries organize and finance their health care systems; and health care spending growth and efforts to constrain it.

Social Medicine: applying the perspectives of social science to understand the role of medicine, the challenges that medicine faces, and possible solutions; introduction to the social, economic, and political forces that affect both the burden of disease and the ability of health care to improve patients’ lives; health care disparities and social determinants of disease; how and why the burden of disease changes over time; the meaning of efficacy, how doctors assess it, and an introduction to the limits of “evidence based medicine”; responsibility for disease; an introduction to the social factors influencing health care; and examples of health care providers who work both within and outside the traditional clinical setting to advocate for their patients, improve access to health care, address the social determinants of health, and alleviate disparities.

Medical Ethics and Professionalism: role of the physician and the moral framework of modern health care practice; deciding for others (e.g., advanced directives); introduction to ethical issues at the beginning and end of life; overview of futility; introduction to research ethics; reproductive ethics and genetic testing; and introduction to ethics of bedside rationing.

Likely topics for EoP II (Year 3/4):

Clinical Epidemiology and Population Health: interpreting medical evidence; physicians and public health emergencies; data to support patient safety and quality; and interface of clinical practice and public health.

Health Policy: malpractice policy, long-term care policy; mental health policy; pharmaceutical and device policy and regulation; and end of life care policy.

Social Medicine: caring for complex patients; delivering high value care; reverse innovation (learning from global perspectives to improve health care in the U.S.); race and other “isms”; poverty’s impact on child health and well-being; applying social medicine to global health.

Medical Ethics and Professionalism: ethics of conflict of interest and commercialization; ethical issues in disclosure and apology after errors and adverse events.

HT934. Introduction to Global Medicine: Bioscience, Technologies, Disparities, Strategies

Required for first year Health Sciences and Technology students.
This course explores basic themes in social medicine via specific examination of issues in global medicine. The course takes as its challenge to understand new paradigms for global health that focus on providing complex medical services to treat complex health conditions (e.g. multi-drug resistant TB, HIV/AIDS, and mental health problems) in low resource settings. Special attention is given to the development of new technologies or adapting existing technologies in ways that enable new solutions to global health problems, as well as overcoming barriers to translation of medical technologies for use in settings of great need. The course addresses classic themes of social inequalities and health disparities, as well as such issues as patenting and the development and delivery of pharmaceuticals or other biotechnologies in international context. The course will include presentations by Harvard faculty involved in global health, basic or clinical research with a global reach, or medical humanitarian activities, as well as class discussion.

ME715.J. Clinical Topics in Global Health

Clinical Topics in Global Health introduces students to the evidence-based knowledge and skills they will need to be effective clinicians in resource-limited settings. Ten evening sessions, led by Harvard faculty who practice clinically in developing countries in Africa, orient students to the most important global health problems, explore each of these conditions with particular focus on clinical practice, and provide practical guidance for students interested in pursuing further training or careers in global health. Topics include the leading causes of morbidity and mortality in developing countries, such as malnutrition, malaria, diarrheal illness, perinatal disease, HIV/AIDS, TB and chronic non-communicable diseases. Teaching methods are tailored to each clinical topic and include lectures, practical skills sessions, case discussions, key readings, and invited guest speakers.