Teaching public health to medical students in the United Kingdom--are the General Medical Council's recommendations being implemented?

Enhancing an International Perspective in Public Health Teaching through Formalized University Partnerships

Teaching in the field of public health needs to employ a global perspective to account for the fact that public health problems and solutions have global determinants and implications as well. International university partnerships can promote such a perspective through the strengthening of cooperation, exchange, and communication between academic institutions across national boundaries. As an example for such an academic network in the field of public health, we introduce the International Public Health Partnership-a collaboration between a university in Germany and universities in India, Turkey, and Nigeria. Formed in 2005, it facilitated the exchange of information, fostered discussion about the transferability of public health concepts, contributed to the structural development of the universities involved, and promoted an intercultural dialog through a combination of local and distance learning activities. Although well accepted by students and staff, different obstacles were encountered; these included limited external funding, scarce own financial, time and personnel resources, and diverging regulations and structures of degree programs at the partnership sites. In the present article, we share several lessons that we learned during our joint collaboration and provide recommendations for other universities that are involved in partnerships with institutions of higher education or are interested to initiate such collaborations.

Teaching public health in UK medical schools: 'things have improved: teaching no longer feels like an expensive hobby'

BACKGROUND

Recent policy initiatives in the UK have underlined the importance of public health education for healthcare professionals. We aimed to describe teaching inputs to medical undergraduate curricula, to identify perceived challenges in the delivery of public health teaching and make recommendations that may overcome them.

METHODS

We undertook a cross-sectional survey; questionnaires were sent electronically to 32 teaching leads in academic departments of public health in UK medical schools and followed up by telephone interviews.

RESULTS

We obtained a 75% response rate; 13 public health teaching leads were interviewed. We found much variability between schools in teaching methods, curricular content and resources used. Concerns regarding the long-term sustainability of teaching focus on: staffing levels and availability, funding and the prioritization of research over teaching. We give examples of integration of public health with clinical teaching, innovative projects in public health and ways of enabling students to witness public health in action.

CONCLUSIONS

There is a need to increase the supply of well-trained and motivated teachers and combine the best traditional teaching methods with more innovative approaches. Suggestions are made as to how undergraduate public health teaching can be strengthened.

Formal public health education and career outcomes of medical school graduates

BACKGROUND

Few data are available evaluating the associations of formal public health education with long-term career choice and professional outcomes among medical school graduates. The objective of this study was to determine if formal public health education via completion of a masters of public health (MPH) degree among US medical school graduates was associated with early and long-term career choice, professional satisfaction, or research productivity.

METHODS

We conducted a retrospective cohort study in 1108 physicians (17.1% completed a MPH degree) who had 10-20 years of follow-up post medical school graduation. Multivariable logistic regression analyses were conducted.

RESULTS

Compared to their counterparts with no MPH, medical school graduates with a MPH were more likely to have completed a generalist primary care residency only [relative risk (RR) 1.79, 95% confidence interval (CI) 1.35-2.29], obtain employment in an academic institution (RR 1.81; 95% CI 1.33-2.37) or government agency (RR 3.26; 95% CI 1.89-5.38), and practice public health (RR 39.84; 95% CI 12.13-107.38) or primary care (RR 1.59; 95% CI 1.18-2.05). Furthermore, medical school graduates with a MPH were more likely to conduct public health research (RR 8.79; 95% CI: 5.20-13.82), receive NIH or other federal funding (RR 3.11, 95% CI 1.74-5.33), have four or more peer-reviewed publications (RR 2.07; 95% CI 1.56-2.60), and have five or more scientific presentations (RR 2.31, 95% CI 1.70-2.98).

CONCLUSION

Formal public health education via a MPH was associated with career choice and professional outcomes among physicians.

Public health education in Ege University Medical Faculty: developing a community-oriented model

BACKGROUND

Ege University Medical Faculty (EUMF) introduced a community-oriented curriculum in 2001.

AIMS

To evaluate the new public health education program in EUMF curriculum.

METHOD

The study adopted triangulated methods. Quantitatively, a comparison of the students who were exposed to a community-oriented curriculum (Year 4 in 2007) was made with the students who were exposed to the traditional curriculum (Year 4 in 2005) in terms of their assessment of their achievement of our learning objectives. A total of 255 students in 2005 (80.7%) and 243 students in 2007 (81.5%) were surveyed using a questionnaire. Qualitatively, five focus group- and five individual interviews were performed with the 2007 cohort.

RESULTS

Except the one related to teamwork (p > 0.05) all learning objectives yielded significantly higher scores in the 2007 cohort than in the 2005 cohort (p < 0.05). The qualitative analysis supported the achievement of objectives in the 2007 cohort. The students appreciated the relevance of public health education with clinical subjects and interactive methods, but criticized didactic lectures and written assignments.

CONCLUSIONS

A community-oriented approach is more effective in achieving a holistic approach to health problems. Improving community-based activities and assessment methods would be more successful in integrating population health into medical training.

Participatory identification of learning objectives in eight medical schools in Vietnam

The advantages of outcome-based education for medical students have been recognised for several years and in several countries. Until recently in Vietnam, as in many countries, the curriculum for medical doctors was a broad framework that individual teachers filled in according to their own ideas and experience. During the past few years, the main eight medical schools in Vietnam have worked together to develop detailed learning objectives within the framework from the Ministries of Health and of Education and Training. The process was planned in an innovative and participatory way that involved more than one thousand teachers and other experts and resulted in a book listing the expected outcome in the form of the knowledge, attitudes and skills expected of a medical doctor graduating from any medical school in Vietnam. The process of identifying the objectives was followed by revision of the curriculum to be more community-oriented and to include more focus on teaching of skills, and by production of teaching, learning and assessment materials to fit the new curriculum. The process is described as an example of a comprehensive and bottom-up approach to curriculum development that could provide an example for other disciplines and schools in Vietnam or elsewhere.

Undergraduate public health education in UK medical schools - struggling to deliver

INTRODUCTION

Recent policy initiatives in the United Kingdom (UK) have underlined the importance of public health education for health care professionals. We aimed to describe teaching inputs to medical undergraduate curricula, to identify perceived challenges in the delivery of public health teaching and strategies that may overcome them.

METHODS

We undertook a cross-sectional survey; questionnaires were sent electronically to 28 teaching leads in academic departments of public health in UK medical schools. These were followed-up by telephone interviews.

RESULTS

We obtained a 75% response rate. We found a great deal of variability between schools in teaching methods, curricular content and resources used. In 76% of medical schools, public health and clinical teaching were integrated to some extent. The proportion of teaching delivered as lectures is decreasing and that of self-directed learning is increasing. A range of methods is used to assess students and in 33% of schools these assessments contributed to final Medical School marks. More than half the medical schools had difficulty finding teachers and staffing levels had deteriorated in 55% of schools. Many interviewees felt that their contributions were undervalued. Few were aware of the level of funding received to support teaching.

DISCUSSION

There is a need to increase the supply of well-trained and motivated teachers and combine the best traditional teaching methods with more innovative, problem-based approaches. Faculties need to share 'learning about what works' and teaching resources across medical schools as well as addressing a culture of neglect of teaching in some departments. Suggestions are made as to how undergraduate public health teaching can be strengthened.

Reforming medical education to enhance the management of chronic disease

Medical education must adapt to change if it is to remain relevant to the needs of doctors, patients and society. Ideally, it should anticipate and lead change. Undergraduate education remains rooted in urban medical schools where the focus is on acute disease, while most graduates spend their working lives in the community, dealing mainly with chronic health problems. Medical graduates need to acquire specific knowledge, skills and attitudes if they are to effectively manage people with chronic disease. Strategies that create a better balance between education in acute and chronic disease are being developed. These include a transfer of clinical teaching to community and nursing home settings and the development of interdisciplinary teaching.

Helping tomorrow's doctors to gain a population health perspective - good news for community stakeholders

INTRODUCTION

The modernising agenda of the NHS and recommendations of professional bodies demand that all doctors achieve a basic understanding of a population health perspective. The principle of integrated learning and the logistics of provision make it inappropriate for such learning to be delivered solely by public health specialists, and community-based learning has been promoted as the best setting in which to assist this objective. However, there is little evidence from practice as to whether non-specialist staff are willing or able to play a role in orienting tomorrow's doctors to the needs of communities.

METHODS

Semi-structured interviews, questionnaires and focus groups iterated the opinion of key stakeholders on their preferred contributions to community-oriented undergraduate medical education. Framework analysis was used to elicit key outcomes and process factors.

RESULTS

There was consensus that community-based learning should be a core element of the medical curriculum as it can demonstrate the socioenvironmental context of care and the doctor's role in interagency working and preventive care. Effective academic/NHS partnerships were called for, with higher education leading the agenda on aims and objectives, creating collaborative structures, and reallocating resources to support new learning. Community-based stakeholders would offer the translation of theory into practice by demonstrating clinical and social diversity, models of teamworking, and a context for the application of prior learning. They also promoted recurrent contact with communities, and suggested an enhanced role in mentoring students through longer term relationships.

CONCLUSION

Community-based personnel and NHS users are an under-used resource for medical education. Their proposed contributions strongly accord with the agenda for a population health perspective in basic training. Curriculum planners need to make long-term partnerships with community-based agencies, rather than using them as an intermittent provider of limited learning sessions with narrowly defined objectives.

Self-directed learning in population health. a clinically relevant approach for medical students

BACKGROUND

In this article, we describe the education model used to integrate population health learning into a new 4-year medical program at the University of Sydney.

METHOD

Our two-pronged approach aims to prepare third-year students to integrate population health thinking into their day-to-day clinical reasoning and to equip them with skills to investigate specific population health topics. We provide an example of a student-led, small-group session on health issues for disadvantaged populations, along with an outline of our assessment and evaluation methods. This innovative course illustrates one approach to the challenge of motivating students to bridge the gap between their interest in the medical care of individual patients and the healthcare needs of whole populations.

RESULTS/CONCLUSIONS

Students performed adequately in the assessments required for progression to the next year of the program. Students rated the case-based exercises; self-directed learning; on-line and library resources; tutor facilitation; and student-led, small-group sessions as effective methods for learning.

Use of a journal club and letter-writing exercise to teach critical appraisal to medical undergraduates

INTRODUCTION

There is growing interest in methods of teaching critical appraisal skills at undergraduate and postgraduate levels. We describe an approach using a journal club and subsequent letter writing to teach critical appraisal and writing skills to medical undergraduates.

METHODS

The exercise occurs during a 3-week public health medicine attachment in the third year of the undergraduate curriculum. Students work in small groups to appraise a recently published research paper, present their findings to their peers in a journal club, and draft a letter to the journal editor. Evaluation took place through: informal and formal feedback from students; number of letters written, submitted and published, and a comparison of marks obtained by students submitting a literature review assignment with and without critical appraisal teaching during the public health attachment.

RESULTS

Feedback from students was overwhelmingly positive. In the first 3(1/2) years, 26 letters have been published or accepted for publication, and 58 letters published on the Internet. There were no significant differences in overall marks or marks for the critical appraisal component of the literature review assignments between the two student groups.

DISCUSSION

We believe our approach is an innovative and enjoyable method for teaching critical appraisal and writing skills to medical students. Lack of difference in marks in the literature review between the student groups may reflect its insensitivity as an outcome measure, contamination by other critical appraisal teaching, or true ineffectiveness.

Public health in the undergraduate medical curriculum--can we achieve integration?

Public health is widely regarded by medical students as peripheral or even irrelevant to the acquisition of clinical knowledge and skills. This paper attempts to set out some of the reasons for this, to encourage innovative approaches to integrating public health with clinical teaching and to offer a theoretical framework of integrated public health education for curriculum development and evaluation. The points of convergence between public health and clinical practice should not be regarded as self-evident. A practical demonstration of the application of public health principles to clinical problem solving may be the most effective means of overcoming resistance. Almost anywhere that clinical services are provided is suitable for this purpose. Community clinics, health centres or general practices have obvious appeal but acute hospitals have important advantages arising from students' preoccupation with clinical medicine. The main aim of integrated public health teaching is to facilitate the students' acquisition of knowledge, skills and attitudes that promote the effective application of public health approaches to clinical practice. The interrelationships between clinical practice and public health may be represented in the form of a grid. The vertical headings are the clinical skills that relate to the different stages of the natural history of disease -- from the pre-disease state through diagnosis, treatment and follow up. The horizontal headings describe four key public health dimensions: epidemiology, behaviour/lifestyle, environment and health policy. The text in the boxes suggests appropriate topics for discussion. The grid is also potentially useful for course documentation and content evaluation.