1. 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

2. 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

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

4. 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)

5. 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

6. 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

7. 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 -

8. 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

9. 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

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

11. 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

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