March Back to Basics, 2013 POPULATION HEALTH Nick Birkett Epidemiology & Community Medicine

March THE PLAN Mon, Mar Intro; Epidemiology methods (Dr. N. Birkett) Wed, Mar Health Care System (Dr. D. Coyle) Health determinants, prevention in theory (I. McDowell) Mon, Mar Vital statistics (Dr. N. Birkett) Immunization & Communicable disease control (Dr. N. Birkett) Thur, Mar Prevention in practice: Periodic Health Exam (Drs. M. Maher & L. Bourns) Occupational & Environmental Health (Drs. M. Maher & L. Bourns)

March Structure Lectures with discussion & some trial MCQs. Built around the MCC Objectives for Qualifying Examination Emphasis is on core ‘ need to know ’ rather than on depth and justification Focus is on topics not well covered in the Toronto Notes Toronto Notes

March MCC QE, Part I Revised objectives arose from many discussions over Public (or Population) Health competencies for physicians (much of what UOttawa covers in SIM) MCC content now named Population Health, Ethics, Legal & Organizational topics (PHELO).PHELO This has absorbed some earlier CLEO and C 2 LEO topics (Culture, communication, legal, ethics, organization)C 2 LEO

March MCC QE, Part I Aim is to merge population health & some CLEO objectives into main pool of questions, showing clinical relevance of prevention, etc., rather than keeping separate. Many C 2 LEO topics are included in Part II of the exam. MCC now mapping all its objectives onto CanMeds roles. Population health content links to roles such as scholar, advocate, manager: these may be the themes underlying some questions.

March MCC MCQ format Questions generally include a clinical scenario –Topics should be clinically relevant to a CanMeds role One correct answer & 4 plausible distractors –No “ except ” questions. No “ all of the above ” –Sometimes: correct = the better answer –Management: often “ What is your best next step? ” –Avoid “ factoids ” ( ‘ which is the second most important cause of death in Canada? ’ ) Key features – each question tests one concept

March LMCC New Objectives (1) Population Health Concepts of Health and Its Determinants (78-1) Assessing and Measuring Health Status at the Population Level (78-2) Interventions at the Population Level (78-3) Administration of Effective Health Programs at the Population Level (78-4) Outbreak Management (78-5) Environment (78-6) Health of Special Populations (78-7)

March LMCC New Objectives (2) C 2 LEOC 2 LEO (URL to LMCC objective page) Considerations for –Cultural-Communication, Legal, Ethical and Organizational Aspects of the Practice of Medicine

March LMCC New Objectives (3) We won ’ t be able to cover every objective in detail. Sessions will be based around objectives, with links identified as appropriate. Start with some overviews.

March LMCC New Objectives (4) 78.1: CONCEPTS OF HEALTH AND ITS DETERMINANTS (March 20) Define and discuss the concepts of health, wellness, illness, disease and sickness. Describe the determinants of health and how they affect the health of a population and the individuals it comprises. Lifecourse/natural history Illness behaviour Culture and spirituality

March LMCC New Objectives (5) 78.1: CONCEPTS OF HEALTH AND ITS DETERMINANTS Determinants of health include: –Income/social status –Social support networks –Education/literacy –Employment/working conditions –Social environments –Physical environments –Personal health practices/coping skills –Healthy child development –Biology/genetic endowment –Health services –Gender –Culture

March LMCC New Objectives (6) 78.2: ASSESSING AND MEASURING HEALTH STATUS AT THE POPULATION LEVEL (March 18, March 25) Describe the health status of a defined population. Measure and record the factors that affect the health status of a population with respect to the principles of causation –Principles of Epidemiology, critical appraisal, causation, etc..

March LMCC New Objectives (7) 78.3: INTERVENTIONS AT THE POPULATION LEVEL (March 20) Understand three levels of prevention Concepts of Health Promotion, etc.. Role of physicians at the community level. Impact of public policy

March LMCC New Objectives (8) 78.4: ADMINISTRATION OF EFFECTIVE HEALTH PROGRAMS AT THE POPULATION LEVEL (March 20) Structure of the Canadian Health Care System Concepts of economic evaluation Quality of care assessment

March LMCC New Objectives (9) 78.5: OUTBREAK MANAGEMENT (March 25) Know defining characteristics of an outbreak Demonstrate essential skills in outbreak control

March LMCC New Objectives (10) 78.6: ENVIRONMENT (March 28) Recognize implications of environmental health at the individual and community levels Know methods of information gathering Work collaboratively with other groups Recommend to patients and groups how they can minimize risk and maximize overall function

March LMCC New Objectives (11) 78.7: HEALTH OF SPECIAL POPULATIONS (March 28) Specific target population include: –First Nations, Inuit, Métis Peoples –Global health and immigration –Persons with disabilities –Homeless persons –Challenges at the extremes of the age continuum