St Onge Joan E, Cata Ann M, Horigian Viviana E
Internal Medicine, Graduate Medical Education, University of Miami Miller School of Medicine, Miami, USA.
Miscellaneous, Graduate Medical Education, University of Miami Miller School of Medicine, Miami, USA.
Cureus. 2019 Jul 23;11(7):e5213. doi: 10.7759/cureus.5213.
The future physician will face a career challenged by a number of significant changes in healthcare, including changes in demographics and disease, an increasing focus on population health and value-based care, and changes in healthcare funding. National organizations have called for medical schools to better prepare students for these challenges, and to incorporate more public health education in medical school. While many medical schools have responded, the topics covered, the timing in the curriculum, and the importance of these topics for graduation vary widely. Florida has been a site of growth in medical education in the last 10 years. Given that new medical schools were developed during a period of increased emphasis on the need for public health education, a survey was developed to assess the state of public health education in medical schools accredited by the Liaison Committee for Medical Education (LCME) in the state of Florida.
The survey included questions on school location, size of the student body, date of initial LCME accreditation, presence of department or school of public health, and presence of a pathway or track in public health. The survey asked detailed questions about public health content, curricula delivery methods, and timing of the curriculum within the four-year course of study as well as the courses providing public health content. The survey asked about the value of curricular content and the survey itself. The online survey was sent to the associate or senior associate deans for education in the seven LCME accredited schools who had full or provisional accreditation as of December 2017. Data collection occurred between March 14 and March 30, 2018.
Six of the seven medical schools responded. Of the eleven competencies included in the survey, schools reported between five and eleven. Three schools cover nine or more of the eleven competencies. The number of competencies covered was not statistically influenced by age of the school, percentage of underrepresented students in medicine, the presence of a school or department of public health, or a special pathway or track in public health. The most common teaching method used was a didactic lecture, and the least was the structured experience with a local health organization. The fourth year of medical school saw the least amount of public health education. Five of the six respondents felt that the competencies presented here are very important to extremely important, and one school feels that they are moderately important.
Nationally, education in public health is an important component in medical education, but the topics included, educational methods used and the importance of the content varies from school to school. The state of public health education in medical schools in Florida is robust in some schools. The individuals responsible for the curriculum support the importance of these topics. The content is delivered through a diversity of pedagogical methods. The study results demonstrate a number of opportunities for enhancement.
Given the importance of public health content in medical schools, survey methodology using established competencies to assess public health curricula could be used in the US to provide an up-to-date assessment of the strengths and opportunities for improvement in this area.
未来的医生将面临职业生涯中的诸多重大挑战，这些挑战来自医疗保健领域的一系列显著变化，包括人口结构和疾病的变化、对人群健康和基于价值的医疗保健的日益关注，以及医疗保健资金的变化。国家组织呼吁医学院校让学生更好地应对这些挑战，并在医学院校中纳入更多的公共卫生教育。虽然许多医学院校已经做出了回应，但所涵盖的主题、课程中的时间安排以及这些主题对毕业的重要性差异很大。在过去十年中，佛罗里达州一直是医学教育发展的地区。鉴于新医学院校是在更加强调公共卫生教育需求的时期建立的，因此开展了一项调查，以评估佛罗里达州经医学教育联络委员会（LCME）认证的医学院校的公共卫生教育状况。
该调查包括有关学校位置、学生人数规模、LCME首次认证日期、是否存在公共卫生系或学院以及是否存在公共卫生相关路径或轨道的问题。该调查询问了有关公共卫生内容、课程授课方法、在四年学习课程中的课程时间安排以及提供公共卫生内容的课程等详细问题。该调查询问了课程内容的价值以及调查本身的价值。在线调查发送给了七所LCME认证学校中负责教育的副院长或高级副院长，这些学校截至2017年12月已获得完全或临时认证。数据收集于2018年3月14日至3月30日期间进行。
七所医学院校中有六所做出了回应。在所调查的11项能力中，各学校报告涵盖了5至11项。三所学校涵盖了11项能力中的9项或更多。所涵盖能力的数量在统计学上不受学校年龄、医学专业中代表性不足学生的百分比、是否存在公共卫生学院或系，或公共卫生相关的特殊路径或轨道的影响。最常用的教学方法是讲授式讲座，最少使用的是与当地卫生组织的结构化实践。医学院校的四年级公共卫生教育最少。六位受访者中有五位认为这里列出的能力非常重要至极重要，一所学校认为它们具有中等重要性。
在全国范围内，公共卫生教育是医学教育的重要组成部分，但所涵盖的主题、使用的教育方法以及内容的重要性因学校而异。佛罗里达州医学院校的公共卫生教育状况在一些学校中较为良好。负责课程的人员支持这些主题的重要性。内容通过多种教学方法进行传授。研究结果显示出许多有待改进的机会。
鉴于公共卫生内容在医学院校中的重要性，在美国可以使用基于既定能力来评估公共卫生课程的调查方法，以提供该领域优势和改进机会的最新评估。
