We hear so often that health systems the world over should be investing more in population and public health.
If we want to prevent illness and suffering, if we want a fairer distribution of health, and if we want a better bang for our buck, then public health can help.
But what is the role of doctors in this brave new world?
Public health has not traditionally been seen as a particularly glamorous area, especially for medical students who so often end up being drawn to the super specialty end of clinical medicine.
So what are medical schools doing to ensure graduates are well-equipped in public health? And what skills do they need?
Associate Professor Mavis Duncanson, head of the Population and Public Health Domain at Notre Dame University’s Sydney medical school, is keen to hear what other medical schools are doing in this area.
What are Australian and NZ medical schools doing in public health?
Mavis Duncanson writes:
We are reviewing how we teach medical students about population and public health (PPH), and would like to hear from other medical schools in Australia and New Zealand about their approaches.
We would like to hear about the general structure of their courses and in particular:
- Perceived PPH priorities for medical students (and doctors) in Australia/ Aotearoa NZ
- Broad topics covered within PPH in the medical degree
- Expected learning outcomes/ competencies before graduation
- Mode of delivery of the PPH learning (lectures/ small groups/ hands on)
- Assessment methods in PPH
- Any practical components or assignments that students are required to complete.
At the NDU School of Medicine, Sydney, the PPH Domain comprises 10% of the curriculum in each of the four years of the MBBS course.
In the first two years, students have a one hour PPH tutorial every two weeks in groups of eight with a clinical tutor; in their third year there are 15 PPH tutorials delivered at Clinical School sites and a weekly structured journal club.
Students are encouraged to apply the “eight questions” previously described by Trevena et al (2005) to their paper-based and real-life cases.
Assessment is by written examination (short answer and MCQ) and in third year a continuous mark is given by the Head of Clinical School to reflect participation in Journal Club.
In the fourth and final year the PPH assessment is derived from a PPH project and participation in the weekly structured journal club.
In reviewing the PPH component of the MBBS curriculum, the Committee identified the following major topic areas, using the Australasian Faculty of Public Health Medicine Advanced Training Curriculum as a guide:
- General public health
- Reviewing the literature and epidemiology
- Equity and social determinants
- Health care and health policy
- Health protection and health promotion
- Chronic disease and injury
- Integrating public health into clinical practice.
We welcome suggestions from other medical schools about specific learning tasks to help students develop the knowledge and skills required to meet learning outcomes in these or other relevant areas of population and public health.
We are also interested to pursue further collaborative work to promote consistency across Australasia and New Zealand.
Further reading on these issues
• Population health integration within a medical curriculum: an eight-part toolkit
• An enhancement strategy for integration of population health into medical school education: employing the framework developed by the Healthy People Curriculum Task Force
• Integrating collaborative population health projects into a medical student curriculum at Stanford.
• Public health in the graduate medical curriculum at Flinders University
• Public health has no place in undergraduate medical education
• Details of Canadian conference workshop re online resource re public health content for medical curricula
• Steps to improve the teaching of public health to undergraduate medical students in Canada
• Links to Canadian medical faculties public health initiatives
• An innovative approach for training medical students for the real world of public health
• Relevant extract from the WHO’s Commission on the Social Determinants of Health
• Public health in the undergraduate medical curriculum–can we achieve integration?
• Teaching public health to medical students in the United Kingdom–are the General Medical Council’s recommendations being implemented?
• Global health competencies and approaches in medical education: a literature review
Other perspectives on what matters in the medical curriculum…
• A surgeon’s perspective: more anatomy, less dumbing down
• And what about health policy?
• And what about ethics and law?
• From the archives (1923), the more things change… The revision of the medical curriculum
Update, 20 July
The Institute of Medicine in the US responded via Twitter. The link given is to the Institute’s latest reports, including ones on oral health, health literacy and pain management.
I don’t know about medical students but I know nursing students are now studying primary health care models of care from first year in nursing faculties and students are encouraged as undergrads to experience primary health care models in action in their clinical placements, if placments can be found.
Whilst my information comes from Physicians in training, it also relates to medical students as there is good evidence that if medical students do not have a good understanding of the influences of pharmaceutical industry marketing and promotion provided to them in their medical training they will find it difficult later on to change their minds. There is also good evidence too that information provided to medical students on many aspect of the consequences of interactions with the pharmaceutical industry are not done well.
We have recently completed a survey of awareness of the the Royal Australasian College of Physicians (RACP) “Guidelines for Ethical Interactions with Industry” among physicians and physicians in training and we found that physicians in training were less likely to be aware of these guidelines and also more likely to take part in pharmaceutical industry activities that the guidelines and Medicines Australia Code of Conduct suggest advise against.