To the Editor:  

There has been an ongoing effort by both the American Osteopathic Association (AOA) and the American Medical Association (AMA) to fulfill their obligations to society by preparing medical students to act professionally. Professionalism has been identified as a missing component in the unspoken contract among physician, patient, and the public. ¹ The challenge facing medical education, then, is to identify methods that better address physician professionalism in the curriculum. 

In 1999, Swick et al ¹ reported that the majority of medical schools surveyed had little formal instruction related to professionalism and no explicit method for assessing professional behavior. Most undergraduate medical education curricula are based on structured cognitive objectives. Addressing developmental behavior issues in such a curricular model has been a major challenge to medical educators, who often find it difficult to provide students with behavioral training experiences that allow them to develop their skills as professionals in a traditional classroom setting. 

The long-accepted Flexnerian paradigm of medicine, which assumes that physicians can be adequately trained by the development of only cognitive skills, is increasingly being recognized as antiquated. ^2,3 Experimental training of physicians, including role-playing, standardized patient experiences, and case study exercises, are beginning to improve skill development in professional behavior. ⁴ The Kirksville (Mo) College of Osteopathic Medicine (KCOM) of A.T. Still University of Health Sciences has chosen an additional mechanism to address this need—the development of a mentorship program called the Societies. 

In 2002, KCOM began its mentorship activities by developing the Societies as a cocurricular program consisting of multiple, randomly selected small groups. ⁵ This program was designed to address many of the problems and challenges revealed by mentorship programs at other schools of medicine. By selecting highly respected faculty and staff members as mentors—in particular physicians—KCOM created the Societies as an avenue of support in which students can seek refuge during their challenging medical school years. The Societies also give students expanded opportunities to receive advice and accept constructive criticism in their professional and psychosocial development. 

The KCOM students are assigned to the individual Societies randomly when they first arrive on campus during freshman orientation. Many of the Societies have activities during this time, such as discussions on health policy, medical ethics, professionalism, residencies, peer reviews, and development of student portfolios, as well as social events. When the next class arrives the following year, the new students are also randomly assigned to the Societies. Thus, the Societies provide not only the opportunity for faculty and staff in the clinical and basic sciences to serve as mentors, they also give upperclassmen the opportunities to mentor their fellow students. 

The KCOM program is designed so that students remain in the same Society throughout their undergraduate and postgraduate years, and even as alumni. We expect that the program will also promote increased alumni involvement in the development of the undergraduate medical curriculum, as well as with the institution as a whole. 

Ten Societies were created in the fall of 2002, each consisting of approximately 15 students from the freshman class. In 2003, the membership in each society increased from 30 to 35 students. In the fall of 2005, we added an additional six Societies. With the addition of these new Societies, the active Societies on campus each consist of only about 20 to 30 members, because, after the second year, the students are off campus on clinical rotations. When the students return to campus for various activities, such as the third-year performance assessment testing or graduation ceremonies, they may choose to meet with their Societies again. In addition, third- and fourth-year students can easily remain connected with their Societies via e-mail or other electronic forms of communication, even when they are off campus. 

With the Societies serving as a “new classroom,” the KCOM program has a sound educational pedagogy to address various professional-development issues and many other components of medical education. The program also gives mentors the opportunity to identify improper professional behavior and resolve any issues before there is an ethical or legal obligation to confront trainees with more formal mechanisms, such as promotions boards or disciplinary actions on or off campus. 

The administration and faculty of KCOM anticipate that the Societies will help preserve the outstanding academic record of KCOM while assisting students in the development of the psychosocial skills needed to become leaders in the osteopathic medical profession. We plan to incorporate the program into KCOM's curriculum in the future.