Integrating Environmental Medicine into Pre-Clinical Physician Education: Lessons Learned

Abstract

Background: Environmental exposures are responsible for approximately 10-12% of morbidity in the United States. Although the Institute of Medicine recommended integration of Environmental Medicine throughout the medical training continuum in 1995, currently medical students and residents in primary care only receive a few hours of Environmental Medicine throughout their 7 years of training. With renewed emphasis on teaching the social determinants of health, this is a venue to integrate environmental medicine into the curriculum.Objective: To create and evaluate Environmental Medicine integration in the pre-clinical teaching in an urban medical school in the United States.Methods: During two consecutive years (2018 & 2019), 1st year medical students (n=355) participated in a 2-hour Environmental Justice session during their "Physician & Society" class. Students were previously assigned to neighborhood-level service-learning groups (n=15) to identify and assist a local organization in addressing social determinants of health in that neighborhood. After a brief introductory lecture, groups were provided with neighborhood-specific US EPA EJSCREEN Lead Index data and childhood lead testing results from the Ohio Department of Health Data Warehouse. Graphical results by neighborhood were created by the students and displayed for the class to understand exposure-outcome associations during a facilitated Q&A session. A panel discussion followed that included representatives of families affected by lead poisoning, community organizations, and health professionals involved in childhood lead poisoning prevention. Students completed an anonymous on-line questionnaire about the session.Results: Eighty-two students (23%) completed the questionnaire: 89% reported that the community-level data and 90% reported that the panel discussion helped them achieve the learning objectives. Respondents rated their learning experience on a Likert scale (1=poor, 5=excellent) 3.9+0.8 (Mean+SD). Discussion: When integrated into a social determinants of health framework, pre-clinical medical students reacted positively to reviewing local epidemiological data and a panel discussion to teach environmental medicine concepts.