A framework for mapping public health learning exposures and competency alignment in undergraduate medical education Professor Roger Hughes Head, Public Health & Health Systems School of Medicine

Context for curriculum renewal UTAS MBBS program- 5 years, first 2 year largely on-campus, year 3-5 progressively more practice integrated learning Complex curriculum governance – year (5) x domain (4) matrix structure of committees- complex and many stakeholders Health & Society Domain one of 4 domains of the AMC Graduate Outcomes for Medical Graduates Non-negotiable standards for graduate competency Maps broadly (sometimes vaguely) to public health competencies (e.g. CAPHIA’s) Curriculum renewal triggers: Staff turnover and gaps- a pragmatic need for review and reorganisation AMC recommendations post accreditation review (2016) Student evaluations indicating dissatisfaction

Curriculum renewal process Mapping Educator consultation Framework design and development Implementation Evaluation Student evaluations Timetable audit

Step 1: Mapping: Minimal vs Aspirational competency expectations Competency standards Guidance AMC (2012)- Health and Society graduate outcome statements Minimum expectations CAPHIA (2016)- Foundation competencies for public health graduates in Australia Aspirational CAPHIA (2017)- National Aboriginal and Torres Strait Islander Public Health Curriculum Framework (2nd) RACP (2014) – Public Health Medicine Advanced Training Curriculum PHEMS (2014)- Undergraduate public health curriculum for UK Medical Schools International The Council on Linkages between Academia and Public Health Practice (2014)- core competencies for public health professionals International (aspirational)

Step 2: Timetable Auditing Actual time-tabled allocations for domain 3 content Unequal distribution/exposure Years 4 & 5 integrated but difficult to quantify Curriculum squeeze 10-15% range

Step 3: Educator consultation Key themes: Domain 3 “underdone” Curriculum squeeze- biomedical and clinical domains the priority Need for greater integration and cross fertilisation No broadly understood framework for public health- confusion Disorganisation- under-resourced

Step 4: Student evaluations A place to rest? + Repetition No clear structure/logic Perception of importance + - - - Relevance to practice Sequencingand scaffolding Reliance on external teachers -

Challenges /opportunities at commencement Curriculum crowding Established and rigid timetable- progressive squeeze out Medical educators disengaged from domain 3 content and delivery Staff turnover- immediate teaching gaps No clear curriculum framework or logic AMC report expectations- staffing and leadership needed Some excellent educational materials existing- legacy School Leadership- encouraging innovation Widespread enthusiasm and recognition for the need for renewal

Curriculum intent and strategy Recognise T&L exposure limitations in a crowded curriculum Fit within existing limitations with some gradual squeeze back Modularisation of content- flexible Explicit curriculum framework (with scaffolded learning) The Public Health lens Enhance relevance to medical practice- actual and perceived Better understand opportunities for year 4 & 5 learning opportunities- public health practice

The public health lens Conceptual Epidemiology Determinants Populations Interventions Health systems Workforce Current & Emergent

Scaffolding, the lens…public health competency Practice Intervention management Capacity building Populations Indigenous, mothers and infants, elders, refugees, NESB Priorities Diabetes, Cancer, Mental Health, CVD, Dementia, Injury prevention Risks Diet, physical activity, sleep, smoking, alcohol, drugs, sex Determinants Social, economic, cultural, environmental Conceptual Socio-ecological, Ottawa, Systems thinking etc Professional Cultural competence, ethics, EBP Prevention Practice Competency Conceptual Determinants Risk Factors Health Priorities Populations Professional

A work in progress !!!!! Team Dr Rosie Nash Dr Jen Ayton Dr Nick Cooling Professor Jenny Presser