Evaluation of a one-year Masters of Public Health program for medical students between their third and fourth years.

For physicians to better treat and advise their patients on the roles of behavioral and social factors in health and disease, greater levels of competency in social and behavioral sciences are needed. Physicians should also understand the structure, financing, and administration of the health care delivery system, so that they will be able to practice medicine effectively and participate in planning and managing the delivery of care. And, improving overall public health requires that physicians understand the basic tenets of population-based medicine. One way to achieve these goals is to develop education and training programs for integrating formal public health training with formal medical training.There are many models by which a medical student or practitioner can obtain a master of public health (MPH) degree. In this article, the authors describe an accelerated one-year MPH program for competitively selected New York City medical students who have completed their third year of training and enroll at the Mailman School of Public Health, Columbia University. The Macy Scholars Program, offered between 1999 and 2007 to 12 students per year, is completed between the third and fourth years of medical school. Under full-tuition scholarships, students complete a practicum experience, attend seminars, and write a master-level paper or thesis, among other requirements. Data from an evaluation of this program demonstrate participant satisfaction and support of the program, outstanding academic performance, and the effect of public health training on their residency and career choices.     

The Urban Health Program to encourage minority enrollment at the University of Illinois at Chicago College of Medicine.

Since 1969, the University of Illinois at Chicago College of Medicine has worked to recruit, admit, and graduate a more diverse population of physicians. The state of Illinois ranks third in the nation in the number of African American residents, and fifth in the number of Latinos, and these groups together account for approximately 60% of Chicago's population. To attract applicants from these groups, the medical school created the Medical Opportunities Program and its successor, the Urban Health Program, to maximize this pool of applicants. Outreach activities at undergraduate colleges, in association with premedical organizations, identify underrepresented-minority (URM) students who should receive support in their applications. The organizations assist in monitoring the applications of URM candidates. Also, the medical college created academic and social support programs for its URM students: a prematriculation program, small-group review sessions for every major course in the first two years of the curriculum, help for second-year students preparing for the United States Medical Licensing Examination Step 1 and fourth-year students preparing for Step 2, and support for organizations for minority students. Over its 30 years, the program has had a substantial impact on the number of URM students entering the medical college, other medical schools, and other health professions. Over these years, the proportion of URM students in the medical college's overall enrollment rose from 10% to 23%. Also, a higher proportion of the college's URM graduates than its non-URM graduates practice in the Chicago area.     

Educating future physicians for a minority population: a French-language stream at the University of Ottawa.

The Faculty of Medicine at the University of Ottawa has recently developed a French-language undergraduate medical education stream in order to train physicians for the francophone minority population of the province of Ontario. This new program was planned with the following societal requirements in mind: the need to receive health care in one's mother tongue, the need to have physicians who know the community, and the expectation of receiving good medical care in an ambulatory setting. A systematic educational planning model was used in order to develop three educational innovations in response to these needs and expectations: a communication skills laboratory; early student exposure to the ambulatory, primary care setting for development of clinical skills; and clerkship rotations in a francophone community hospital. Program developers provided ongoing faculty development activities in order to prepare francophone faculty for their new roles. They also considered student participation in program development an essential element of its success. The program has positive outcomes both within and outside the Faculty of Medicine. These include an enrichment effect on the English-language stream, an increased interest in medical education, student satisfaction with their community hospital clerkship rotations, and the recognition of the educational program as a national resource for francophone minority groups. Medical schools that serve minority population groups may benefit from the experience gained at the University of Ottawa.     

The integrative family medicine program: an innovation in residency education.

The Integrative Family Medicine (IFM) Program is a four-year combined family medicine residency program and integrative medicine fellowship. It was created in 2003 to address the needs of four constituencies: patients who desire care from well trained integrative physicians, physicians who seek such training, the health care system which lacks a conventional integrative medicine training route, and educational leaders in family medicine who are seeking new strategies to reverse the declining interest in family medicine amongst U.S. graduates. The program was designed jointly by the University of Arizona Program in Integrative Medicine (PIM) and family medicine residency programs at Beth Israel/Albert Einstein College of Medicine (AECOM), Maine Medical Center, Middlesex Hospital, Oregon Health & Science University, and the Universities of Arizona and Wisconsin. One or two residents from each of these institutions may apply, and when selected, commit to extending their training by a fourth year. They complete their family medicine residencies at their home sites, enroll in the distributed learning associate fellowship at PIM, and are mentored by local faculty members who have training in integrative medicine. To date three classes totaling twenty residents have entered the program. Evaluation is performed jointly: PIM evaluates the residents during residential weeks and through online modules and residency faculty members perform direct observation of care and review treatment plans. Preliminary data suggest that the program enhances interest amongst graduating medical students in family medicine training. The Accreditation Council of Graduate Medical Education Family Medicine residency review committee has awarded the pilot experimental status.     

The suicide prevention and depression awareness program at the University of California, San Diego School of Medicine

To address physician depression and suicide at one U.S. medical school, a faculty committee launched a Suicide Prevention and Depression Awareness Program in 2009 whose focus is medical students', residents', and faculty physicians' mental health. The program consists of a two-pronged approach: (1) screening, assessment, and referral and (2) education. The screening process is anonymous, confidential, and Web based, using customized software created by the American Foundation for Suicide Prevention. The educational component consists of a medical-school-wide campaign including Grand Rounds on physician burnout, depression, and suicide as well as similar sessions geared toward trainees. The authors document the process of developing and implementing the program, including the program's origins and goals, their critical decision-making processes, and successes and challenges of the program's first year.Of the 2,860 medical students, housestaff, and faculty who received the e-mail invitation in the first year, 374 individuals (13%) completed screens, 101/374 (27%) met criteria for significant risk for depression or suicide, and 48/374 (13%) received referrals for mental health evaluation and treatment. The program provided 29 Grand Rounds and other presentations during the first year.This may be the first program that aims to increase awareness of depression and to destigmatize help-seeking in order to prevent suicide and whose target population includes the full panoply of medical school constituents: students, residents, and faculty physicians. The program was well received in its first year, and while demonstrating the prevention of suicides is difficult, the authors are encouraged by the program's results thus far.     

Master of science program in health information management at Heidelberg/Heilbronn: a health care oriented approach to medical informatics

In the year 2000 the University of Heidelberg and the University of Applied Sciences Heilbronn established a second educational program in medical informatics, leading to a Master of Science (MSc) degree. In addition to their 4.5 year medical informatics program as an informatics-based approach to medical informatics, a postgraduate program in 'health information management' (Informationsmanagement in der Medizin) was set up as a complementary health care oriented approach to this field. The aim of the MSc program is to qualify physicians and other health care professionals to work as medical informaticians, particularly in the area of health information management. We admit 15 new students into the program each year. The intended program length is 15 months, comprising two study semesters (14 weeks per semester) and three months for the Master's thesis. The graduates are awarded the title 'Master of Science' by the Medical Faculty of the University of Heidelberg. The program is part of the International Partnership in Health Informatics Education of the Universities of Amsterdam, Heidelberg/Heilbronn, Minnesota and Utah. We report on this new program and on our experience with our very first students. The curriculum is compared with the related MSc programs.     

The Community Partnerships Experience: a report of institutional transition at East Tennessee State University.

The Community Partnerships Program, sponsored by the W. K. Kellogg Foundation, served as a catalyst for significant changes within East Tennessee State University (specifically its schools of medicine, nursing, and public and allied health) and the rural communities involved. The authors describe the development and implementation of the program and its effects on the students, faculty, communities, and the three participating schools over the period 1992-1999. They also review the changes the program fostered in health professions education and the resulting institutional changes at their university. The primary motivation for change at East Tennessee State University was the desire to develop primary care providers who could more effectively function in an interdisciplinary and interprofessional health care system and who would be sensitive to community needs in rural and underserved areas. The planning process, curricular transformation, implementation of inquiry-based learning, community collaboration, and interdisciplinary education involving students from the three health professions schools are described, including challenges and difficulties (e.g., student attrition; retention of volunteer community-based clinical preceptors; initial faculty resistance; a climate of competition rather than cooperation). Outcomes are described, including students' enrollment and attrition in the program over time, performances on the U.S. Medical Licensing Examination, program graduates' career choices, and the types and locations of their practices. The program's students performed as well on professional licensing examinations as did their peers enrolled in traditional programs. Program graduates have been much more likely to select primary care careers and to practice in rural locations than have their non-program peers. The development strategies and experience gained could give useful insights to other universities contemplating a community-based component for health professionals within their existing curricula.     

Bringing faculty development to community-based preceptors.

Community-based education of health profession students has increased dramatically, yet providing faculty development to a large, dispersed, and diverse population of community-based faculty is challenging. The authors describe lessons learned from 1997 to 2000 in developing, using, and disseminating a collection of preceptor development materials designed to be relevant to community-based faculty and easy to use. These activities were carried out by the Preceptor Development Program, which was developed by the Mountain Area Health Education Center of Asheville, North Carolina, which works with over 500 community preceptors of health profession students and medical residents. The program includes materials on nine core faculty development topics in a variety of formats: seminars, monographs, Web modules, and one-page summary "thumbnails." Faculty developers can download these free, customizable materials from the Web and are encouraged to adapt them for their own use.     

Support programs for minority students at Ohio University College of Osteopathic Medicine.

The Ohio University College of Osteopathic Medicine ranks high among the nation's 19 osteopathic medical schools with respect to the percentage of underrepresented minorities (URMs) in the entering class. The college has strong recruitment and retention programs for URM and disadvantaged students. URM enrollment rose steadily from 11% in 1982-83 to 22% in 1997-98, despite the school's location in a rural, residential public university with few minorities as students or town residents. The college has six programs to support minority students through both undergraduate and medical school: the Summer Scholars Program (1983 to present), an intensive six-week summer program to prepare rising under-graduate seniors and recent graduates to apply to medical school; Academic Enrichment (1987 to present), to support first- and second-year medical students; the Prematriculation Program (1988 to present), an intensive six-week summer program for students who will matriculate in the college; Program ExCEL (1993 to present), a four-year program for undergraduates at Ohio University; the Summer Enrichment Program (1993 to present), an optional six-week program for students who will enter the premedical course at Ohio University; and the Post-baccalaureate Program (1993 to present), a year-long, individually tailored program for URM students who have applied to the medical college but have been rejected. The medical college first focused on supporting students already in the medical school curriculum, then expanded logically back through the undergraduate premedical programs, always targeting learning strategies and survival strategies, peer and faculty support, and mastery of the basic science content. The college plans to create an on-site MCAT preparation program and perhaps expand into secondary education.     

An evaluation of the Rural Medical Education Program of the State University Of New York Upstate Medical University, 1990-2003.

PURPOSE: The Rural Medical Education Program (RMED) of the State University of New York (SUNY) Upstate Medical University is a 36-week clinical experience in rural communities for medical students that began in 1989. The authors sought to assess RMED's success in providing a valuable educational experience for students that assists rural communities recruit physicians. METHOD: In 2004, the authors used the Physician Masterfiles of the American Medical Association to compare practice locations of SUNY Upstate graduates who completed RMED with those who did not; surveyed former RMED students to assess their satisfaction with their practice location and the importance of RMED in helping them choose a location; interviewed hospital administrators in communities that have hosted RMED students to understand the impact of RMED on host communities; and compared United States Medical Licensing Examination Step 2 scores of RMED students with those of non-RMED students to evaluate educational attainment. RESULTS: A greater percentage of former RMED students practiced in rural locations [22/86 (26%)] than did non-RMED students [95/1,307 (7%)]. Ninety-one percent (69/76) of former RMED students were satisfied with their location, and 84% (64/76) believed that RMED was important in helping them choose a location. Hospital administrators viewed the program highly because it helped them recruit physicians and benefitted their medical staff. RMED students had higher adjusted mean Step 2 scores than did non-RMED students (212.3 versus 199.1). CONCLUSION: The RMED program has successfully met its goals of providing a valuable educational experience for medical students and assisting rural communities recruit physicians.     

A mentoring program for underrepresented-minority students at the University of Rochester School of Medicine.

Mentoring underrepresented-minority (URM) students poses a special challenge because most medical schools have few URM faculty and many non-URM faculty hesitate to be mentors for URM students. Some medical students perform less well in the clinical years than would be expected from their pre-clinical performances. One factor is some students' difficulty in adapting to the culture of medicine, which mentors can help students overcome. The University of Rochester School of Medicine created the Medical Student Mentoring Program to address the needs of URM students and non-URM faculty who could be mentors. The program, offered in 1995-96 and 1996-97, trained mentors, created a bicultural support group for URM students, and provided structured mentoring. Interviews were conducted with faculty and students to identify critical areas that influence the success of URM students in their clinical years; URM faculty, residents, and advanced students shared their experiences with the program students at reflection group meetings. Mentors participated in an initial orientation. Of the 42 students eligible during 1995-1997, 30 participated and were assigned to 15 mentors. At the end of the program's first year, the students and mentors gave their reactions, and although there were some differences in their viewpoints, overall they considered the program useful. Non-URM faculty appreciated the support and guidance that allowed them to mentor URM students more effectively. The program ran formally for two years, and some of the mentoring relationships continued into the third year. Loss of funding and change in administrative leadership contributed to the ending of this program. Mentoring continues to be a priority at the medical center, and a new mentoring program has been developed for URM and non-URM medical students.     

Paving Pathways: shaping the Public Health workforce through tertiary education

Public health educational pathways in Australia have traditionally been the province of Universities, with the Master of Public Health (MPH) recognised as the flagship professional entry program. Public health education also occurs within the fellowship training of the Faculty of Public Health Medicine, but within Australia this remains confined to medical graduates. In recent years, however, we have seen a proliferation of undergraduate degrees as well as an increasing public health presence in the Vocational Education and Training (VET) sector.Following the 2007 Australian Federal election, the new Labour government brought with it a refreshing commitment to a more inclusive and strategic style of government. An important example of this was the 2020 visioning process that identified key issues of public health concern, including an acknowledgment that it was unacceptable to allocate less than 2% of the health budget towards disease prevention. This led to the recommendation for the establishment of a national preventive health agency (Australia: the healthiest country by 2020 National Preventative Health Strategy, Prepared by the Preventative Health Taskforce 2009).The focus on disease prevention places a spotlight on the workforce that will be required to deliver the new investment in health prevention, and also on the role of public health education in developing and upskilling the workforce. It is therefore timely to reflect on trends, challenges and opportunities from a tertiary sector perspective. Is it more desirable to focus education efforts on selected lead issues such as the "obesity epidemic", climate change, Indigenous health and so on, or on the underlying theory and skills that build a flexible workforce capable of responding to a range of health challenges? Or should we aspire to both?This paper presents some of the key discussion points from 2008 - 2009 of the Public Health Educational Pathways workshops and working group of the Australian Network of Public Health Institutions. We highlight some of the competing tensions in public health tertiary education, their impact on public health training programs, and the educational pathways that are needed to grow, shape and prepare the public health workforce for future challenges.     

A core curriculum for international health: evaluating ten years' experience at the University of Arizona.

215 graduates (118 women and 97 men) of the University of Arizona's International Health Core Curriculum received a questionnaire after completion of their clinical practice in order to evaluate the experience of 10 years from 1982-91. The curriculum consisted of a 3- week orientation course given to 4th year medical students with core contents of population, nutrition, and infectious diseases followed up by student evaluation upon completion. 192 students were eligible for the survey of whom 154 completed it yielding an 80% response rate: 139 future physicians and 15 nurses, health educators, and nutritionists. 113 of 154 respondents completed an international health field experience after the course in 43 developing countries: 22% in Africa, 39% in Asia-Pacific, and 39% in Latin American-Caribbean. 79% were in rural and 34% in urban areas. A public health-community medicine program was incorporated in the clinical work at most sites. 95% of them participated in clinical care, 73% in community teaching, and 51% in research and evaluation. The duration of this field experience lasted 6-12 months for 69% of them. The median responses regarding the possibility of postcourse international field work and rating the worth of the course for clinical care, teaching others, and research were well or very well. They also rated the preparation of the course for subsequent work at 43 specific sites as good and dealing with limited resources and cross-culture communication as very good. All were willing to recommend the course to their peers.     

Effect of two Howard Hughes Medical Institute research training programs for medical students on the likelihood of pursuing research careers.

PURPOSE: To assess the effect of Howard Hughes Medical Institute's (HHMI) two one-year research training programs for medical students on the awardees' research careers. METHOD: Awardees of the HHMI Cloister Program who graduated between 1987 and 1995 and awardees of the HHMI Medical Fellows Program who graduated between 1991 and 1995 were compared with unsuccessful applicants to the programs and MD-PhD students who graduated during the same periods. Logistic regression analyses were conducted to assess research career outcomes while controlling for academic and demographic variables that could affect selection to the programs. RESULTS: Participation in both HHMI programs increased the likelihood of receiving National Institutes of Health postdoctoral support. Participation in the Cloister Program also increased the likelihood of receiving a faculty appointment with research responsibility at a medical school. In addition, awardees of the Medical Fellows Program were not significantly less likely than Medical Scientist Training Program (MSTP) and non-MSTP MD-PhD program participants to receive a National Institutes of Health postdoctoral award, and awardees of the Cloister Program were not significantly less likely than non-MSTP MD-PhD students to receive a faculty appointment with research responsibility. Women and underrepresented minority students were proportionally represented among awardees of the two HHMI programs whereas they were relatively underrepresented in MD-PhD programs. CONCLUSIONS: The one-year intensive research training supported by the HHMI training programs appears to provide an effective imprinting experience on medical students' research careers and to be an attractive strategy for training physician-scientists.     

A teaching scholars program to develop leaders in medical education.

The authors describe a year-long faculty development initiative to develop leaders in medical education. The Teaching Scholars Program for Educators in the Health Sciences at McGill University enables faculty to improve their educational knowledge and skills while maintaining their clinical, teaching, and research responsibilities. The program, tailored to the participant's individual needs, consists of five main components: two university courses; independent study; participation in faculty-wide faculty development workshops and medical education rounds; a monthly seminar; and attendance at a national or international conference or course. Since its inception in 1997, 22 faculty members have completed the program; four are currently participating in it. This report discusses the experience of 15 scholars who completed the program by September 2000. Evaluations indicate that the scholars achieved most of their stated objectives. The university courses provided a foundation in educational principles and methodology; independent study allowed them to work on educational projects relevant to their disciplines; and the monthly seminars, faculty development workshops, and outside courses offered opportunities for skill acquisition and reflection. Participants also appreciated the opportunity to meet others interested in medical education and to become aware of available educational resources. A year after completing the program, many had joined new educational committees, taken on new leadership roles in medical education, and developed new courses for students and residents. Some of their projects had been presented at national meetings and were being prepared for publication. Two scholars had pursued further study at a master's level. Despite the ongoing challenge of protecting time for educational pursuits, this program has been beneficial in helping to develop educational leaders in the Faculty of Medicine.     

M.D.-Ph.D. training at the Johns Hopkins University School of Medicine, 1962-1991.

From 1962 to 1991, 150 students earned both the M.D. and the Ph.D. degrees in a combined program of study at The Johns Hopkins University School of Medicine (JHUSM). Seventy-five of these individuals were supported by the Medical Scientist Training Program (MSTP) of the National Institutes of Health. The authors analyzed the professional development of these dual-degree recipients, focusing particularly on the 109 M.D.-Ph.D.s who graduated since 1980, when the first MSTP-supported student received both degrees. Of the 109 graduates since 1980, 42 are now in career positions. Thirty-four of the 42 graduates (81%) obtained clinical housestaff training, and 21 of the 34 also had postdoctoral science training. Nearly all of the 42 M.D.-Ph.D.s are in full-time academic posts (81%) or positions in research institutes (14%); the remaining 5% hold research positions in biotechnology firms. All 42 graduates are actively involved in research, and 67% have regular and well-defined clinical responsibilities. Analysis of the representation of M.D.-Ph.D.s on the JHUSM faculty from 1962 to 1991 shows a striking increase with time in the percentage of M.D.-Ph.D.s among the full-time faculty, particularly at the level of assistant professor. These findings suggest that M.D.-Ph.D. graduates nationwide are being recruited in increasing numbers to medical school faculties and are pursuing medical careers encompassing both research and clinical practice.     

An innovative clerkship module focused on patients with disabilities

Lack of medical training results in physicians being unprepared to provide care to people with disabilities, which, in turn, contributes to the substantial health disparities that are evident in this population. Few medical schools or primary care residencies address the care of adults with disabilities. Competencies and guidelines to assist American physicians in caring for patients with physical or intellectual disabilities have yet to be established, thus making educational goals unclear. This article describes one novel training module regarding people with disabilities that was developed at the University of South Florida Health, Morsani College of Medicine (USF) and inserted into the primary care clerkship during a major curriculum redesign in 2005. Since then, all USF third-year medical students have been required to participate in this disability-related course component. The authors describe the module's development and integration into the primary care clerkship, as well as the specific elements of their curriculum. By using a variety of teaching modalities in the classroom and community, and especially by involving people with disabilities themselves, the medical students have a very comprehensive learning experience regarding people who have physical, sensory, or intellectual disabilities. The authors have been able to show that USF medical students, on completion of this module, demonstrate improved knowledge, attitudes, and comfort in caring for people with disabilities, which the authors believe will lead to improved health and health care access for this underserved population. Suggestions for program replication, including common challenges, are also discussed.     

Teaching population health as a basic science at Harvard Medical School

In 2006-2007, Harvard Medical School implemented a new, required course for first-year medical and dental students entitled Clinical Epidemiology and Population Health. Conceived of as a "basic science" course, its primary goal is to allow students to develop an understanding of caring for individuals and promoting the health of populations as a continuum of strategies, all requiring the engagement of physicians. In the course's first iteration, topical content accessible to first-year students was selected to exemplify physicians' roles in addressing current threats to population health. Methodological areas included domains of clinical epidemiology, decision sciences, population-level prevention and health promotion, physicians' roles in the public health system, and population-level surveillance and intervention strategies. Large-group settings were selectively used to frame the relevance of each topic, and conceptual learning of statistical and epidemiologic methods occurred in conference groups of 24 students. Finally, tutorials of eight students and one or two faculty were used for critical reading of published studies, review of problem sets, and group discussion of population health issues. To help students appreciate the structure and function of the public health system and physicians' role in public health emergencies, the course included a role-playing exercise simulating response to an influenza pandemic. The first iteration of the course was well received, and assessment of students suggested mastery of basic skills. Preclinical courses represent a progressive step in developing a workforce of physicians who embrace their responsibility to improve the health of the population as a whole, as well as the health of the patient in front of them.     

A multifaceted program to encourage medical students' research.

Clinician-scientists are important members of a research community that has more opportunities than ever before to solve problems important to patients. Nevertheless, the number of physicians applying for and receiving grants from the National Institutes of Health (NIH) has dropped. Introducing medical students to research and relevant support mechanisms early in their education may help to reverse this trend. In 1995, the Mount Sinai School of Medicine created its Office of Student Research Opportunities (OSRO) to stimulate students to engage in research. It also appointed a new dean to direct the OSRO; the person who filled this new position was a senior faculty member involved in patient-oriented research. The OSRO advises students, identifies faculty who want to mentor students, sponsors the Distinction in Research program, organizes an annual research day, helps fund summer and full-time research, and has created an endowment to support student travel to national meetings. Between 1997 and 2000 the number of students who participated in the research day increased from 18 to 74, and the number of publications by the graduating classes increased from 34 to 58 between 1997 and 1999. Participants have presented both basic and clinical projects. The authors' experience has shown that medical students can be motivated to carry out research with appropriate encouragement from the administration and the faculty, something that may help to reverse a troubling national trend. Based upon these early successes, Mount Sinai is developing a novel five-year program to provide medical students with research training.