Curricular Innovations in Public Health & Health Policy STFM MSE Conference 2015 David Power, MD, MPH Jacob Prunuske, MD, MSPH David Satin, MD

Agenda Background Our experience National resources Our working recommendations Lots of time for Discussion!

Background, PHHP Initiative State of the Curriculum Retreat Student Interest Community Stakeholders Local SPH ACA Innovations contest CUB retreat: gaps in readiness to practice

Medical School Education Innovations Contest

Top 4 Vote Getters 340 VOTES: Public Health Integration into the Medical School Curriculum - Rachael Harlos, Wendy Jin, Brian Park, Roma Patel, Gina Piscitello, Kate Weir 255 VOTES: Specialty-Specific Residency Match Support Program - Luke Dolezal, Mackenzie Becker, Scott Davenport, Sandra Montezuma, Michael Lee 205 VOTES: MEDules, Low-cost, Mechanical Devices for Training Procedural Surgical Skills - Alexander Doud 165 VOTES: Health Policy in an Era of Health Reform - Tyler Winkelman, David Satin, Ezra Golberstein, Sarah Gollust

Public Health in Medical Education Who Will Keep the Public Healthy: Educating Public Health Professionals for the 21st CenturyWho Will Keep the Public Healthy: Educating Public Health Professionals for the 21st Century Training Physicians for Public Health CareersTraining Physicians for Public Health Careers Primary Care and Public Health: Exploring Integration to Improve Population HealthPrimary Care and Public Health: Exploring Integration to Improve Population Health -IOM 2002, 2007, 2012

Standing on the Shoulders of Giants The AAMC-CDC Regional Medicine and Public Health Educational Centers have developed and published (2010) Public Health Competencies Specific to Medical StudentsPublic Health Competencies Specific to Medical Students Duke has developed a Competency Map for teaching public health. Competency Map: Integrating Population Health Into Clinician Education. Kaprielian VS, Silberberg M, McDonald MA, et al. Teaching population health: a competency map approach to education. Acad Med. 2013;88(5): Competency Map The CDC has a page of Public Health and Health Care Collaboration Resources that includes a resource list for integrating public health into health professions education Public Health and Health Care Collaboration Resources integrating public health into health professions education The Association of Faculties of Medicine of Canada (AFMC) has a Resource Page including annotated bibliographies, lit reviews, executive summaries and other useful resources for integrating public health and medical education. Resource Page The AAMC has a Public Health & Medical Education Bibliography Public Health & Medical Education Bibliography The IOM report, Training Physicians for Public Health Careers (2007), discusses public health roles for all physicians and those who practice public health specifically. Pages 68 – 70 discuss what all physicians should know. Training Physicians for Public Health Careers New Mexico and Wisconsin are examples of schools that have strong integration of public and population health into the curriculum. Many examples of curricular innovation can be found in the dedicated AJPM issue, October 2011, Volume 41, Issue 4, Supplement 3, S145-S318 focused on the integration of public health into medical education.New MexicoWisconsin AJPM The AAMC has a new website, Public Health Pathways, featuring public health training opportunities throughout the medical education continuum. Public Health Pathways

Students Report Inadequate Instruction 27% Public Health 32% Role of Community Health, Social Service Agencies AAMC. GQ Medical School Graduation Questionnaire 2014.

Students Report Inadequate Instruction Health policy 40% Occupational medicine 37% Health care systems 35% Environmental health 34% Medical Economics 62% Disparities 13% AAMC. GQ Medical School Graduation Questionnaire 2013.

2012 CERA Survey Majority of PH curricula in FMC devoted to behavioral science, communication and cultural competence Less time devoted to health policy, law & ethics, global health, health services 68% of FM CD agree PH Training appropriate for clerkship PH must extend beyond FMC Fam Med 2014;46(7):544-8.)

Many Options Dual Degree Certificate Track Extracurricular

Social Mission Social Mission & Ranking of Medical Schools -Mullan et al. Ann Intern Med. 2010;152(12):

3 Workgroups Public Health / Health Policy (PHHP) Quality Improvement / Patient Safety Interprofessional Education

PHHP Workgroup Five monthly 2.5 hour meetings Representation: –Faculty, students, FM, IM, ID, Rural track, both campuses, SPH Policy Division, School of Public Affairs, State Dept of Health and MN Medical Association Size matters! –large (12-16), diverse for brainstorming –small (8 or less) for decision making

SCOPE “overhaul” of curriculum V “dabbling”

Background, baggage, something to say... Individual meetings Going to meet the other on their turf pre-planning between meetings

ENVIRONMENTAL SCAN Institutional attitudinal survey of students, course and clerkship directors, program directors Institutional survey of what’s taught where Not everyone is ‘on board’: “Covering topics like public health and health policy distracts from the real work of being a medical student – namely learning about health and disease and how to practice clinical medicine”

ENVIRONMENTAL SCAN

Summary of Environmental Scan DIFFICULT! Many topics already addressed Existing content sometimes superficial Much of content is applied –eg. journal club format to critique an article, EBM project Little or no collaboration across courses

Working Recommendations

Play to our strengths Lots of local PH goodwill School of Public Health = Great asset Augment Health Policy curriculum Build on significant existing PH content in curriculum: poorly identified, not coordinated, unintentionally duplicative

curricular progress Increased PHHP content within courses Increased PHHP integration across courses course management/tracking software ‘Brand’ PHHP content in courses so it is readily identifiable [(c) Einstein]

Build on success Incorporate successful, elective content into required curriculum: eg., “The Poverty simulator” “Equity and diversity presentation” “Slam Poetry”

Set the Stage from Day 1 All incoming medical students receive formal introduction to population health and public health at the start of year 1 Acknowledge PH role of all physicians Focus on local populations for relevance

Partnerships explore partnerships with local state and city health depts partner with local medical associations partner with community advocacy groups

Faculty Development Provide faculty development for PHHP Repository of curricular resources/materials/content experts

Applied project for all Every medical student participates in a project: –Existing Service-learning, –To add: PH,HP, QI, Interprofessional Care –Augment projects within LICs

Longitudinal Emphasis Core days/weeks for Years 3&4 students to return to campus for ‘Back to the Basics’, including PHHP educational activities

Advanced experiences Facilitate and encourage certificate or MPH (tuition breaks?) Encourage combined MD/MPH For students in MPH program, allow concurrent med school credit Electronic ‘BADGE’

Curricular Innovations in Public Health & Health Policy Discussion