1. Building A Fund of Knowledge for Community Medicine

2. It is a safe rule to have no teaching without a patient for a text, and the best teaching is that taught by the patient himself. - Sir William Osler

3. Mattie 67-year-old African American female Long history of type 2 diabetes Admitted with progressive shortness of breath Evaluated appropriately with history, physical exam, lab, x-ray, echocardiogram Silent myocardial infarction and congestive heart failure

4. Mattie, continued From a CV standpoint, she did well Blood sugars were poorly controlled “Non-compliant”

5. Mattie’s Vices

6. ADA Diet, Board Exam Prep Which of the following would NOT be considered the most healthful food choices for an individual with type 2 diabetes? A. Fresh fruits and vegetables B. Dried beans C. Fatback and buttermilk D. Whole grain foods

8. We don’t always tell the truth. We don’t always know the truth. The Truth

9. ABCs of Preventive Cardiology A – Aspirin/antiplatelet; ACE B – Beta blocker C – Cholesterol; cigarettes D – Diabetes; E – Vitamin E; Estrogen; Exercise

10. ABCs of Preventive Cardiology A – Aspirin/antiplatelet; ACE/ARB B – Beta blocker C – Cholesterol; cigarettes D – Diabetes; E – Vitamin E; Estrogen; Exercise

11. We don’t always tell the truth. We don’t always know the truth... The Truth Yet!

12. Aristotle’s Intellectual Virtues Ways of Knowing Techne Sophia Episteme Phronesis Nous

13. Quality of Evidence Level I: Evidence obtained from at least one properly designed randomized controlled trial. Level II-1: Evidence obtained from well-designed controlled trials without randomization. Level II-2: Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group. Level II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence. Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees

14. The Scientific Method Experience: start from observation Conjecture: formulate hypothesis Prediction: reasoning from hypotheses Experiment: testing these elements

15. Characteristics External Third person Dispassionate I-It

16. Classic Experimental Design Pre-InterventionPost- Experimental Group OXO Control Group OO

17. Challenges of Communities Complex organisms Chaotic Non-linear

18. People are Messy!

19. SimpleComplex Rigorous Not so much ?

20. How do we embrace a broader range of ways to generate new knowledge, while still retaining rigor?

22. Anxiety about “Community” Focus? –Primary care –Indigent Imagery Content –Community college?

23. The “Honors College” A Value-Added Curriculum Traditional biomedical curriculum Biopsychosocial model Public health themes/content

24. Community Medicine From Molecule to Culture Molecule

25. Public Health Disciplines Biostatistics Epidemiology Health Administration and Policy Health Promotion Sciences Occupational and Environmental Health

26. Certificate in Public Health Biostatistics Epidemiology Social and Behavioral Sciences in PH US Health Care Systems Environmental Health Integrated Public Health Practice

27. Who Will Keep the Public Healthy? Epidemiology Biostatistics Environmental health Health services administration Social and behavioral sciences Informatics Genomics Communication Cultural competence Community-based participatory research Global health Policy and law Ethics

28. Training Physicians for Public Health Careers Leadership Public health emergency preparedness Clinical and community preventive service provision Across contiunuum of medical education Regardless of specialty

29. Medicine is the most humane of sciences, the most empiric of arts, and the most scientific of humanities. - Edmund Pellegrino Humanism and the Physician

30. Re-visiting Mattie How would the perspective of a provider trained in community medicine enhance her care? How have or can public policy and public health practice impact her care?

31. Outside the doctor-patient relationship there is a wider place filled with community. And it calls to us through the voice of public health. - Author unknown