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Patients and Populations – Hoping the Twain Shall Meet

November 12, 2011
Medical students in class

Image courtesy of the Columbia University Medical Center

Historically, the public health, population health and prevention aspects of medical education were often omitted from physician training. Concerns about this gap have been noted for at least a century, prompting a wide range of professional discussions and recommendations. But as one of our recent supplements notes, there’s more reason today than ever before to change this paradigm.

“Contemporary medical educators continue to struggle to secure the time and resources to effectively integrate this content into the curricula, despite the urgent need for physicians with a better appreciation for these issues to help address complex public health challenges that include rising chronic disease burdens, persistent health disparities, and healthcare financing that encourages treatment over prevention,” supplement editors Rika Maeshiro, MD, MPH, of the Association of American Medical Colleges (AAMC); Denise Koo, MD, MPH of the Centers for Disease Control and Prevention (CDC); and C. William Keck, MD, MPH, of the Northeastern Ohio Universities College of Medicine, in Rootstown, Ohio, write in an introductory essay.

So how do we see that medical students and physicians in training get a healthy dose of prevention, public and population health principles and practices?

Our supplement, sponsored by the AAMC and CDC, offers a roadmap for reaching this goal. Its more than 30 research papers and commentaries outline the scope of the issue, the need for change, and provide a series of examples of how a number of medical schools are more effectively integrating public health and prevention principles and practices into medical education. As Institute of Medicine President Harvey V. Fineberg, MD, PhD notes in an essay, many initiatives “are bringing the principles, values, experience, and analytic perspectives of public health into the daily practice of medical education.”

And it does appear that at least some progress is being made.

The supplement grew out of a conference, “Patients and Populations: Public Health in Medical Education,” that the AAMC and CDC organized in 2010 as part of a commitment to strengthen collaborations between academic medicine and public health. A survey taken 6 months after the conference found that more than 95% of the respondents had been successful in achieving at least some of the actions motivated by the meeting, although time limitations in current curricula and funding/resources continue to be barriers to more effective implementation.

Although the survey findings are limited by a self-selected group of respondents and relatively low response rate, the editors are optimistic about opportunities for more progress. Recent changes in accreditation standards for schools granting the MD degree more explicitly identify the health of populations, public health sciences, and preventive medicine as part of required curricular content, they note. DO-granting schools also include preventive medicine and public health in their standards, they add, and national examinations will soon devote more attention to public health content.

AAMC Chief Academic Officer John E. Prescott, MD, underscores the need for that trend to become even more common. “Producing better physicians for the future clearly requires a reconsideration of their education,” he says in his essay. In the future, he notes, physicians must be “skilled team players, who excel in systems-based practice, who provide patient-centered care, and who can work with and in their communities to improve health.”

What’s your take? How can we do a better job of seeing physicians in training have a deeper understanding of prevention and population health issues? Did your own training devote enough time to these areas? Do you see more interest among today’s medical students and young physicians in becoming proficient in these areas? Post a comment or let us know what you think at ajpmblog@ucsd.edu.

NOTE: An AJPM Pubcast offers a video overview of the supplement and how medical education initiatives are helping future physicians better understand and apply population health principles.

— Bill Silberg, AJPM Editor-at-Large

4 Comments leave one →
  1. August 2, 2014 12:42 pm

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  2. August 2, 2014 5:50 am

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  3. C. William Keck, MD, MPH permalink
    November 23, 2011 1:39 pm

    One way to help physicians-in-training have a deeper understanding of prevention and population health issues is to provide them with service learning opportunities in community health agencies, particularly health departments. Public health practice rotations in such settings can be seen as comparable to medical student clinical practice rotations in hospital or outpatient settings. A model that may prove useful is that of the Academic Health Department, defined as a formal affiliation between an academic health professions institution and a state or local health department. Academic Health Departments can serve as sites enhancing both teaching and research in the area of population health. If this is of interest, consider joining the new Academic Health Department Learning Community as described at link above.

    C. William Keck, MD, MPH
    AJPM Blog Contributing Editor

    • September 17, 2012 6:22 am

      hey Wiliams i think you are right and for me i will sure join the new Academic Health Department or i will try to … thanks guys for this great post.

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