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Building A Fund of Knowledge for Community Medicine
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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
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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
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Mattie, continued From a CV standpoint, she did well Blood sugars were poorly controlled “Non-compliant”
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Mattie’s Vices
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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
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We don’t always tell the truth. We don’t always know the truth. The Truth
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ABCs of Preventive Cardiology A – Aspirin/antiplatelet; ACE B – Beta blocker C – Cholesterol; cigarettes D – Diabetes; E – Vitamin E; Estrogen; Exercise
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ABCs of Preventive Cardiology A – Aspirin/antiplatelet; ACE/ARB B – Beta blocker C – Cholesterol; cigarettes D – Diabetes; E – Vitamin E; Estrogen; Exercise
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We don’t always tell the truth. We don’t always know the truth... The Truth Yet!
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Aristotle’s Intellectual Virtues Ways of Knowing Techne Sophia Episteme Phronesis Nous
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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
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The Scientific Method Experience: start from observation Conjecture: formulate hypothesis Prediction: reasoning from hypotheses Experiment: testing these elements
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Characteristics External Third person Dispassionate I-It
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Classic Experimental Design Pre-InterventionPost- Experimental Group OXO Control Group OO
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Challenges of Communities Complex organisms Chaotic Non-linear
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People are Messy!
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SimpleComplex Rigorous Not so much ?
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How do we embrace a broader range of ways to generate new knowledge, while still retaining rigor?
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Anxiety about “Community” Focus? –Primary care –Indigent Imagery Content –Community college?
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The “Honors College” A Value-Added Curriculum Traditional biomedical curriculum Biopsychosocial model Public health themes/content
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Community Medicine From Molecule to Culture Molecule
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Public Health Disciplines Biostatistics Epidemiology Health Administration and Policy Health Promotion Sciences Occupational and Environmental Health
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Certificate in Public Health Biostatistics Epidemiology Social and Behavioral Sciences in PH US Health Care Systems Environmental Health Integrated Public Health Practice
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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
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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
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Medicine is the most humane of sciences, the most empiric of arts, and the most scientific of humanities. - Edmund Pellegrino Humanism and the Physician
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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?
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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
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