Table 1.

Major themes identified by focus group participants regarding the BSS curriculum

IOM domain	Sense of preparation
Health policy and economics	Strength: Good exposure to alternative models of health care (e.g. VA, medical home, rural practice, free clinics) Weakness: Scant sense of prices of procedures and products, no knowledge of billing, no acknowledgement of the personal debt burden students carry and what healthcare reform and specialty mean to individuals
Patient behaviour	Strength: Motivational interviewing class, some good modelling Weakness: Inadequate instruction on how to deal with modification of patient behaviour in delicate or challenging situations such as sexually transmitted diseases and irritable bowel syndrome. Inadequate preparation for conflict resolution with no instruction available in the clinical years
Physician-patient interaction	Strength: Didactic training in the first two years helped students to value a patient-centred model of care. Palliative care and psychiatric rotations offer more consistent patient-centred care, debriefing and self-care focus Weakness: Clinical modelling of a patient-centred model of care was inconsistent at best
Physician role and behaviour	Strength: Professionalism very well covered in the first two years of classes Weakness: Professionalism inconsistently mentored in the clinical setting, no emphasis on self-reflection and development of emotional intelligence, teamwork is mostly titular and students feel disenfranchised through much of the process
Mind-body interaction	Strength: Exposed to didactic evidence for mind-body interaction Weakness: Presented in a way that sets it in direct conflict with the biomedical paradigm and thus very difficult to understand or incorporate into clinical practice; clinical mentors largely sceptical of mind-body interaction (with notable exceptions)
Social and cultural issues in health care	Strength: A lot of didactic exposure. Free clinics presented real-life experience with cultural differences Weakness: The principles of cultural sensitivity are not internalised and not modelled or reaffirmed in the clinical setting. Books, essays and reports are an inadequate way to internalise cultural sensitivity
Emergent themes Mentor modelling third and fourth years	Strength: Some mentoring, particularly in family medicine, palliative medicine and psychiatry BSS centred Weakness: Most mentors do not apply the principals of BSS to clinical practice
Timing and orchestration of BSS courses	Strength: Solid exposure to BSS in first two years of curriculum Weakness: No recursiveness to BSS curriculum once students are in third and fourth year. BSS curriculum taught as something outside standard medical curriculum
Dissonance between BSS culture and biomedical culture	Strength: Students recognise the disparity between the values of BSS and dominant biomedical values Weakness: It is hard for students to practise patient-centred culturally sensitive care in the extant biomedical culture