Health Medical Education Research Articles

Medical education for obstetricians and gynecologists should incorporate environmental health

Obstetricians-gynecologists can protect the reproductive health of women, men, and their offspring from environmental hazards through preconception and prenatal counseling and encouraging patients to take actions to reduce environmental exposures. Although obstetricians-gynecologists are well positioned to prevent hazardous exposures, education on environmental health in medical education is limited. The Mid-Atlantic Center for Children's Health and the Environment and the Department of Obstetrics and Gynecology of George Washington University convened a meeting to begin integration of environmental health topics into medical education for obstetricians-gynecologists. Several avenues were identified to incorporate environmental health topics into medical education including continuing education requirements, inclusion of environmental health questions on board certification examinations and the creation of a curriculum on environmental health specific to obstetrics-gynecology.

Cultivation and practice of post competency of health education for army medical candidates

Training for army medical candidates is an important method to improve their over-all competency and is also an crucial part of military medical education. Thus, this study initiated a teaching model to advance the necessary competency of army medical candidates conducting health education through optimizing the traditional content of training program and teaching strategies, changing evaluating system and highlighting ability of practice. Key words: Army medical candidates; Health education; Teaching model

Factors Associated With Family-Centered Involvement in Family Practice—A Cross-Sectional Multivariate Analysis

The importance of a family-centered approach in family practice has been emphasized. Knowledge about factors associated with higher family-centered involvement seems beneficial to stimulate its realization. German office-based family physicians completed a questionnaire addressing several aspects of family-centered care. Logistic regression was used to identify associations with the involvement overall and in different domains: routine inquiry and documentation of family-related information, family orientation regarding diagnosis and treatment, family-oriented dialogues, family conferences, and case-related collaboration with marriage and family therapists. We found significant associations between physicians’ family-centered involvement and expected patient receptiveness, perceived impact of the family’s influence on health, self-perceived psychosocial family-care competences (overall and concerning concepts for family orientation, psychosocial intervention in family conferences, and the communication of the idea of family counseling), advanced training in psychosocial primary care (PPC), personal acquaintance with family therapists (regarding case-related collaboration), and rural office environment. Increased emphasis on the family’s influence on health in medical education and training, the provision of concepts for a family-centered perspective, and versatile skills for psychosocial intervention and inquiry of patient preferences, as well as the strengthening of networking between family physicians and family therapists, might promote the family-centered approach in family practice.

Policy and programmes for mental health in Kerala

A meta-analysis of 13 epidemiological studies shows a prevalence of 5.8% for mental illnesses. Psychiatric morbidity is associated with urban residence, female gender, 35-44 years age group, low socio economic status and nuclear family type. Mental health care facilities are lacking along with a huge gap in professional manpower availability. The available manpower is top heavy and concentrated in the private sector. The National mental health programme aims to assure minimum mental health care for all by application of mental health knowledge in general health care, community participation, and equitable and balanced distribution of resources and integration of mental health with general health services. The programme has failed so far to achieve its objectives due to the absence of a national mental health policy and a lack of mechanism to incorporate political leadership. There is a definite trend towards shifting from public to private health care across all income groups. A draft mental health policy for Kerala has been submitted with sections on helping family, health care delivery systems, health care services (public sector), health care services(private sector), voluntary sector and administrative aspects. The special features with regard to Kerala in mental health included higher suicide rates, alcohol use, breakdown of marriage and family, problems of ageing, strain due to unmatched parental aspirations and children’s achievements in studies, high rates of migration and single parent families. The seekers of alternate systems are not negligible but the percentage drops in subsequent episodes. Major faith healing centres and initiatives have started hospitals with psychiatric facility in the due course. Majority seek care for non-psychotic syndromes. Stigma is less intense, but people reject health workers (other than doctors) as healers. There is also poor follow up and lack of continuity in care from hospital to community. Special programmes included the district-based suicide prevention programme in Thrissur and the Ponnani initiative which included a school mental health programme, old age care, suicide prevention and palliative care. Decentralisation of administration, political will of the local leadership and availability of a committed young psychiatrist in the community were the success formula behind the Ponnani initiative. There is an urgent need to include various aspects of mental health in medical education and to promote research in the area.

Clinical Topics in Global Health: A Practical Introduction for Pre-Clinical Medical Students

Abstract Introduction The Clinical Topics in Global Health course introduces students to the most important global health problems with a focus on clinical practice. This multi-disciplinary, skills...

History of the LIME Network and the development of Indigenous health in medical education.

History of the LIME Network and the development of Indigenous health in medical education.

Learning to account for the social determinants of health affecting homeless persons

Intersecting social determinants of health constrain access to care and treatment adherence among homeless populations. Because clinicians seldom receive training in the social determinants of health, they may be unprepared to account for or address these factors when developing treatment strategies for homeless individuals. This study explored: (i) clinicians' preparedness to provide care responsive to the social determinants of health in homeless populations, and (ii) the steps taken by clinicians to overcome shortcomings in their clinical training in regard to the social determinants of health. Qualitative interviews were conducted with doctors (n = 6) and nurses (n = 18) in six Canadian cities. Participants had at least 2 years of experience in providing care to homeless populations. Interview transcripts were analysed using methods of constant comparison. Participants highlighted how, when first providing care to this population, they were unprepared to account for or address social determinants shaping the health of homeless persons. However, participants recognised the necessity of addressing these factors to situate care within the social and structural contexts of homelessness. Participants' accounts illustrated that experiential learning was critical to increasing capacity to provide care responsive to the social determinants of health. Experiential learning was a continuous process that involved: (i) engaging with homeless persons in multiple settings and contexts to inform treatment strategies; (ii) evaluating the efficacy of treatment strategies through continued observation and critical reflection, and (iii) adjusting clinical practice to reflect observations and new knowledge. This study underscores the need for greater emphasis on the social determinants of health in medical education in the context of homelessness. These insights may help to inform the development and design of service-learning initiatives that integrate understandings of the social determinants of health, and thus potentially improve the readiness of clinicians to address the complex factors that shape the health of homeless populations.

Pedagogical Shifts in Medical Health Education

The medical education system has evolved over time and undergone a radical transformation in the past few decades. With advancements in disease treatments, emergence of new specialties and highly competitive practicing environment, the focus has shifted from gaining knowledge to acquiring degrees. This paper presents 1) where we have been, 2) problems that we have faced, 3) our present status and 4) where we need to be in the future.

Integrating Environmental Health Into Medical Education

Although environmental factors contribute to more than 25% of all global disease, and toxic agents ranked fifth in underlying causes of U.S. deaths in 2000, environmental medicine education is largely omitted in the continuum of U.S. medical education. The paucity of specialists trained in environmental medicine (i.e., occupational medicine and other preventive medicine specialties and subspecialties), coupled with the lack of adequate general medical education on how to prevent, diagnose, refer, or treat patients exposed to hazardous substances in the environment, contributes to lost opportunities for primary prevention or early intervention to mitigate or minimize environmentally related disease burden. Survey findings of graduating medical students over the past few years have identified environmental health as a medical school topic area that can be improved. This article reflects a panel presentation on the challenge of including environmental health in general medical education. It was given at the 2010 “Patients and Populations: Public Health in Medical Education” conference cosponsored by the CDC and the American Association of Medical Colleges. A variety of educational strategies, models, and educational resources are presented that illustrate how recommended competency-based environmental health content can be integrated into medical education to better prepare medical students and physicians without specialized expertise in environmental medicine to provide or facilitate environmental preventive or curative patient care.

Role of Preventive Medicine Residencies in Medical Education: A National Survey

In an era of substantial reform to the nation's health system, there has never been a greater need for physicians to understand public health. One way to foster public health in medical education is to utilize the resources within General Preventive Medicine and Public Health (PM) residency programs. Trained in public health and clinical medicine, PM physicians are uniquely positioned to bridge these disciplines. Little is known about the level of engagement of PM residency programs in medical education. This study explores the current state of their involvement. Program directors from all Accreditation Council for Graduate Medical Education-accredited PM residency programs were asked to participate in a survey to assess involvement in medical student and non-PM resident education, including on nine key engagement criteria covering teaching, rotations, career interest groups, and other activities. The study was conducted and data analyzed in 2010. Thirty-five of 38 (92%) programs responded. Seventy-four percent reported that PM faculty taught medical students, and 34% taught at non-PM residency programs. The lowest level of engagement was seen in PM residents teaching non-PM residents (12%). Over half of all programs met four or fewer of the nine criteria. The most common barriers to engagement were lack of funding (53%) and lack of time (50%). These results suggest that PM residency programs are an underutilized resource in fostering public health in medical education, especially on engagement at the level of graduate medical education. Strategies to improve engagement should consider the nine criteria outlined in this study, as well as common barriers.

Innovative Ways of Integrating Public Health Into the Medical School Curriculum

Abstract This is one of six short papers that describe additional innovations to help integrate public health into medical education; these were featured in the “Patients and Populations: Public Health in Medical Education” conference. They represent relatively new endeavors or curricular components that had not been explored in prior publications. Although evaluation data are lacking, it was felt that sharing a description of the methods use by Morehouse School of Medicine to integrate public health in the curriculum would be of value to medical educators.

A Mapping Process for Identifying and Enhancing Public Health Education in Required Medical Student Clerkships

Abstract This is one of six short papers that describe additional innovations to help integrate public health into medical education; these were featured in the “Patients and Populations: Public Health in Medical Education” conference. They represent relatively new endeavors or curricular components that had not been explored in prior publications. Although evaluation data are lacking, it was felt that sharing a description of the mapping process for linking public health competencies to clinical clerkship activities at the University of Wisconsin School of Medicine and Public Health would be of value to medical educators.

Exploring the Context: Contemporary Medical Education

t t A w n s t s h e A d o Iwas honored to help kick off the “Patients and Populations: Public Health in Medical Education” conference on September 14, 2010. The Association of American Medical Colleges (AAMC) and the CDC had convened close to 200 energized medical educators and public health professionals who were committed to integrating public health content into medical education. Together with Dr. Judith Monroe from the CDC and Dr. Scott Frank from Case Western Reserve University, I participated in an opening plenary session that helped set the context for 2 days of presentations and discussions featuring curricular innovations focused on increasing the teaching of public health in themedical curriculum at institutions across theU.S. andCanada. As an emergency physician with over 25 years of experience practicing in challenging military and rural environments, I have a strong appreciation of the power of prevention, particularly as a component of injury control. As a leader in academic medicine, I have witnessed first-hand the vital interplay of the public health and medical education disciplines. Thus it was a privilege to discuss the pressing issues facing medical education and share my belief that now, more than ever before, those of us committed to educating the health professionals of the future must work together to meet the complex health needs of the nation.

The Integration of Public Health and Prevention Into All Years of a Medical School Curriculum

Abstract This is one of six short papers that describe additional innovations to help integrate public health into medical education; these were featured in the “Patients and Populations: Public Health in Medical Education” conference. They represent relatively new endeavors or curricular components that had not been explored in prior publications. Although evaluation data are lacking, it was felt that sharing a description of the public health, prevention, population health, and policy (P4) curriculum at the University of Arizona College of Medicine, Phoenix (UACOM-P), would be of value to medical educators.

A Primer on Population Health: A New Resource for Students and Clinicians

Abstract This is one of six short papers that describe additional innovations that support the integration of public health into medical education. These were featured in the “Patients and Populations: Public Health in Medical Education” conference and describe innovative endeavors or curricular components not previously published. This paper describes the Association of Faculties of Medicine of Canada's Primer in Population Health and its collaborative development with contributions from all Canadian medical schools, in particular from the medical faculties of the University of Ottawa and the Université de Sherbrooke. Although evaluation data will not be available until the primer has been in use for at least 1 year, sharing a description of it is of potential value to medical educators.

Laying the Foundation: A Residency Curriculum That Supports Informed Advocacy by Family Physicians

Abstract This is one of six short papers that describe additional innovations to help integrate public health into medical education; these were featured in the “Patients and Populations: Public Health in Medical Education” conference. They represent relatively new endeavors or curricular components that had not been explored in prior publications. Although evaluation data are lacking, it was felt that sharing a description of a longitudinal curriculum focused on the development of basic advocacy skills through practical activities in community assessment and engagement combined with legislative advocacy at the University of New Mexico would be of value to medical educators.

Refocusing Knowledge Generation, Application, and Education: Raising Our Gaze to Promote Health Across Boundaries

Those educating healthcare professionals face the undeniable challenge that the current U.S. healthcare system is untenable.1 U.S. health care epitomizes low value, spending more than any other country while ranked 37th in the world—between Costa Rica and Slovenia—in its ability to equitably engender health.2 The September 14–15, 2010, conference on Patients and Populations: Public Health in Medical Education, sponsored by the Association of American Medical Colleges (AAMC) and the CDC, provided inspiring examples from those who are trying to show the healthcare professionals of the future a better way.

Planning and Incorporating Public Health Preparedness Into the Medical Curriculum

As part of a 2010 conference entitled “Patients and Populations: Public Health in Medical Education,” faculty from four U.S. medical schools (Case Western Reserve University, Harvard Medical School, the University of Colorado School of Medicine, and the University of Vermont College of Medicine), collaborated on a workshop to help other medical educators develop scenario-based learning experiences as practical, engaging, and effective mechanisms for teaching public health principles to medical school students. This paper describes and compares four different medical schools' experiences using a similar pandemic exercise scenario, discusses lessons learned, and suggests a curricular framework for medical schools adding such exercises to their population health curriculum. Different strategies to create realistic scenarios and engage students, including use of professionals and stakeholders from the community, are described.

Overcoming Challenges to Integrating Public and Population Health Into Medical Curricula

Integrating public health into medical curricula poses a substantial challenge to educators. However, the needs of trainees and the population requirements of accrediting bodies provide a compelling call to action to improve how tomorrow's medical practitioners are prepared to incorporate public health into their practices. This article provides insights about the nature of the challenges, and it identifies opportunities and practical approaches to integrating public health content into medical school curricula. The paper incorporates authors' opinions with a synthesis of the discussions from a workshop at the 2010 “Patients and Populations: Public Health in Medical Education” conference.

The Power of Collaboration: Integrating a Preventive Medicine–Public Health Curriculum Into a Pediatric Residency

Abstract This is one of six short papers that describe additional innovations to help integrate public health into medical education; these were featured in the “Patients and Populations: Public Health in Medical Education” conference. They represent relatively new endeavors or curricular components that had not been explored in prior publications. Although evaluation data are lacking, it was considered to be of value to medical educators to share a brief description of the collaboration between the Division of Preventive, Occupational, and Aerospace Medicine and the Department of Pediatrics at Mayo Clinic to integrate a preventive medicine–public health curriculum into the pediatric residency.