Reuniting Public Health and Medicine: The University of New Mexico School of Medicine Public Health Certificate

doi:10.1016/j.amepre.2011.06.001

American Journal of Preventive Medicine

Volume 41, Issue 4, Supplement 3, October 2011, Pages S214-S219

https://doi.org/10.1016/j.amepre.2011.06.001 Get rights and content

Abstract

The University of New Mexico School of Medicine (UNMSOM) sought to train medical students in public health concepts, knowledge, and skills as a means of improving the health of communities statewide. Faculty members from every UNMSOM department collaborated to create and integrate a public health focus into all years of the medical school curriculum. They identified key competencies and developed new courses that would synchronize students' learning public health subjects with the mainstream medical school content. New courses include: Health Equity: Principles of Public Health; Epidemiology and Biostatistics; Evidence-Based Practice; Community-Based Service Learning; and Ethics in Public Health. Students experiencing the new courses, first in pilot and then final forms, gave high quantitative ratings to all courses. Some students' qualitative comments suggest that the Public Health Certificate has had a profound transformative effect. Instituting the integrated Public Health Certificate at UNMSOM places it among the first medical schools to require all its medical students to complete medical school with public health training. The new UNMSOM Public Health Certificate courses reunite medicine and public health in a unified curriculum.

Introduction

The professions of medicine and public health in America became increasingly fragmented in the 20th Century.¹ Medicine focused on its newfound curative potential and sophisticated technologies applied at the individual level, while public health emphasized the population-based perspectives of prevention, health systems, and health policies. In her landmark address to the Association of American Medical Colleges (AAMC)102nd annual meeting in 1992, June Osborn, MD, then Dean of the University of Michigan School of Public Health, issued a prescient call to reintegrate the two professions to produce a rational system of health care after reform.² Since that time, there have been important initiatives involving many medical schools attempting to integrate public health into their medical school curricula. One was the Rockefeller Foundation and Pew Charitable Trusts–supported Health of the Public Program³ and the other, the current AAMC/CDC-supported Regional Medicine–Public Health and Education Centers (RMPHECs).⁴ Lessons from these initiatives have informed current curricular planning at the University of New Mexico. The current environment of healthcare reform favoring investments in prevention and community-based approaches strengthens the case for the integration of public health and medicine.

Section snippets

Background

In 2003, the University of New Mexico School of Medicine (UNMSOM) adopted the goal of an integrated Public Health Certificate for all medical students as one of its top strategic priorities. This effort supports the core strategic goal of the UNM Health Sciences Center: “Working with community partners, UNM Health Sciences Center will help New Mexico make more progress in health and health equity than any other state by 2020.”⁵

The goal of the certificate program is to educate a physician

Implementation

Integrating a public health program into all phases of the UNMSOM curriculum required merging two distinct and sometimes rival disciplines. Brief descriptions of the curricular components are provided below.

Methods utilized included (Figure 1):

1
identifying public health competencies and determining appropriate didactic and practical experiences that would allow the medical students to achieve mastery during their medical curriculum;
2
meeting Liaison Committee for Medical Education and Council of

Outcomes

Students in the integrated certificate of public health courses and rotations rate each course in an online evaluation on standard items like course organization, objectives, content, and assessment using a 5-point Likert rating scale with 1=strongly disagree and 5=strongly agree. In the first-year Health Equity Course, students' mean ratings for four items were 4.06 for increased understanding of public health concepts based on course assignments, 4.23 for increased knowledge and understanding

Discussion

Providing excellent medical services alone is important but not a sufficient condition to improve community health. The impact on community health of all medical students receiving a Public Health Certificate will be enhanced if students observe their residents and faculty applying these skills, and if they experience an integration of public health and medicine in clinical practice.

The UNM Health Sciences Center has therefore begun introducing public health training into residency,¹⁷

Conclusion

In 2003 the IOM issued its landmark report on the education of public health professionals, “Who Will Keep the Public Healthy?”²⁰ The report recommends that schools of medicine and public health develop collaborations as a means of overcoming the 20th-century schism between the two professions.²¹ The UNMSOM Public Health Certificate Program is an innovative approach to restoring medicine and public health to their historic Hippocratic unity.

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Clinical practice and public health practice are two sides of a coin though, sadly, a palpable dichotomy exists between the two. Clinical practice comprises primarily on curative care and to a certain extent rehabilitative care with almost exclusive focus on the individual. Public health practice, on the other hand, delivers preventive and promotive care in addition to curative and rehabilitative care focusing much beyond the individual—on the family and larger community—and deals with the root causes of the diseases, for example, social determinants of health. The understanding and expectations related to health care vary between a clinician, public health practitioner, and end user (patient/population), which have to be understood for optimal care delivery for the individual and community. The integration of public health practice and clinical practice will help to (a) understand the health-related behavior and choices and improve effectiveness of the interventions; (b) shorten the pathway of care; and (c) establish equity in clinical care. The anticipated benefits when they work in sync make a strong case for their integration. The strategies and approaches to integrate public health and clinical medicine need to be undertaken at the stages of training of medical graduates, care delivery, and monitoring and assessment of quality of health care for better individual and population health outcomes.
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Experiences during medical schoolReuniting Public Health and Medicine: The University of New Mexico School of Medicine Public Health Certificate

Abstract

Introduction

Section snippets

Background

Implementation

Outcomes

Discussion

Conclusion

Medicine and public health: the power of collaboration

The nature of public health after reform

Acad Med

Health of the publicThe academic response. Health of the Public Mission Statement Working Group

JAMA

Responding to the challenge: population health education for physicians

Acad Med

School of Medicine

Strategic Plan

Liaison Committee on Medical EducationFunctions and structure of a medical school: standards for accreditation of medical education programs leading to the M.D. degree

Innovative health care disparities curriculum for incoming medical students

J Gen Intern Med

Unnatural causes: is inequality making us sick?

Public Health in America

Building foundations for effective library skills in medical education: library/biometry projects in the first month of medical school

Experiences during medical school
Reuniting Public Health and Medicine: The University of New Mexico School of Medicine Public Health Certificate