Utility of the AAMC's Graduation Questionnaire to study behavioral and social sciences domains in undergraduate medical education.

The Institute of Medicine (IOM) released a report in 2004 summarizing how undergraduate medical school curricula should be enhanced to address critical health issues faced in the United States.1 One major finding was that approximately half of all causes of mortality in the United States are linked to social and behavioral factors, such as smoking, diet, alcohol, sedentary lifestyle, and accidents.2 It is generally recognized that biomedical research cannot address these issues alone. Rather, it will likely take the work of multidisciplinary collaborations to study the interactions between biology and behavior. Less than 5% of the more than $2 trillion spent on health care annually in the United States is devoted to reducing behavioral and social risk factors.3,4 The IOM also found that the curriculum in most U.S. medical schools does not provide sufficient training about these behavioral and social risk factors, despite the fact that significant mortality and morbidity reductions could be realized.1 In response to the IOM report, the National Institutes of Health (NIH) awarded grants to nine medical schools* to develop, pilot, and disseminate social and behavioral sciences (SBS)-modified curricula across the six domains identified by the IOM: (1) Mind-Body Interactions in Health and Disease, (2) Patient Behavior, (3) Physician Role and Behavior, (4) Physician-Patient Interactions, (5) Social and Cultural Issues in Health Care, and (6) Health Policy and Economics. The collaborations among the schools and the curricular innovations that emerged are described in detail elsewhere.5 Briefly, the projects vary with respect to the focus of the interventions, but all nine medical schools are incorporating SBS content throughout all four years of medical school in both the preclinical and clinical curricula. Of note is that the IOM recommended revised curriculum integration rather than the development of new courses. Examples of the curricular changes implemented include incorporation of biopsychosocial approaches that stress holistic, culturally sensitive, and interactive approaches to patient care, development of student empathy, communication, and teamwork skills with a particular focus on patient safety,6 – 8 and promotion of lifelong habits of self-directed learning and self-care. Approximately 6,100 medical students will be affected by curricular innovations implemented during the five years of the collaborative.5 Individual institutions in the collaborative are using a variety of evaluative methods (e.g., curricular mapping, logic modeling, qualitative and quantitative assessments) to evaluate the effectiveness of these curricular innovations, and we believe that the results from these evaluations will help promote the dissemination of effective components to other medical schools. To optimize evaluative interactions within the collaborative, one school, Oregon Health and Science University (OHSU), submitted an administrative supplement to create an evaluation core. This core, overseen by one of us (P.A.C.), would establish a database of various outcomes from the nine schools, increase sample size from one school to nine, and allow for more robust analyses. In the present report, we describe how we explored the utility of using existing multiinstitutional data from the Association of American Medical Colleges (AAMC) Graduation Questionnaire (GQ) to detect changes in students’ scores related to curricular innovations over time. The GQ is a Web-based survey administered annually to all students graduating from allopathic medical schools in the United States. The GQ allows the collection of information on student characteristics as well as evaluations of the medical school experience. The summary data from this survey are available to all medical schools in the United States. We hypothesized that this standardized survey instrument could inform the development of relevant elective activities, management of curricular time, improvements in confidence with clinical knowledge and skills, and attitudes toward medicine and the medical profession. We undertook a modified Delphi approach9 to come to agreement on which variables could potentially capture curricular change and whether our collaborative efforts would provide enough statistical power to do so. Although we acknowledge that the GQ was not designed for this specific purpose, if the instrument could be used in the way we hypothesize, then all medical schools in the United States might benefit from its use to assess these important areas of medical training that the IOM identifies.