George Washington University Medical Center
The behavioral science curriculum at GWUMC involves 24 problem based learning cases each comprised
of about 20 pages of teaching material. Early on, the departments of Psychiatry, Pediatrics and Family
Medicine collaborated on determining the behavioral science objectives and topics they thought
important to cover. These topics were then assigned to different faculty who prepared relevant cases,
each case including both biomedical and behavioral science issues, the latter including biostatistics,
ethics and epidemiology. Students were given scenarios and questions to answer which they would
research. They would then present their findings to the class, get more information about the same
case, raise more questions, and have another session of presentations (3 sessions per case in the first
year). The initial list of behavioral science topics included the sick role, Eriksonian human development,
cognitive development, dealing with cultural differences between doctor and patient, the role of family
in care, advising habit change. (See the attached examples of power point presentations of clinical
scenarios, and accompanying student leader’s and faculty Tutors’ Guides for conducting
discussions/presentations (Sean O’Malley ppt/ Sean O’Malley Student Leader Guide).
Child development is taught by including child cases in the syllabus and case discussions (e.g., a baby
with failure to thrive because of separation anxiety after her caregiver suffers a broken hip), a toddler
with sickle cell disease (Erikson and doctor patient variance, role of family history, public financing of
care), a school aged child with asthma (Piaget, family conflict), a teenager with new onset diabetes
(privacy, confidentiality, Erikson). Adult development is discussed in the context of cases of a man with
new onset angina (Erikson again, motivating behavior change), a middle aged woman with a stroke (mid
life development, family involvement), and an older adult with a broken hip (Erikson again, patients use
of internet).
Psychopathology is illustrated in a problem based learning case of a physician with depression and
suicidal ideation (see James Carter ppt/James Carter Tutors’ Guide). For substance abuse we created a
“time lapse” case to illustrate differing pathways to either dependence or remission and the role of
professional counseling in substance abuse (see Michael Phillips ppt/ Michael Phillips Student Leader
Guide).
In the second year, students are presented with a case of an elderly Asian immigrant with TB
(epidemiology, Asian cultural issues, and community care), a Hispanic man with an ulcer, an older
teenager who finds out she is pregnant, an opiate addict who needs pain medication, and a woman with
end stage COPD (end of life care and Medicare).
In the second semester of the second year, the cases become progressively less focused on behavioral
etiological issues and more on behavioral interviewing and intervention skills, taught in small groups as
part of our Practice of Medicine course. In either of the first two years students may take electives in
Medical Humanities and History of Medicine. These courses encourage further reflection on the role of
behavioral factors in health care.
It has been proposed that students also research disease specific behavioral medicine issues in the
second year, e.g., the role of personality in heart disease, the role of psychological issues in dialysis
patients and families of patients, etc, but this plan has yet to be implemented.
In addition to the problem based learning cases, students have a psychopathology course. This was
moved from the second year to the first year to provide an earlier clinical exposure to psychiatric
assessment, interviews with actual patients with anxiety, depression, chronic mental illness, and some
lectures on the neurology of behavior. We also recently added four behavioral neuroscience lectures to
the introductory neuroscience course and hope to add more. (A concise psychopathology syllabus and
clerkship manual can be obtained from Shaira Morales smorales@mfa.gwu.edu).
Case based instruction has been effective, but to maximize its effectiveness, we find that behavioral
science is best taught by behavioral specialists, utilizing the tutor guides provided, to maximize the
likelihood that students understand and absorb the underlying logic of the behavioral science principles
presented. Also, although they learn a great deal from doing their own research and presentations, it is
less clear that they benefit much from other students’ presentations. Ongoing procedures for evaluating
students' mastery of behavioral sciences material are essential to being able to determine the
effectiveness of methods such as these.
For further information on the GWU behavioral science curriculum contact Dr. Julia Frank
(jfrank@mfa.gwu.edu)
Julia Frank, M.D.
Professor of Psychiatry
Director, Medical Student Education in Psychiatry
George Washington University Medical Center
Washington, D.C.