Antemortem care in an afternoon: a successful four-hour curriculum for third-year medical students

Numerous well-designed studies have shown that patients near the end of life often receive substandard palliative care. Medical students have expressed a strong interest in antemortem care; however, palliative medicine education remains poorly integrated into the overall curriculum at most medical institutions in the United States. In response to this need, a palliative medicine curriculum has been developed for medical students in the required third-year clerkship in family medicine at the University of Tennessee Health Sciences Center The implementation of this curriculum resulted in a statistically significant increase in student competence (as measured by a standardized pretest and post-test) and a significant trend in student confidence (as measured by a single-item Likert scale). The curriculum was popular with students, and encouraged many of them to request hospice clinical experiences during their family medicine clerkship, or to register for the elective fourth-year clerkship in palliative medicine.     

The challenge of teaching occupational medicine to medical students: the Université de Montréal experience

Nonrecognition and mismanagement of work-related diseases is often linked to inadequate medical training. However, undergraduate training in occupational medicine faces many challenges, including lack of student interest and limited curriculum time. The purpose of this article is to present an undergraduate training program developed in one medical school to ensure that all medical students acquire the basic knowledge to recognize work-related health conditions and understand the fundamental principles of workers' comprehensive care. The program involves various learning methods including case studies, small-group learning, interactive large-group teaching, field activities, and e-learning. It has resulted in improving students' attitudes and competencies in occupational medicine and requires little curriculum time.     

中国中医事业发展的瓶颈与对策研究

中医药的发展，人才培养是关键。但更重要的前提还是中医认识要更新，要在中医认识观、学生素质、医疗环境、评价体系上进行深刻的反思和调整，尽快在中小学健康课程中加入医学内容，制定出合理的评价体系，只有这样，中国医学才能得到深入的发展。     

Developing primary care curricula in preventive medicine: some practical considerations.

I describe a practical approach to developing primary care curricular in preventive medicine, starting with the articulation of a rationale that relates training to current medical education, mortality, medical manpower, and health care system characteristics. I discuss recommended features of the ambulatory care setting for instruction and include automated record systems, practice teams, multidisciplinary staff, faculty role models, conferences and rounds, and needs of low-income populations. Further, I advocate a careful review of the three-year residency curriculum including conferences, rounds, and rotations to identify elements of the desired curriculum on which to build preventive medicine training so as to alter scheduling minimally. I consider longitudinal as well as block rotation experiences. I highlight published resources for defining preventive medicine content areas and recommend local resources for preventive medicine training and for involving residents in personal health promotion. Finally, I offer an example of a family medicine resident experience in breast and cervical cancer screening to illustrate an approach to accomplishing specific objectives for preventive medicine training.     

Use of a sports medicine clinic in a family practice residency

The experience of a pilot sports medicine clinic in affiliation with a family practice residency program is reviewed. The use of volunteer orthopedic staffing along with residents working in an acute sports medicine clinic in a community hospital proved to be a valuable addition to the orthopedic exposure during residency training. Seventy-eight patient contacts involving 93 injuries were encountered over a seven-week period. Three injuries required hospitalization for further definitive care. The benefits derived suggest that a similar clinic setup in other residency training programs could enhance the required orthopedic rotation as well as give acute, responsible care to the injured athlete. Educationally the resident's role as the athlete's physician provided a clinical experience valuable to a primary care practice.     

A plea for an initiative to strengthen family medicine in public health care services of developing countries.

An analysis of standards for the best practice of family medicine in Northern European countries provides a framework for identifying the difficulties and deficiencies in the health services of developing countries, and offers strategies and criteria for improving primary health care practice. Besides well-documented socioeconomic and political problems, poor quality of care is an important factor in the weaknesses of health services. In particular, a patient-centered perspective in primary care practice is barely reflected in the medical curriculum of developing countries. Instead, public sector general practitioners are required to concentrate on preventive programs that tackle a few well-defined diseases and that tend to be dominated by quantitative objectives, at the expense of individually tailored prevention and treatment. Reasons for this include training oriented to hospital medicine and aspects of GPs' social status and health care organization that have undermined motivation and restricted change. A range of strategies is urgently required, including training to improve both clinical skills and aspects of the doctor-patient interaction. More effective government health policies are also needed. Co-operation agencies can contribute by granting political protection to public health centers and working to orient the care delivered at this level toward patient-centered medicine.     

The postgraduate education of physicians in preventive medicine

The Graduate Medical Education National Advisory Committee report projected a serious shortage of preventive medicine specialists in 1990, and the recommendations of a recent report from the Association of American Medical Colleges called for increased training of medical students in health promotion and disease prevention and in adapting to changes in health and health care. To help meet the need for physician manpower in preventive medicine a new residency was established at the State University of New York at Stony Brook in July 1983. The program features a structured approach to the practicum year, incorporating an organized core curriculum and opportunities for a varied field experience. In addition to the School of Medicine and University Hospital, major training sites include two large county health departments on Long Island, three community hospital departments of community medicine, a health maintenance organization as well as several neighborhood health centers, and community-based programs operated by these hospitals and health departments. The curriculum includes both longitudinal experiences at the medical school involving teaching, research, and didactic conferences, and block field rotations within the above affiliated agencies, providing practice experience in preventive medicine and public health. The diversity in the organization and type of preventive medicine institutions used for training enriches the residency experience and is complemented by core educational activities.     

Community Medicine in India — Which Way Forward?

Today, the Community Medicine professionals in India feel both “confused” and “threatened” by the mushrooming of schools of public health and departments of family medicine. The phenomenon of identity crisis and low-self esteem is not a recent one, nor is it restricted to India. The disciplines of community medicine and public health have evolved differently and despite some overlaps have differences especially in the need for clinical training. The core of the issue is that while the community medicine fraternity is keen to retain its clinical tag, what differentiates it from clinicians is the use of public health approach. I believe the strength of community medicine is that it bridges the gap between traditional fields of public health and clinical medicine and brings community perspective into health. The perceived threat from non-medical persons led public health is largely a result of us undervaluing our strength and our inability to foster partnership on equal footing with non-clinicians. While departments of community medicine have a fully functional rural or urban field practice area used for training at primary level care, these can serve as an excellent platform for training in secondary level care required for family medicine. National needs dictate that all three disciplines are required for improvement of population health, whether these are housed together or separately can be left to individual institutions to decide as long as they enable collaborations between them. We need to strengthen community medicine and market it appropriately to ministries of health.     

The teaching of preventive medicine in American medical schools, 1940–1980

The concept of incorporating prevention into clinical medicine has been addressed by academic medicine since the 1940s. Results reflect the dominant interests of academic medicine over time. This paper reviews this experience, as reflected in national conferences and related activities largely sponsored by the Association of Teachers of Preventive Medicine, and assesses implications for the 1980s. The consensus of the 1940s was that medical education should focus upon quantitative disciplines. Clinical applicability was considered important, but little was developed. Convening in 1952, deans, clinicians, and preventive medicine faculty strongly recommended teaching clinical prevention in “comprehensive care” programs. This movement was eclipsed by research and specialization. Academic preventive medicine focused on residency training and research, culminating in a major conference in 1963. Epidemiology and biostatistics flourished, while teaching clinical prevention received little attention. By 1970, dominant interest shifted to health services policy and research. Currently, some preventive medicine departments have affiliated with primary care training programs, and policy makers are focusing upon prevention. A number of nationally sponsored curriculum development projects deal with preventive aspects of primary care. Under these circumstances, incorporation of prevention into medical practice seems likely to succeed at the academic level. This may in turn stimulate similar occurrences in the medical care system.     

A mini-workshop to train medical students to use a patient-centered approach to smoking cessation

Leaders in preventive medicine and medical education have called for more attention to preventive medicine in medical education curricula. This study describes the implementation of a training program designed to introduce preventive medicine skills into the medical school curriculum. The specific issue addressed was smoking cessation. A two-hour workshop on the patient-centered approach to smoking intervention was presented to medical students during the family medicine rotation of the second-year clinical medicine course sequence. Two of the four student groups in the family medicine clinical rotation received the training and were afforded practice opportunity with at least one smoking patient at the clinical site. The other two groups went through the usual rotation with no special instruction or clinical emphasis on preventive interventions. Second-year medical students expressed positive perceptions of preventive medicine as assessed by self-rating on attributes important to successful preventive practice. These positive perceptions were retained by both groups after the clinical experience. Students with the workshop training were more confident in their smoking intervention skills and performed better overall on an objective clinical evaluation of intervention skills.     

Strategies for Reducing Homophobia During Medical Training

This paper describes the need for teaching about homosexuality in medical schools in order to improve the health care of homosexual patients and to improve the learning environment for gay and lesbian physicians-in-training. Homophobic attitudes and heterosexual biases in medical training and clinical interventions are reviewed. Next, teaching approaches that have been used to address homosexuality and homophobia in medicine are discussed. Finally, strategies and opportunities to integrate teaching about homosexuality with the needs of homosexual patients throughout the medical school experience are presented. Opportunities for teaching about homosexuality and the clinical needs of homosexual patients are present throughout the medical school curriculum. Impediments to utilizing these opportunities need to be overcome so that homosexual patients receive optimal health care by physicians trained to understand their clinical needs.     

Undergraduate training in occupational health at Kocaeli University Medical School: a Turkish experience

Processes and conditions of production may produce unhealthy effects. Both must therefore be included in the education of health care personnel. Vocational training in occupational health at Kocaeli University Medical School, Turkey aims to demonstrate students that occupational health is a specific and important area of work within the context of primary health care. This research is a cross-sectional study. It was planned as a three stage study: 1- reviewing literature and grouping of countries according to their occupational health curricula; 2- reviewing the occupational health programs of medical schools in Turkey, and 3- recommendations for an occupational health curriculum to include an occupational health vocational training period of one week in the two month public health education program for medical interns. During this experience, senior students would be assigned to workplace health units. Of 283 medical schools found on the web, with occupational health teaching, only 20 have a curriculum that includes training in workplace health care units. In Turkey, there is no structured practical education on occupational health. In the third part of this study, we initiated at Kocaeli University School of Medicine's curriculum, a new occupational health education model applied in the workplace health units of factories. Practical experience of occupational health in the workplace is useful in introducing the community-based approach to occupational health in undergraduate medical education and understanding the determinants of health in industry.     

A resident's internal medicine practice

The decision-making experience of residents in a primary care internal medicine training practice was examined. The patient population provided residents appropriate training opportunities but the experience of many residents making decisions about prevalent primary care problems was often inadequate. The residents' evaluation of their educational experience with patients suggests that several elements of patient care affect their ability to learn. These include the occurrence of diseases in their patients, opportunities to treat and follow patients, the chance to use diagnostic procedures, and the option of reviewing their care with supervisors and consultants or through reading. The results of this study and the current understanding of the development of clinical judgment are discussed as arguments for evaluating internal medicine training programs in part by examining the content of residents' decision-making opportunities in their ambulatory patient practices.     

Health promotion beliefs and practices of fourth-year medical students

Little is known about medical student beliefs about health promotion issues or about their prevention practices with patients. We administered a questionnaire about health promotion beliefs and practices to fourth-year medical students in a required course, "Preventive Medicine in Clinical Practice," at the University of Maryland School of Medicine. During a three-year period we surveyed 343 students. A majority of students believed that most of 23 health behaviors were of some importance to health promotion, and their responses were similar to those of practicing physicians in prior studies. Most students reported that they assessed preventive practices in their patients but did not feel well prepared to counsel patients about health issues. Students reported they were currently unsuccessful in modifying patient health behaviors and expressed limited optimism about future success in helping patients change health promotion behaviors with further training and support. There were no differences between students entering primary care specialties and other students. Information about medical student health promotion and disease prevention beliefs and practices can be applied in curriculum development.     

The Patient-centered Medical Home: a new perspective for the family medicine clerkship

BACKGROUND AND OBJECTIVES: The Patient-centered Medical Home (PCMH) concept, essential functions of primary care, and an appropriate primary care workforce have been shown to improve health outcomes and reduce health care costs. This paper describes a curriculum that uses the PCMH and related health policy concepts as the foundation for didactic, clinical, and self-directed elements. The PCMH-focused curriculum improved overall student clerkship ratings and maintained student performance on the National Board of Medical Education subject exam.     

Country report: medical education in France

CONTEXT: The last 10 years have represented a period of significant reform within both the health care and education systems in France. In terms of its workforce, France faces a shortage of doctors, particularly in primary care. METHODS: This paper examines the French medical curriculum, student selection, licensure and continuing medical education and discusses the challenges currently facing French medical faculties. RESULTS: The French medical curriculum is defined nationally, with methods adapted at medical school level. There has been some uptake of innovative methods such as problem-based learning, skills-based teaching and performance-based assessment. However, traditional didactic teaching of scientific medicine and the apprenticeship model remain dominant. France uses a unique method of selection, which is the subject of much debate. Following a general year, medical students are subject to a selection examination that permits only a small number to continue studies. Similarly, at the end of medical school, a written test is used to rank students for the purpose of matching to specialty training. France has no national colleges or licensing authorities and thus authorisation to practise rests on the diploma delivered by each faculty of medicine. From 2005, continuing medical education became compulsory for all doctors. It includes the evaluation of medical practice. CONCLUSIONS: French faculties of medicine face several challenges, including: rising numbers of students without a commensurate growth in the number of faculty members; an increasing emphasis on multidisciplinary health care; a drive towards mandatory continuing education and performance-based outcomes, and the development of national selection examinations that are knowledge-based.     

A student health HMO as a partnership model within an academic medical center

The Department of Family Practice, College of Medicine, in partnership with the University of Illinois at Chicago, was responsible for the reorganization of the Student Health Service into a health maintenance organization (HMO), Campus Care. Historically, the two campuses of the University of Illinois at Chicago operated student health as an infirmary model. Reorganization of student health into the Campus Care HMO provided expanded health care services to students, preserved more health care dollars in the university system, and provided a nonincremental increase in the size and responsibility of the Department of Family Practice. One year's experience showed that while the capitation was low compared with standard HMOs, the variable and less frequent use of services by the student population resulted in a fiscally viable operation. Numerous transition difficulties were encountered, including the need for rapid systems conversion within a complex university system, reeducation of students as well as traditional university-based practitioners for operation in a managed care system, and the rapid expansion of a small family practice department. The positive experience of the University of Illinois at Chicago supports the notion that family practice is better suited to providing student health care than other primary care disciplines. Three issues are paramount to success: (1) approval, support, and protection by higher level administration from university territorialism, (2) a core family practice faculty with strong leadership and experience in high-volume clinical activity, and (3) a close examination of financial resources in light of expected utilization.     

Attitudes, knowledge, and training of medical residents regarding adolescent health issues.

This study examined attitudes, knowledge, and training relating to adolescent health issues, of medical residents in six different specialties who provide care to adolescents, at a southern, rural medical school without an organized curriculum in adolescent medicine. An original 18-item questionnaire was developed which examined four broad health care categories: general medicine, sexuality, high-risk behaviors, and development. Of 118 residents 91 (77%) responded. For any health care area, residents reported managing fewer than 10 adolescent patients and often fewer than 3 patients. However, they reported comfort and confidence and little desire for additional training in most of these areas. There were few differences between specialties or year of training. Almost one-half (42%) believed that pediatric care should end by age 16 years; 32% thought it should end at age 18 years. However, there was little support for pediatricians providing prenatal care to pregnant teens. These findings are useful for planning curriculum in ambulatory adolescent health and developing strategies for encouraging residents to understand and embrace the challenge of adolescent health care.     

Education in family and community health: the challenge faced by a new medical school

This paper describes the efforts of the Department of Family and Community Health at Sultan Qaboos University in providing opportunities for the development of 'hands-on' problem-solving skills appropriate for Oman. The curriculum of the Department is discussed, highlighting the unusual emphasis of this discipline in both the preclinical and clinical curriculum of the College of Medicine. The importance of continuous assessment and supervision of students is discussed. Course-work in the preclinical curriculum of the Department is kept to a minimum. Field-work forms an important part of preclinical training, where application and problem-based learning are emphasized. During the clinical years the students are exposed to an integrated series of lectures and practicals covering core knowledge in clinical medicine. Practical clinical training, over a total period of 15 weeks, takes place at a variety of sites where common problems in primary health care in Oman are handled by students under supervision.