Findings underscore the need for additional medical student education for healthcare reform

University of VermontDec 5 2009

As the population of people with chronic conditions and health care costs rise, so do opportunities for implementing health prevention strategies. Jan Carney, M.D., M.P.H., associate dean for public health at the University of Vermont (UVM) College of Medicine, believes a critical strategy for reforming the health care system lies in teaching medical students about prevention and public health.

Ensuring that these future physicians both understand the principles of public health and the role it plays in the work of a clinician is at the core of a curriculum led by Carney, a former Vermont Commissioner of Health and trained internist. In collaboration with the local United Way's Volunteer Center, she annually identifies public health problems posed by area agencies and organizes 16 corresponding public health projects, which are carried out by students in the second-year Medical Student Leadership Groups. A faculty mentor and agency contact work with each group of seven to eight students.

"Student projects cover many national priorities — access to health care, improving nutrition and physical activity, climate change and public health — and also examine some of the policies and laws that impact health," said Carney. "We know that our students will become better physicians by understanding health, and the challenges of improving it."

Carney's program and its "Community First" model have been published and presented nationally. Students' projects are so well executed that eight of the fall 2008 group projects were presented at the November 2009 APHA meeting, including one that examined the public health impact of varying employer sick day policies.

"Teaching medical students about prevention and public health and its relationship to clinical medicine is an essential part of their education," says Carney, who presented at the 2009 APHA meeting on teaching public health preparedness using technology in a pandemic influenza simulation.

"It's hard to get Vermont-specific data, because our state is so small," says Colin Robinson, a Burlington, Vt.-based Peace and Justice Center staff member who works on the Economic Justice Project and served as students' agency contact on the sick day project. "We had Vermont medical students doing research on Vermonters — focusing on the impact of sick day policies on first- through fourth-graders in four counties — and they found a correlation between parents' number of sick days and children's access to receiving well child check-ups. When you have well-executed research, the information is powerful."

Carney's latest area of research focuses on the effectiveness of a Regional Public Health-Medicine Education Center model in promoting the integration of population health into medical education. Surveys assessed students' attitudes and public health knowledge at the start of medical school through third-year clinical clerkships. Her findings, presented at the Association of American Medical Colleges' November 2009 annual meeting in Boston, underscored the need for additional medical student education in population health, with reinforcement during clinical years.