Prevention education and evaluation in U.S. medical schools: a status report

Knowledge, Attitude, Practice, and Perceived Barriers Regarding Colorectal Cancer Screening Practices Among Healthcare Practitioners: A Systematic Review

The recommendations of medical professionals play a significant role in colorectal cancer (CRC) screening. This study aims to systematically review knowledge, attitude, practice, and perceived barriers regarding CRC screening practices among healthcare practitioners (HCPs). From January 2023 to December 2023, a comprehensive literature search was conducted using online databases, including Web of Science, PubMed, Scopus, and Research Gate, by using the following keywords in combination: "knowledge," "attitude," "practice," "perceived barriers," "colorectal cancer," and "health practitioners." The researchers screened and examined the retrieved literature. A total of 21 studies were considered relevant for the current review. Among these studies, eight assessed the level of knowledge, attitude, practices, and perceived barriers toward CRC screening among various health practitioners. Three studies assessed knowledge and attitudes toward CRC screening among health practitioners. The remaining ten studies assessed awareness, perceived barriers, or only knowledge of CRC screening among HCPs. In addition, all the included studies employed a cross-sectional design. The review shows that many healthcare providers need more fundamental knowledge of CRC screening. Healthcare procedures must be improved to enhance the knowledge, attitudes, and practices of healthcare professionals regarding CRC screening and their understanding of the associated barriers.

Final-year medical student mental wellness during preparation for the examination for specialty in Turkey: a cross-sectional survey study

BACKGROUND

In Turkey, most final-year medical students prepare for the Examination for Specialty in Medicine in a high-stress environment. To the best of our knowledge, this is the first study on final-year medical student general psychological distress during preparation for the Examination for Specialty in Turkey. We aim to evaluate psychological distress and understand the variables associated with depression, anxiety, and stress levels among final-year medical students preparing for the Examination for Specialty.

METHODS

A self-reporting, anonymous, cross-sectional survey with 21 items consisting of demographic variables, custom variables directed for this study, and the DASS-21 was utilized. Survey results were expounded based on univariate analysis and multivariate linear regression analysis.

RESULTS

Our study revealed four variables associated with impaired mental wellness among final-year medical students during preparation for the examination for Specialty: attendance to preparatory courses, duration of preparation, consideration of quitting studying, and psychiatric drug usage/ongoing psychotherapy.

DISCUSSION

Considering that physician mental wellness is one of the most crucial determinants of healthcare quality, impaired mental wellness among future physicians is an obstacle to a well-functioning healthcare system. Our study targets researchers and authorities, who should focus on medical student mental wellness, and medical students themselves.

Awareness of the European Code Against Cancer of Family Medicine Residents and Nursing and Medicine Students in Spain

Health professionals and students in training are key for early diagnosis of cancer. The objective of this study was to evaluate the awareness of Family Medicine (FM) residents and Medicine and Nursing undergraduate students in Spain regarding the European Code Against Cancer (ECAC). This was a descriptive, cross-sectional, and multicenter study.

LOCATION

Teaching Units of FM of Cordoba and Ceuta and Schools of Medicine and Nursing of the Universities of Cordoba and Francisco de Vitoria of Madrid (Spain).

PARTICIPANTS

residents of FM and Medicine and Nursing undergraduate Spanish students.

INTERVENTION

self-administered questionnaire to assess the awareness about the ECAC. A total of 651 subjects participated (52.4% [95% CI 48.5-56.2] Nursing students, 34% [95% CI 30.3-37.6] Medicine students, and 13.6% [95% CI 11.0-16.3] FM residents). Of the total subjects participated, 74.8% were women. Mean age: 22.34 years (standard deviation, 4.68; range, 18-52; 95% CI, 21.98-22.70). A total of 76.8% (95% CI 73.5-80.1) declared to be unaware of the ECAC. Those referring to be aware of the ECAC mainly knew it through degree subjects (7.5% [95% CI 5.5.5-9.6]). Residents of FM (p < 0.001), older participants (p < 0.001), and those belonging to the Teaching Units (p = 0.002) showed a better awareness of the ECAC. Our findings reveal the unawareness on the ECAC in three out of four participants. The access to the advice described in the ECAC through the Medicine and Nursing Schools and FM Teaching Units is poor. The awareness of the ECAC of postgraduate residents is higher than that the awareness of the undergraduate students.

CHECK UP: A student-designed model for creating innovative patient education materials that your patients will actually use

OBJECTIVE

As appointments become more rushed, it is crucial that primary care clinicians consider new and effective ways to provide preventive health education to patients. Currently, patient education is often handouts printed from the electronic medical record system; however, these pieces of paper often do not have the desired impact. Well-established advertising methods reveal that repeated exposure is key in recall and swaying consumer decisions. The Creating Health Education for Constructive Knowledge in Underserved Populations (CHECK UP) Program is a medical student-led program that aims to improve patient recall of health information, health promoting behaviors and health outcomes by applying modified advertising concepts to the delivery of health education.

METHODS

Patients were given large magnets containing health education information. These patients were interviewed 3-4 months afterwards to assess use and effectiveness of magnets as a means to provide health education.

RESULTS

In total, 25 of the 28 patients given CHECK UP magnets agreed to participate. The majority of participants (23/25) kept the magnets and reported that they, as well as others in their households, see the magnets daily. All 23 participants recalled at least 1 health tip from 1 of the magnets.

CONCLUSIONS

The use of non-traditional materials for patient education allowed for repeated exposure and recall of health information. Consideration for modified use of evidence-based advertising and marketing strategies for the delivery of patient education may be an easy and effective way to provide information to patients outside of the clinical setting and promote health behavioral changes.

Development of Learning Objectives to Guide Enhancement of Chronic Disease Prevention and Management Curricula in Undergraduate Medical Education

Phenomenon: Chronic disease is a leading cause of death and disability in the United States. With an increase in the demand for healthcare and rising costs related to chronic care, physicians need to be better trained to address chronic disease at various stages of illness in a collaborative and cost-effective manner. Specific and measurable learning objectives are key to the design and evaluation of effective training, but there has been no consensus on chronic disease learning objectives appropriate to medical student education. Approach: Wagner's Chronic Care Model (CCM) was selected as a theoretical framework to guide development of an enhanced chronic disease prevention and management (CDPM) curriculum. Findings of a literature review of CDPM competencies, objectives, and topical statements were mapped to each of the six domains of the CCM to understand the breadth of existing learning topics within each domain. At an in-person meeting, medical educators prepared a survey for the modified Delphi approach. Attendees identified 51 possible learning objectives from the literature review mapping, rephrased the CCM domains as competencies, constructed possible CDPM learning objectives for each competency with the goal of reaching multi-institutional consensus on a limited number of CDPM learning objectives that would be feasible for institutions to use to guide enhancement of medical student curricula related to CDPM. After the meeting, the group developed a survey which included 39 learning objectives. In the study phase of the modified Delphi approach, 32 physician CDPM experts and educators completed an online survey to prioritize the top 20 objectives. The next step occurred at a CDPM interest group in-person meeting with the goal of identifying the top 10 objectives. Findings: The CCM domains were reframed as the following competencies for medical student education: patient self-care management, decision support, clinical information systems, community resources, delivery systems and teams, and health system practice and improvement. Eleven CDPM learning objectives were identified within the six competencies that were most important in developing curriculum for medical students. Insights: These learning objectives cut across education on the prevention and management of individual chronic diseases and frame chronic disease care as requiring the health system science competencies identified in the CCM. They are intended to be used in combination with traditional disease-specific pathophysiology and treatment objectives. Additional efforts are needed to identify specific curricular strategies and assessment tools for each learning objective.

Implementation of a competency-based medical education approach in public health and epidemiology training of medical students

Background

There is increasing agreement among medical educators regarding the importance of improving the integration between public health and clinical education, understanding and implementation of epidemiological methods, and the ability to critically appraise medical literature. The Sackler School of Medicine at Tel-Aviv University revised its public health and preventive medicine curriculum, during 2013–2014, according to the competency-based medical education (CBME) approach in training medical students. We describe the revised curriculum, which aimed to strengthen competencies in quantitative research methods, epidemiology, public health and preventive medicine, and health service organization and delivery.

Methods

We report the process undertaken to establish a relevant 6-year longitudinal curriculum and describe its contents, implementation, and continuous assessment and evaluation.

Results

Central competencies included: epidemiology and statistics for appraisal of the literature and implementation of research; the application of health promotion principles and health education strategies in disease prevention; the use of an evidence-based approach in clinical and public health decision making; the examination and analysis of disease trends at the population level; and knowledge of the structure of health systems and the role of the physician in these systems. Two new courses, in health promotion, and in public health, were added to the curriculum, and the courses in statistics and epidemiology were joined. Annual evaluation of each course results in continuous revisions of the syllabi as needed, while we continue to monitor the whole curriculum.

Conclusions

The described revision in a 6 year-medical school training curriculum addresses the currently identified needs in public health. Ongoing feedback from students, and re-evaluation of syllabus by courses teams are held annually. Analysis of student’s written feedbacks and courses evaluations of “before and after” the implementation of this intervention is taking place to examine the effect of the new curriculum on the perceived clinical and research capacities of our 6-year students.

Integrating Public Health and Health Promotion Practice in the Medical Curriculum: A Self-Directed Team-Based Project Approach

Preparing health professionals in health promotion (HP) and disease prevention is essential for improvement of population health, community HP, and better health care for individuals. The aim of this article is to describe an HP project in the form of a major self-directed project-based learning task integrated within the curriculum in the second year of the medical degree program at United Arab Emirates University. The project introduces students to public health and HP practice and develops students’ literature searching, writing, presentation skills, and team work. Students learn the principles underlying behavioral change, and the design of HP programs and materials, through a lecture format. Small groups of students each choose a specific health topic for their project. Over 11 weeks, students obtain information about their topic from appropriate sources (library, PubMed, Google Scholar, credible health sources such as World Health Organization). Using the principles learned in the lectures, they develop appropriate materials for their target audience: for example, posters, a pamphlet, social media content, or a video or radio message. Students seek advice from specialist faculty as needed. In week 12, each team presents their project background, rationale, and materials to their colleagues in a seminar format open to all faculty. They then submit the materials they developed for assessment. Group marks are assigned for presentations and materials. Key concepts are assessed by multiple choice questions in comprehensive course examinations. By participation in the HP project, many students develop a solid background in prevention. The information retrieval, writing, and presentation skills, as well as experience of team work, are valuable both for the remaining years of their training and their future careers.

A Community Health Assessment Curriculum to Develop Population Health Competencies

Introduction

The Institute of Medicine, Association of American Medical Colleges, and Centers for Disease Control and Prevention recommend population health training for medical students. Medical schools struggle to teach and evaluate population health curricula. We developed, implemented, and evaluated a community health assessment exercise (CHA) within a required clinical rotation to address this need.

Methods

Descriptive statistics and t-test comparison of means were used to analyze student scores on curricular assignments and responses to pretest and posttest items assessing student-rated skill and likelihood of conducting a CHA in practice, and in finding evidence to support public health programs and policies.

Results

Student-rated skill in conducting a CHA increased from 3.3 ± 1.2 on the pretest to 4.8 ± 0.9 on the posttest (P < 0.01). Student-rated skill in finding evidence that supports public health programs and policies increased from 4.0 ± 1.1 to 5.1 ± 0.9 (P < 0.01). There was no difference between pretest and posttest in the likelihood of participating in a CHA organized by others (4.7 ± 1.3 vs 4.9 ± 1.3, p = 0.4), or in initiating a CHA as a practicing physician (4.2 ± 1.4 vs 4.3 ± 1.4, P = 0.8). Asked if the CHA improved their educational experience, 56% of students agreed and 25% disagreed. Asked if the CHA improved their ability to provide patient care, 40% of students agreed and 37% disagreed.

Conclusions

The addition of a CHA to a clinical rotation is feasible and develops key medical student public health competencies.

Knowledge, experiences, and barriers to colorectal cancer screening: a survey of health care providers working in primary care settings

Colorectal cancer (CRC) screening and early detection can effectively decrease the morbidity and mortality associated with this disease. Health care providers (HCPs) working in primary care settings as the first contact with the health care system can play a pivotal role in cancer prevention and screening for early detection. The purpose of this study was to explore the knowledge, experiences, and perceived barriers to CRC screening among HCPs working in primary care settings. A cross-sectional design and a self-administered questionnaire (SAQ) was used to collect data from 236 HCPs working in health centers in Jordan. The 236 HCPs were nurses (45.8%), physicians (45.3%), and others (7.2%). A third of the HCPs (30%) knew the recommended age to begin CRC screening for patients with average risk. Overall physicians scored higher than nurses on questions assessing CRC screening knowledge. The majority of HCPs were not knowledgeable about CRC screening recommendations but believed that CRC is preventable (75.8%). The main perceived barriers to CRC screening were patient's fear of finding out that they have cancer and lack of awareness about CRC screening tests, shortage of trained HCPs to conduct invasive screening procedures, and lack of policy/protocol on CRC screening. HCPs working in primary care settings in Jordan do not have adequate knowledge about CRC screening. There is a need for tailored continuing educational programs and other interventions to improve HCPs' knowledge, as this can increase CRC screening in primary care settings and compliance with current screening guidelines.

Using clinical skills exams to evaluate medical student skills in prevention

BACKGROUND

In 2006, the Brody School of Medicine Regional Medicine-Public Health Education Center integrated the teaching of prevention into the curriculum for first-, second-, and third-year medical students.

PURPOSE

The purpose of this article is to report on the use of clinical skills exams (CSEs) in the evaluation of prevention health instruction for the period 2006-2010.

METHODS

Two CSEs were employed to measure preventive skills at the end of the third year of medical school. CSE-1 was a woman aged 56 years with knee pain. The outcome measure is the percentage of students asking three or more prevention history items. CSE-2 was a boy, aged 15 years, undergoing a sports physical/preventive screening. The outcome measure is the number of prevention items queried.

RESULTS

For CSE-1, the percentage of students who met the outcome measure increased to 83% in 2010 as compared to 62% in both 2009 and 2007. The improvement between 2007 and 2010 was significant with a p=0.0080 (Fisher's exact test). Of the 64 students taking the third-year medical student objective structured clinical examination-2 in June 2009, the greatest number queried the following preventive items: exercise (98%), alcohol misuse (98%), drug use (98%), school and grades (98%), sexual activity (98%), and tobacco use (97%).

CONCLUSIONS

By integrating prevention elements into CSE cases, the results are useful for student assessment and may be a powerful influence on curricular design, leading to an increase in prevention content.

Knowledge and attitudes regarding colorectal cancer screening among medical students: a tale of two schools

Colorectal cancer (CRC) screening has been shown to decrease the incidence of CRC cancers and decrease mortality. Studies show that the most important predictor of patient compliance with CRC screening is physician recommendation. We assessed the knowledge and attitudes of medical students regarding cancer screening. A study-specific questionnaire was distributed to medical students (MS) at two medical schools. There was a significant difference in the percentage of correctly answered questions regarding screening recommendations between first year MS and all other years for both schools. However, MS attitudes towards CRC screening were consistent between classes and schools. Although most MS had positive attitudes regarding cancer screening our survey identified several important deficits in knowledge.

Knowledge about cancer screening among medical students and internal medicine residents in Mexico City

It is extremely important that physicians are aware of cancer screening precise indications. We sought to explore its knowledge among Mexican medical students and internal medicine residents. Students and residents completed a questionnaire-based survey about breast, cervical, colon, and prostate cancer screening. Four hundred fifty-one individuals answered the survey: 64.52% students and 35.48% residents. Mean knowledge score was 63.97 ± 14.97. Residents scored higher than students (p = 0.0001). No difference in the education concerning cervical and colon cancer screening was found. Knowledge of screening guidelines is suboptimal among medical students and residents. Further efforts should be targeted to educational and training programs in this country.

[Implementation of preventive activities by family and community medicine residents in primary care clinics]

OBJECTIVE

To determine the level of preventive activities carried out by Family and Community Medicine medical residents during their stay in the Health Centre, as well as to estimate the time involved in carrying them out.

DESIGN

Cross-sectional, descriptive, observational study.

SETTING

Teaching Health Centres in the Central- Cordoba and Guadalquivir Primary Care Districts.

PARTICIPANTS

Forty medical residents and 384 clinical interviews with patients who were seen at the clinic.

MAIN MEASUREMENTS

The consultations were video recorded and looked at by three medical residents who recorded the preventive activities carried out according to the 2005 PAPPS (Health Promotion and Disease Prevention Activities) recommendations, as well as the time employed in performing these activities.

RESULTS

No preventive activities were performed in 72.1% (95% CI: 67.6 to 76.5%) of the consultations. The most frequent activities were secondary prevention (70.1%), mainly the taking of blood pressure (8.1%). The mean consultation time when there were no preventive activities carried out was 5.6 min (SD=3.1), whilst in those that did perform them it was 7.04 min (SD=3.05) (P<0.0001).

CONCLUSIONS

The performing of preventive activities by medical residents in Primary Care clinics is very limited. A consultation that includes preventive activities requires a significantly longer time than in those that do not include them.

Ethics, information technology, and public health: new challenges for the clinician-patient relationship

Increasingly widespread adoption of health information technology tools in clinical care increases interest in ethical and legal issues related to the use of these tools for public health and the effects of these uses on the clinician-patient relationship. It is argued that patients, clinicians, and society have generally uncontroversial duties to support civil society's public health mission, information technology supports this mission, and the effects of automated and computerized public health surveillance are likely to have little if any effect on the clinician-patient relationship. It is also suggested, nevertheless, that electronic public health surveillance raises interesting and important ethical issues, some of which can be addressed if not resolved by empirical research, especially regarding patient preferences about secondary use of health data and their moral obligation to contribute to population- based health.

The schism between medical and public health education: a historical perspective

The separation of "medicine" and "public health" in academic institutions limits the potential synergies that an integrated educational model could offer. The roots of this separation are deeply imbedded in history. During the past two centuries, there have been repeated efforts to integrate public health education into the core training of physicians, usually in response to a perceived short-term crisis, and without widespread, lasting success. The cost of additional public health instruction and the "overcrowding" of the medical curriculum have been cited as obstacles for creating an integrated medical/public health curriculum for more than a century. Several thoughtful and prescient proposals for integration were developed at a conference convened by the Rockefeller Foundation in the early 20th century, but not all were implemented. Today, there is growing recognition of the considerable value afforded by the integration of medicine and public health education. Many schools have responded to a national call for a renewed relationship between medicine and public health by increasing the availability of MD/MPH programs and/or by incorporating one or more public health courses into the basic medical curriculum. A few schools have created more substantial and innovative changes. Review and consideration of the history and politics of past efforts may serve as a guide for the development of successful new approaches to creating a clinical workforce that incorporates the principles of both clinical medicine and public health.

Perspective: the case for subspecialty clinical learning in early medical education-moving from case-based to patient-based learning

The subspecialty departments are greatly underutilized for teaching during the first two years of medical school. While second-year students are spending most of their time behind closed doors in the laboratory, lectures, and small groups, the clinical environment is teeming with actual patients whose cases are often directly analogous to the material being learned. Moreover, even in today's environment of increased emphasis on quality of medical care and medical education reform, many U.S. medical students still lack essential exposure to common technologies, tests, and procedures performed within several subspecialties. To remedy this situation, the authors propose that educators develop a system of subspecialty clinical learning for first- and/or second-year students correlated to the classroom study of the pathophysiology of the various organ systems. For example, the second-year cardiology course could be augmented with self-directed, patient-centered learning assignments in the cardiac unit, the pathology lab, the echo lab, and other areas. The authors explain the several advantages of comprehensive subspecialty clinical learning (e.g., it will help prepare physicians to practice distributed care, aid development of competencies within the behavioral and social sciences, foster students' professional development, and encourage creative approaches to issues of health care quality). The authors acknowledge the multiple difficulties of implementing such an approach, and present evidence supporting their argument that with the appropriate vision and leadership, such a living curriculum is important and achievable.

An enhancement strategy for integration of population health into medical school education: employing the framework developed by the Healthy People Curriculum Task Force

The authors describe an enhancement strategy for integration of population health content into the medical school curriculum at The Brody School of Medicine at East Carolina University conducted in 2005-2006. The Clinical Prevention and Population Health Curriculum Framework developed by the Healthy People Curriculum Task Force served as the planning template for curriculum analysis. Key to success was the incorporation of population health as a "curriculum enhancement," as opposed to curricular expansion or substitution. Strategies included introduction of a Case-Based Series in Population-Oriented Prevention (C-POP) in the preclinical years; community assessments, home visits, and public health assignments in the family medicine and pediatrics clinical clerkships; and prevention history-taking. The Brody integrated curriculum included a wide range of topics and clinical experiences specific to prevention and population health; however, the coverage was uneven. Hybrid teaching cases were developed from four C-POP cases which were adapted to existing instructional materials. Students learned to define the determinants of health, disease burden in their community settings, and community strengths and obstacles specific to dealing with chronic conditions. Factors contributing to the successful integration of population health included a receptive primary care medical school, use of the Framework, analysis of gaps between the Framework and the existing curriculum, providing enhancements to the existing curriculum, employment of patient cases, and integrating population health into a variety of classroom and community medical learning experiences. This approach, as opposed to a separate and distinct course, seeks to reinforce the interconnectedness of communities, families, and individuals.

Evidence-based public health education as preparation for medical school

The Institute of Medicine has recommended that all undergraduates have access to public health education. An evidence-based public health framework including curricula such as "Public Health 101" and "Epidemiology 101" was recommended for all colleges and universities by arts and sciences, public health, and clinical health professions educators as part of the Consensus Conference on Undergraduate Public Health Education. These courses should foster critical thinking whereby students learn to broadly frame options, critically analyze data, and understand the uncertainties that remain. College-level competencies or learning outcomes in research literature reading, determinants of health, basic understanding of health care systems, and the synergies between health care and public health can provide preparation for medical education. Formally tested competencies could substitute for a growing list of prerequisite courses. Grounded in principles similar to those of evidence-based medicine, evidence-based public health includes problem description, causation, evidence-based recommendations for intervention, and implementation considering key issues of when, who, and how to intervene. Curriculum frameworks for structuring "Public Health 101" and "Epidemiology 101" are provided by the Consensus Conference that lay the foundation for teaching evidence-based public health as well as evidence-based medicine. Medical school preparation based on this foundation should enable the Clinical Prevention and Population Health Curriculum Framework, including the evidence base for practice and health systems and health policy, to be fully integrated into the four years of medical school. A faculty development program, curriculum guide, interest group, and clear student interest are facilitating rapid acceptance of the need for these curricula.

Strengthening public health medicine training for medical students: development and evaluation of a lifestyle curriculum

BACKGROUND

Lifestyle factors are major determinants for health and safety. Although many graduates lack interviewing and observational skills for prevention and student lifestyle often deteriorates during training, few medical schools teach comprehensive assessment of lifestyle, particularly in the context of the home environment.

AIMS

A lifestyle curriculum was developed to teach basic causality and provide practical experience in assessing nutrition, exercise, safety, tobacco addiction, and food hygiene, together with generic skills in history taking, on-site observation, researching and presenting.

METHODS

Lifestyle has been integrated into the first-year curriculum, evaluated, and improved at the United Arab Emirates University since 2001. After an introduction to determinants of health, students conduct a home interview and observational survey for family residential and traffic safety, smoking, and food hygiene. For nutrition and exercise, students assess personal lifestyle. Generic skills are developed in the context of lifestyle. Evaluations were by faculty and students, including assessed impact on knowledge, skills, and personal lifestyle. The lifestyle curriculum was compared with other countries by detailed search.

RESULTS

Detailed evaluation found strong agreement/agreement among students that knowledge had improved on: counselling of patients and families 97%, promoting healthy lifestyles 100%; interviewing 88%; history taking 84%; using research for medical practice 89%; and importance of prevention 96%. Eighty six percent were stimulated to think in new ways about health. Improved personal diet was reported by 60% (p < 0.0004) and exercise by 55% (p < 0.0004), while 36% of non-users started wearing a safety belt in front (p < 0.0004) and 20% in the rear (p = 0.008). Literature review found comprehensive lifestyle curricula to be rare.

CONCLUSIONS

A lifestyle curriculum developed prevention-oriented history-taking and observation skills for health maintenance, addressing health priorities, improving medical student lifestyle, and strengthening generic skills. Since lifestyle is a major determinant of health, medical schools should consider development of an appropriate curriculum to address their local and national health priorities.

A proposal for teaching basic clinical skills for mastery: the case against vertical integration

The authors argue that medical school faculty should (1) make a distinction among competencies that they feel need to be taught for mastery (i.e., at a level of proficiency expected from a practicing physician) and those that should be taught at lower levels of proficiency, and (2) impart the former competencies in single teaching units. The authors propose that the skills that students should be expected to master include patient interviewing, physical examination, patient counseling on health promotion and disease prevention (HP/DP), and self-directed learning. The concepts of a hypothetical teaching unit that aims to impart these skills are described. By the end of this unit, the students would be expected to (1) examine simulated and real patients to detect risk indicators and physical findings for the diseases that are the most common causes of death in the patient's gender and age group, and to look for risk indicators and physical findings for diseases where early diagnosis and treatment have been shown to reduce mortality for such patients, and (2) provide counseling for lifestyle changes and future clinical examinations. The authors believe that the objective of acquiring an ability to counsel a patient on HP/DP at the level of competence of a practicing physician will motivate students to acquire the skills of patient interviewing, physical examination, and self-directed learning more effectively than would a succession of reinforcements of these subjects throughout the curriculum.

Clinical prevention and population health: curriculum framework for health professions

The Clinical Prevention and Population Health Curriculum Framework is the initial product of the Healthy People Curriculum Task Force convened by the Association of Teachers of Preventive Medicine and the Association of Academic Health Centers. The Task Force includes representatives of allopathic and osteopathic medicine, nursing and nurse practitioners, dentistry, pharmacy, and physician assistants. The Task Force aims to accomplish the Healthy People 2010 goal of increasing the prevention content of clinical health professional education. The Curriculum Framework provides a structure for organizing curriculum, monitoring curriculum, and communicating within and among professions. The Framework contains four components: evidence base for practice, clinical preventive services-health promotion, health systems and health policy, and community aspects of practice. The full Framework includes 19 domains. The title "Clinical Prevention and Population Health" has been carefully chosen to include both individual- and population-oriented prevention efforts. It is recommended that all participating clinical health professions use this title when referring to this area of curriculum. The Task Force recommends that each profession systematically determine whether appropriate items in the Curriculum Framework are included in its standardized examinations for licensure and certification and for program accreditation.

Disease prevention and health promotion in medical education: reflections from an academic health center

PURPOSE

It is unclear whether academic health centers are successfully addressing societal needs and expectations by preparing students with knowledge and skills in disease prevention and health promotion. The authors assessed whether students were exposed to key content in these areas and whether they felt this exposure was adequate.

METHOD

All components of the first three years of the Case Western Reserve University (Case) curriculum were examined in 2001 to create a curricular map, using competencies in disease prevention and health promotion identified by the Association of Teachers of Preventive Medicine (ATPM) as a template to assess the scope of instruction. Case students' United States Medical Licensing Examination (USMLE) Step 2 subscores in preventive medicine and health maintenance from 1994 to 2000 and graduating seniors' assessment of the adequacy of their training were compared to national data from the Association of American Medical Colleges' 2000 Graduation Questionnaire (GQ).

RESULTS

Most content areas identified by ATPM were present in the Case curriculum and were offered frequently in a variety of educational venues over the first three years. USMLE scores increased nationally and at Case from 1994 to 2000 and Case students' perception of training adequacy in preventive medicine and health promotion was comparable to national ratings from the 2000 GQ.

CONCLUSIONS

Broad and frequent exposure to disease prevention and health promotion core competencies has value, but may not sufficiently prepare students to deliver health-promoting services confidently. Creative curricula highlighting prevention's relevance throughout clinical practice and incorporating formal opportunities to apply knowledge and build experience may result in greater success.

Eliminating disparities: empowering health promotion within preventive medicine

The estimated 800,000 U.S. deaths in 1990 related to behavioral decisions challenge physicians to better assist behavioral change through expanded health promotion activities. Based on the format guidelines of this special issue, this brief paper first examines the current and optimal roles of health promotion within Preventive Medicine, including five physician roles for improving modifiable public health-risk behavior burdens: (1) preventive services clinician, (2) health promotion researcher, (3) educator-communicator, (4) systems manager, and (5) health promotion advocate. After presenting a new vision statement, this paper proceeds to discuss the opportunities and barriers, including system, clinician-office, and patient factors, to attaining this new vision of empowering health promotion within Preventive Medicine. Finally, all physicians are invited to engage in a threefold strategic plan for change through at least one of five action items: (1) health promotion advocacy, (2) health promotion research, (3) public communication, (4) protocol dissemination and implementation, and (5) Preventive Medicine training.

Evaluation of a cancer prevention and detection curriculum for medical students

BACKGROUND

Undergraduate medical education needs revision to ensure that medical students graduate with the skills necessary to assist their patients in cancer prevention and detection. We sought to implement and incorporate a cancer education curriculum into the students' core curriculum and to assess their skill levels prior to (1996), during (1997), and at the peak (1998-1999) of the incorporation of new hours.

METHODS

We conducted pretest and posttest surveys of students at Boston University School of Medicine (medical student years 1-4) enrolled in each of the four study years (1996-1999). A total of 1,956 surveys (response rate, 82%) were completed. The primary outcome measure was the student's self-reported skill level (with responses ranging from 1 (very unskilled) to 5 (very skilled)) for counseling for tobacco cessation, tobacco prevention, and sun protection and for the early detection of breast, skin, and cervical cancer. Mean scores were computed for each chronological year of the study and medical school year. Differences and trends over time in mean scores of students in each medical school year were evaluated using multiple regression analysis.

RESULTS

The number of hours of cancer education increased from 6 in 1996 to 15 in 1999. Strong improvements in self-rated skill levels were recorded for four of the six measures. In particular, tobacco cessation counseling skill rose from 2.16 (1996) to 3.13 (1999) for second year students (P < 0.001) and from 3.27 (1996) to 4.17 (1999) for fourth year students (P < 0.001). Among fourth year students, the percentage reporting that cancer prevention was given too little emphasis declined from 62% (1996) to 26% (1999) (P < 0.001), suggesting that the expanded curriculum reflected the students' preferences.

CONCLUSIONS

Cancer education can be interwoven into the existing medical school curriculum and produce improvements in students' skill levels for counseling and examinations. Strategies to enhance prevention teaching can use this model.

Experience with the first Internet-based course at the Faculty of Medicine, University of São Paulo

PURPOSE

The Internet expands the range and flexibility of teaching options and enhances the ability to process the ever-increasing volume of medical knowledge. The aim of this study is to describe and discuss our experience with transforming a traditional medical training course into an Internet-based course.

METHOD

Sixty-nine students were enrolled for a one-month course. They answered pre- and post-course questionnaires and took a multiple-choice test to evaluate the acquired knowledge.

RESULTS

Students reported that the primary value for them of this Internet-based course was that they could choose the time of their class attendance (67%). The vast majority (94%) had a private computer and were used to visiting the Internet (75%) before the course. During the course, visits were mainly during the weekends (35%) and on the last week before the test (29%). Thirty-one percent reported that they could learn by reading only from the computer screen, without the necessity of printed material. Students were satisfied with this teaching method as evidenced by the 89% who reported enjoying the experience and the 88% who said they would enroll for another course via the Internet. The most positive aspect was freedom of scheduling, and the most negative was the lack of personal contact with the teacher. From the 80 multiple-choice questions, the mean of correct answers was 45.5, and of incorrect, 34.5.

CONCLUSIONS

This study demonstrates that students can successfully learn with distance learning. It provides useful information for developing other Internet-based courses. The importance of this new tool for education in a large country like Brazil seems clear.

Curriculum assessment for prevention topics and the population perspective

BACKGROUND

According to the Association of American Medical College's (AAMC) Senior Questionnaire, medical students spend an inadequate amount of time learning about health promotion, disease prevention, and the population health perspective.

OBJECTIVE

Determine the health promotion/disease prevention (HPDP) content of the medical school curriculum at the University of Kansas School of Medicine, using an inventory of knowledge and skills in HPDP and using physician education objectives from Healthy People 2000.

METHODS

A 121-item survey to evaluate curriculum content was developed. All course directors evaluated their course by using this instrument. An average of three medical students used this instrument to assess each curriculum lecture and every clinical clerkship day in the required medical school curriculum. A teaching session was defined as spending a minimum of 3-5 minutes teaching an HPDP topic.

RESULTS

Of 21 required courses in the medical school curriculum, 11 accounted for the 393 teaching sessions in HPDP. Seventy-five percent (293 sessions) of these dealt with clinical prevention. Quantitative methods received 40 sessions, whereas the health services organization and delivery and the community dimensions of medical practice received 37 and 23 sessions, respectively. Course directors and students disagreed significantly in which HPDP topics were taught in the curriculum.

CONCLUSIONS

Clinical prevention was fairly well covered in the medical school curriculum. Quantitative methods, health services organization and delivery, and community dimensions of medical practice were poorly covered. This assessment was used to substantially improve the curriculum. To track and improve curriculum content in all courses, course directors need to know more precise details about the content of their courses, so this detail can be used to better evaluate the overall curriculum.

Evaluating the teaching of clinical preventive medicine: a multidimensional approach

BACKGROUND

A study was undertaken to determine the amount, methods, and adequacy of instruction in clinical preventive medicine topics in the medical school curriculum at the University of California, San Francisco (UCSF) in the 1996-1997 academic year.

METHODS

A protocol of 35 clinical preventive medicine topics was developed. The preclinical (Years 1 and 2) curriculum was evaluated by reviewing all syllabi and other printed materials for the presence and quantity of instruction in the specific clinical preventive medicine topics. The clinical curriculum (Years 3 and 4) was evaluated by asking students on completion of eight clinical clerkships to answer a questionnaire. Clerkship directors were also asked to answer the same questionnaire.

RESULTS

In the preclinical curriculum, clinical preventive medicine topics were found to receive 63.3 hours of instruction (4.2% of total instruction hours). Counseling and screening topics received the most hours (31.3 and 20.5, respectively) with immunization/prophylaxis and prenatal care receiving considerably less (4.0 and 2.4 hours, respectively). In the clinical curriculum, students reported receiving an average of 118.5 hours of instruction in preventive medicine (5.9% of total instruction hours). Clerkship directors reported more than twice as many hours of instruction (330.8) as students. Overall, only 50% of students reported that a topic had been covered in a clerkship when the clerkship director reported that it had been covered. Both students and clerkship directors reported that exposure to clinical preventive medicine topics was in general inadequate.

CONCLUSIONS

Instruction in clinical preventive medicine constituted a relatively modest percentage of the total instruction time in both the preclinical and clinical curricula at UCSF. Some topics were only minimally covered in the curriculum, and instruction during the clinical years was variable across students and clerkships. The disparity in the amount of instruction in clinical preventive medicine reported by students and faculty illustrates the importance of using multiple methods, including student input, to evaluate curriculum content.