Teaching Public and Population Health in Medical Education: An Evaluation Framework

Training socially accountable clinician-citizens: integrating clinical public health education in a medical school curriculum

By adopting a holistic perspective that looks 'upstream' at the underlying determinants of health, physicians can develop more effective strategies for promoting wellness and reducing health inequities in an increasingly diverse and complex society. Public health focuses on disease prevention and promotion of health through organized efforts by individuals and society. Population health focuses on the health outcomes of a group of individuals. We designed the Clinical Public Health curriculum, a pedagogical framework designed at the George Washington University School of Medicine & Health Sciences that breaks down traditional silos between didactic public and population health teaching, patient care and community engagement for medical students. It aims to train socially accountable clinician-citizens through an integrated, longitudinal curriculum across the four years of medical school. In this article we describe one aspect of the curriculum - four self-contained 'summits' - which can be used as a template for others seeking to develop a curriculum focusing on social accountability and engagement with community and governmental partners. During these multi-day applied educational experiences, medical students engage with key stakeholders, community members, community-based organizations, and state and national agencies to develop innovative approaches to engage in advocacy and population health. Enhanced medical school curricula focusing on the development of socially accountable clinician-citizens is an urgent need to develop more meaningful clinical-community interventions, support professional development, put context on the impact of health-related social needs on patients and families, and transform healthcare delivery and policy through greater community connection and advocacy.

Evaluation of Navigating a Foodborne Outbreak: Medical Learners Before and During COVID-19

Navigating a Foodborne Outbreak: Preparation for Interprofessional Practice is an interactive, competency-based, online educational module demonstrating interprofessional practice among health professionals to improve and protect population health, in the context of a foodborne outbreak. Authors reviewed registration data, pre- and postmodule knowledge assessments, and module evaluations from the 978 medical students and physicians ("medical learners") who completed the module from July 2018 to June 2021, comparing their outcomes as well as assessing potential impacts of the COVID-19 pandemic. Analyses were conducted in 2022 and 2024. Students' use remained stable, while physicians' use increased over time, primarily as part of MPH curricula. Premodule knowledge assessment scores were higher for physicians. Average medical student performance improved by 51.37%; average physician performance improved by 33.33%. Premodule questions that addressed the coordination of clinical and public health practices, governmental public health emergency response processes, and how clinicians can inform the response were challenging for physicians and may represent public and population health (PPH) content that has not been emphasized in medical curricula. Medical learners reported high satisfaction with the module. Medical students' agreement with statements about the relevance of the module to their current or future responsibilities and awareness of "how clinical care and public health systems work together to protect the health of populations" increased during the pandemic. The module successfully improved knowledge of clinical-public health collaborations to protect population health and is one model of how to integrate PPH content, including physicians' roles in the public health system, into medical education.

Design and assessment of a public health course as a general education elective for non-medical undergraduates

Although public health programs among undergraduate students have been increasing and gaining popularity worldwide, few studies have focused on the needs and structure of public health courses for non-medical students. This study aimed to design a public health course as a general education elective for non-medical undergraduates at Nankai University, one of China's leading multidisciplinary and research-oriented universities. Students' feedback on the course was collected and analyzed after the completion of the elective course. We designed and developed the course under the general education elective course at Nankai University. The course includes four segments: (a) Public Health Fundamentals and Population Research Methods; (b) Chemical Safety and Health, (c) Diet, Nutrition, and Health, (d) Immunology, Microbiology, and Infectious Diseases, spanning 34 class hours (with 6 class hours designated for a flipped classroom format). The teaching content was divided into five parts: (1) Health and Medicine Knowledge, (2) Public Health Knowledge, (3) Public Health Methodology and Philosophy, (4) Proper View of Health Issues, and (5) Values Education. Students' feedback after the course indicated that Diet, Nutrition, and Health was the most interesting segment, and the students considered basic biological or medical knowledge to be more important than other public health knowledge. A problem-based learning model was implemented for flipped classrooms, and we found that the problem-based learning questions were not only helpful for students' knowledge construction but also for educators in understanding and managing the learning expectations of non-medical students. We believe that the lesson may guide other institutions in designing similar curricula.

Collaborative Teaching and Curricular Integration in Pre-Intern Clinical Placements: Insights from the Greater Bay Area

Introduction

The rising demand for knowledge updates and technological innovations in China has made clinical placement teaching challenging. Reforms for innovative teaching models through pilot classes have shown to improve students' academic performance. This novel integration led to the announcement of healthcare collaboration in the Guangdong-Hong-Kong-Macao Greater Bay Area for projects within China's "Global-Innovation-Hub" zones. First Affiliated Hospital (FAH) of Sun Yat-sen University (SYSU) in Guangzhou and the Faculty of Medicine (FMD) of Macau University of Science & Technology (MUST) in Macau have developed an inaugural project for FMD/MUST medical students to perform pre-internships at FAH-SYSU. This study aimed to reflect on students' experiences with collaborative teaching and learning through medical curricular integration in the "Global-Innovation-Hub" zones designed by both institutions for developing integrated curriculum.

Methods

FMD/MUST students attended medical clerkships at FAH-SYSU using a system-integrated curriculum in China's "Global-Innovation-Hub" zones, allowing different education systems at different locations. Post-clerkship surveys ranked teaching models in conjunction with written reflections in response to post-clerkship questionnaires for all participating students. The teaching models were defined by the way supervisors' interaction with students, and written reflections in response to the post-clerkship questionnaire were descriptively and semantically analysed.

Results

The top-ranked teaching models include first "Student-led consultation under supervision in observers' chair with discussion", second "Observe consultation and discuss with the teacher in-between patients in observers' chair" and third "Student-led consultation under supervision in consultants' chair with discussion". The post-clerkship questionnaires showed positive outcomes.

Conclusion

This study demonstrates the successful delivery of collaborative teaching and learning through medical curricular integration in China's "Global-Innovation-Hub" zones. This integration enables the development of a consistent and student-preferred teaching model being introduced into clinical placement curriculum. The unique location of China's "Global-Innovation-Hub" zones in the Guangdong-Hong-Kong-Macao Greater Bay Area allows this integration to significantly improve students' clinical reasoning learning.

Effects of the Education and Training Programme for Excellent Physicians in China on medical students' academic performance: a cross-sectional study

OBJECTIVES

To evaluate the effect of the Education and Training Programme for Excellent Physicians in China on medical students' academic performance.

DESIGN

This study is a secondary analysis of data from a cross-sectional survey of China Medical Student Survey (CMSS, 2021) and administrative data of the first-stage Medical Licensing Examination-the Standardised Competence Test for Clinical Medicine Undergraduates (the Test, 2021). CMSS used a stratified sampling process, with all undergraduate clinical medicine students participating voluntarily.

SETTING

This programme is implemented at the class level within reformed medical schools, targeting undergraduate students in 5-year clinical medicine in China. The reformed medical schools run pilot classes and traditional classes simultaneously. The analytic sample was a total of 12 243 observations from pilot and traditional classes in 34 medical schools which implemented the reform across 19 provinces in China.

METHODS

This study applied the propensity score matching method to estimate the effect of the reform by comparing the scores of the Test between pilot and traditional classes within the same medical schools. We further explored the potential mechanisms driving the effect from two facets of the Test: medical knowledge modules and cognitive levels.

RESULTS

Pilot classes outperformed traditional classes by 0.104 SD on the Test (95% CI 0.037 to 0.171). Improvements were seen in basic medicine and clinical medicine modules (0.109 and 0.101 SD, respectively) and cognitive levels of memorisation and application (0.116 and 0.111 SD, respectively).

CONCLUSION

These results suggest that the reform had a significant positive impact on medical students' academic performance. Based on the components of this reform and the potential mechanism analysis of the two facets, this study indicates that curriculum reform in integrated learning and teaching methods reform in the adoption of problem-based learning may have been the possible drivers of this positive impact.

A Population Health Impact Pyramid for Health Care

Policy Points To meaningfully impact population health and health equity, health care organizations must take a multipronged approach that ranges from education to advocacy, recognizing that more impactful efforts are often more complex or resource intensive. Given that population health is advanced in communities and not doctors' offices, health care organizations must use their advocacy voices in service of population health policy, not just health care policy. Foundational to all population health and health equity efforts are authentic community partnerships and a commitment to demonstrating health care organizations are worthy of their communities' trust.

Transforming the "SEAD": Evaluation of a Virtual Surgical Exploration and Discovery Program and its Effects on Career Decision-Making

OBJECTIVE

The abrupt cessation of in-person education due to the COVID-19 pandemic has made it difficult for preclerkship students to explore a career in surgery. To supplement the lack of exposure, the Surgical Exploration and Discovery (SEAD) program was transitioned to an entirely virtual format. This study aims to describe the virtual SEAD program and evaluate its effectiveness as a career decision-making (CDM) intervention.

DESIGN

The week-long program was delivered on Microsoft Teams, featured 11 surgical specialties, and comprised four activities: live demonstrations, virtual operating room observerships, career talks, and technical skills workshops. The program was evaluated using the four levels of the Kirkpatrick model: (1) reactions, (2) knowledge, (3) CDM behaviors - assessed using the Career Decision-making Difficulties Questionnaire (CDDQ) - and (4) results. The latter was indirectly assessed using CDDQ scores from an in-person SEAD program, where lower CDDQ scores indicate less difficulty with CDM.

SETTING

Faculty of Medicine at the University of Ottawa in Ontario, Canada.

PARTICIPANTS

Forty pre-clerkship students (27 first and 13 second year students) at the University of Ottawa RESULTS: Level 1: 97.5% of participants rated the program as good or very good. Live demonstration and technical skills workshops were the highest rated activities. Level 2: participants' scores on knowledge-based questions about a surgical career significantly increased following the program (pre: 9/25 vs post: 15/25, p = 0.008). Level 3: overall mean CDDQ scores (±SD) decreased difficulties with significantly following the program (pre: 45.6 ± 10.5 vs post: 38.8 ± 10.9, p < 0.001), which indicates decreased CDM difficulties. Level 4: Except for one sub-category, the difference in mean CDDQ scores between the virtual and in-person programs were not significantly different.

CONCLUSION

The program received the positive reactions and significantly increased participants' knowledge. The change in CDDQ scores following the virtual program suggests it may reduce career decision-making difficulties in the short-term. In-person surgical exposure remains important; however, a hybrid model may be valuable in resource limited settings. WC: 300.

Community engagement education in academic health centers, colleges, and universities

Community engagement (CE) is critical for advancing health equity and a key approach for promoting inclusive clinical and translational science. However, it requires a workforce trained to effectively design, implement, and evaluate health promotion and improvement strategies through meaningful collaboration with community members. This paper presents an approach for designing CE curricula for research, education, clinical care, and public health learners. A general pedagogical framework is presented to support curriculum development with the inclusion of community members as facilitators or faculty. The overall goal of the curriculum is envisioned as enabling learners to effectively demonstrate the principles of CE in working with community members on issues of concern to communities to promote health and well-being. We highlight transformations needed for the commonly used critical service-learning model and the importance of faculty well-versed in CE. Courses may include didactics and practicums with well-defined objectives and evaluation components. Because of the importance of building and maintaining relationships in CE, a preparatory phase is recommended prior to experiential learning, which should be guided and designed to include debriefing and reflective learning. Depending on the scope of the course, evaluation should include community perspectives on the experience.

Health and Clinical Impacts of Air Pollution and Linkages with Climate Change

Air Pollution Impacts and Climate Change LinksAs part of the NEJM Group series on climate change, Keswani and colleagues review the linkages between climate change and air pollution and suggest strategies that clinicians may use to mitigate the adverse health impacts of air pollution.

Adapting the patient and physician versions of the 9-item shared decision making questionnaire for other healthcare providers in Japan

BACKGROUND

In Japan, the number of older people with various health problems and difficulties in living is increasing. In order to practice patient-centered care for them, not only medical professionals but also multidisciplinary teams including care professionals and patients need to practice shared decision making (SDM) in the context of long-term care. For this reason, a measure of SDM in consultations with healthcare professionals (HCPs) other than physicians is needed. Therefore, this study aimed at adapting the patient and physician versions of the 9-item Shared Decision Making Questionnaire (SDM-Q-9, SDM-Q-Doc) for consultations with HCPs other than physicians in Japan.

METHODS

A pair of SDM measures that can be used by HCPs other than physicians, "Care SDM-Questionnaire for care receivers (SDM-C-patient)" and "Care SDM-Questionnaire for care providers (SDM-C-provider)" were prepared based on the Japanese versions of the SDM-Q-9 and SDM-Q-Doc. The internal consistency and conceptual structure of these measures were tested by secondary analysis of data from 496 participants from a workshop on SDM for different HCPs. Measurement invariance were tested by multigroup confirmatory factor analysis (CFA) for the patient (SDM-C-patient and SDM-Q-9) and provider (SDM-C-provider vs. SDM-Q-Doc) versions.

RESULTS

Both the Japanese SDM-C-patient and SDM-C-provider demonstrated high internal consistencies (Cronbach's α coefficient was 0.90 and McDonald's ω coefficient was 0.90 for both measures). CFA showed one-factor structures for both measures and original measures for physicians. Moreover, multigroup CFA showed configural and metric invariance between the novel care measures and original physician's measures.

CONCLUSIONS

Thus, the novel SDM measures for care providers in Japan as well as the original physician's measures could be used in training setting. As these measures were tested only in a training setting, their reliability and validity as new measures for care should be tested in a clinical setting in future.