1. Dr Caroline Shaw Senior Lecturer, UOW April 2018
Medical undergraduate public health teaching: An experiment in case based learning
Dr Caroline Shaw
Senior Lecturer, UOW
April 2018

2. Purpose of session
Outline framework of a new module to be commenced in 2019
Keen to discuss the ideas with other people
Opportunity for me to reflect on this project

3. Otago MBChB Public Health teaching
Year 1 (health sciences)
PUBH 192
Year 2 PH
EBP
Year 3
CCW
Year 4
CDM
Primary care
Hauora Maori
Year 5
Paeds
Year 6
Early learning in medicine (Dunedin)
Advanced learning in medicine (Wellington)
ALM/ELM (dunedin- dud/ch/wgtn)
PUBH 192- first year health sciences course, broadly speaking an epi course, taught to 1200 people, most of whom will not go onto a medical degree. Lecture content in the background material.
2nd and 3rd year PH- About 20 (1-2 hr) sessions over the 2 years Topic based e.g. epidemiology of suicide, control of infectious diseases, scattered over the teaching year (often poorly attended lecture spots)
2nd and 3rd year- evidence based practice- about 10 sessions (lectures and tutes) epi, critical appraisal
4th year teaching is probably the biggest chunk of explicit PH teaching in the degree
However as you can see in the slide there are other parts of the degree where public health content is taught, explicitly or implicitly (not a comprehensive list) more details on each in the background document
CCW- Community contact week, CDM- clinical decision making, EBP- Evidence based practice, PH- Public health

4. Otago MBChB Public Health teaching
Y1 (health sciences)
PUBH 192 Y2 PH
EBP Y3
CCW Y4
CDM
Primary care
Hauora Maori Y5
Paeds Y6
Early learning in medicine (Dunedin)
Advanced learning in medicine (Wellington)
students for 5 weeks, 6x a year
ALM/ELM (dunedin- dud/ch/wgtn)
PUBH 192- first year health sciences course, broadly speaking an epi course, taught to 1200 people, most of whom will not go onto a medical degree. Lecture content in the background material.
2nd and 3rd year PH- About 20 (1-2 hr) sessions over the 2 years Topic based e.g. epidemiology of suicide, control of infectious diseases, scattered over the teaching year (often poorly attended lecture spots)
2nd and 3rd year- evidence based practice- about 10 sessions (lectures and tutes) epi, critical appraisal
4th year teaching is probably the biggest chunk of explicit PH teaching in the degree
However as you can see in the slide there are other parts of the degree where public health content is taught, explicitly or implicitly (not a comprehensive list) more details on each in the background document
CCW- Community contact week, CDM- clinical decision making, EBP- Evidence based practice, PH- Public health

5. Background work
4 sets of PH learning outcomes across the 3 campuses were reviewed and dropped
Development of a set of ILOs that cover all the PH teaching across the degree
MBChB curriculum mapping process
Adoption of Hauora Māori ILOs and new Pacific Curriculum ILOs

6. Implementing the new curriculum
Focus on practising medicine with a population perspective
What would we want doctors to do differently in their clinical careers?
Rose approach
Application of PH principles
Case-based learning
Variant of PBL with more structure
Used in other undergraduate health sciences teaching, but not seen any published reports of using it in a specific PH module
Use cases as spring boards to deliver PH ILOs

7. Module structure T & L Assessment E-Portfolio – determinants of health
4 cases (mix of starting with individual and population issues)
Cross-cutting learning
Community visits
Seminars - “Too much medicine”, health systems, PH ethics
Online resources
Video interviews of clinicians
MCQ bank
Core PH concept videos
E-Portfolio – determinants of health
Practising medicine with population perspective – presentation and brief report
Using cases to illustrate public health content
Relevance to other modules within the degree also

8. Case 1 stem
GP working at a not-for-profit community health service. The practice nurse has asked you to see
Mr X, who is a prominent local leader of the Pacific community and who has had a long history of well-controlled diabetes.
Mr X was visiting the nurse for an annual review of his diabetes care plan (the practice has a well-organised system to support patients with long-term conditions).
Signs and symptoms of TB and contact with a case

9. Week 1 Monday Tuesday Wednesday Thursday Friday AM Intro to module
Monday
Tuesday
Wednesday
Thursday
Friday AM
Intro to module
Case 1 – S1
Infectious disease (TB) & outbreak investigation – with the Medical Officer of Health at Public Health Unit
Case 1 – S2
Immunisation
Case 1 –S3
Antimicrobial resistance & population health intervention (using the Ottawa Charter)
Case 1 –S4
Climate change PM
Case 1 class preparation
Case 2 class preparation
Case 1 - Pacific health session
THREADS
Self-guided work (or wrap up session)

10. Case development
Stem gradually developed to lead into the various workshops
E.g. antimicrobial resistance session: Rapid gene-probe test (Xpert MTB/RIF®) was positive for Rifampicin resistance
E.g. Immunisation – 18 month old toddler in the house who has not had any of the usual immunisation schedule
Use Ottawa Charter to design intervention in DHB/community to reduce infections (one strand of WHO global plan), reflect on what your interventions will do to inequalities
Role play consultations/discussions around vaccine hesitancy and then case study on population level approaches to increase vaccination (focusing on success of Pacific immunisation coverage in NZ)

11. Example of workshop Day 1 of module introduced to case stem In class
Come up with up to 5 actions at end of consultation, them to Medical Officer of Health
Out of class
Outbreak investigation framework (reading from textbook or video depending on preference)
Preliminary information on TB
Video on what a PHU is and what a Medical Officer of Health does (2 mins)
List of notifiable diseases (1 page)
MCQs

12. Example of workshop Time Detail Part A: Immediate actions 9 – 9.30 am
Introduction and whole-group MOH-led discussion about the priority actions contained in the students’ s. Video/activity around notification process.
Part B: Outbreak Investigation
9.30 – 9.45 am
Case update #1 and whole-group discussion about the definition of ‘outbreak’.
9.45 – am
Small group work – outbreak response
10.15 – am
Small groups present back – whole group discussion.
10.45 – 11 am
Morning tea break.
Part C: Communication
11 – am
Case update #2 – Media response small group work.
11.15 – am
Whole group student role play of media interview.
Part D: MoH/PHU work
11.45 – 12pm
Brief MoH presentation/discussion on highlights of other outbreak scenarios and population health surveillance. Provide case update for students to prepare for Session 2 (immunisation).

13. Challenges Stakeholder management during the review process
Module will be delivered by multiple people
Change of content, focus and delivery methods challenging
Designing course materials for other people to deliver is tricky
Risk of curriculum drift (particularly from those that appear reluctant to engage with the new approach)
Input from multiple people needed for each case e.g. microbiology, Medical Officers of Health, Pacific staff, immunisation specialists
Spiral of learning
Evaluation

14. Acknowledgments
Diana Sarfati
Amanda D’Souza
Richard Jaine