Including health promotion and illness prevention in medical education: a progress report.

Abstract

In 1988, the World Federation of Medical Education called for reform in medical education, publishing 12 recommendations. The sixth recommendation of this Edinburgh Declaration was to 'complement instruction about the management of patients with increased emphasis on promotion of health and prevention of disease'. Thirty years on, this paper reports an exploration of what has changed since then. Several search strategies were used, including websites of medical standards organisations, and formal searches of PubMed and Google Scholar using key words such as 'medical education standards', 'health promotion', 'illness prevention', 'effectiveness' and 'assessment'. As these searches produced more descriptive than evidence-based papers, the exploration widened to follow evolving discussions about changing emphases in medical education relevant to public health. Health promotion and illness prevention are in the undergraduate medical education standards of the more influential regulators. There is little evidence of the impact of this inclusion on graduate outcomes and later medical practice, although 'differently educated' doctors may have contributed to the success of broader public health strategies achieved through reorganisation of health care, media campaigns and legislation changes. There is greater success in postgraduate specialty training of general practitioners and public health doctors. The discussion about public health interventions and the roles of doctors has moved on to topics such as patient safety, the health of doctors, global health and planetary health. The inclusion of health promotion and illness prevention strategies in undergraduate curricula varied considerably, but was strongest in programmes claiming social accountability and responding to medical education standards of the more influential regulators. However, the contribution of medical education to improvements in health care and the health of populations is difficult to measure. It may be timely to revisit the purpose and practicality of broadening the scope of undergraduate medical curricula in public health medicine.