Background
Many students have entered medical school with a notion of medical practice that is based on one physician treating one patient. Expanding this frame of reference is critical during the early development of their professional persona, so that as 21st century medical practitioners they will be also prepared to understand the population, public health and preventive aspects of practice. This will also prepare students to provide leadership and guidance beyond the walls of their individual practice, at the community, national or global levels.
Implementation
The School has integrated student learning about population medicine, public health and prevention as a longitudinal curriculum theme through a program of didactic and experiential learning throughout the curriculum.
Beginning with the major curriculum revision implemented in 1992, population medicine and public health have been addressed as a longitudinal curriculum theme that begins during the first week of medical school, during the Introduction to Being a Physician course. Students learn from the beginning that their responsibilities include care of communities not just individual patients, that achieving better health depends on much more than a well-educated physician, and that prevention is just as important and often more effective than sophisticated treatment. The environment at Pittsburgh is terrifically well suited to help students develop in this domain. Medical students have ready access to the resources of all six of the Schools of the Health Sciences, including the Graduate School of Public Health.
The resources of the UPMC Health System, the UPMC Health Plan, and the Allegheny County Health Department, plus community partners such as the Southwest Pennsylvania Area Health Education Center, together provide an exceptional quality and diversity of learning opportunities for our students.
Scalable Curriculum
All students learn about core topics in population medicine through required curriculum experiences in years one through three. A subset of students with a passion for these subjects may opt to participate in Area of Concentration programs that provide opportunity for in-depth study and support for scholarly project activities in this area. These areas of concentration include underserved medicine, women’s health, geriatrics, global health and public health.
Evidence-Based Medicine
In the Evidence-Based Medicine - Fundamentals course, biostatistics and evidence-based medicine are addressed early, throughout the Fall term of the first year.
Population Health
This second year course addresses key subjects within population health, with an emphasis on helping students understand the systems and environment that influence health and health care delivery. The course is comprised of content units on a diverse range of subjects related to health systems science. These subjects include Public Health, Health Care Systems and Safety, and Social Medicine.
Scholarly Pursuits
All UPSOM students complete a Longitudinal Research Project that is conducted throughout the four years of the curriculum. Students have the option of focusing their research project in any area of biomedical science, and many opt to undertake projects in community health, population medicine and public health. Students connect with mentors within the School of Medicine and beyond, including neighboring universities, the Graduate School of Public Health, and community organizations. Students may establish mentoring teams which include collaborations with project mentors from the Bridging the Gaps and Pittsburgh Schweitzer Fellowship programs. Explore this link for additional information about the Longitudinal Research Project.
Senior Electives
Students with a particular interest in population health may choose from a diverse range of senior elective courses that provide a venue for them to experience and tightly focus on a specific topic. Examples include a month-long rotation with Operation Safety Net , a mobile service providing medical care on the streets of Pittsburgh, and elective rotations in public health conducted in conjunction with the Graduate School of Public Health. Students may also opt for customized rotations crafted around their individual interests in areas such as healthcare finance or patient safety.
Elective Experiences
A broad range of electives is available to students who wish to pursue this domain in greater depth. Many first year students connect with underserved populations through experience such as the PALS Program which pairs individual students with pregnant teenagers and through service learning at the English speaking or Spanish speaking health clinics in our community. Students commonly volunteer in programs such as the SALUD Clinic, the Guerrilla Eye Service that brings sophisticated ophthalmology services to underserved regions in Southwest Pennsylvania, and Operation Safety Net that brings medical care to the homeless of Pittsburgh.
Our Changing Population
With UPSOM situated in one of the oldest counties in America, it is easy for our students to develop an understanding of the evolving composition of our population and how health care must evolve to keep pace with these changes. In addition to the third year Interprofessional Geriatrics Week, students are exposed to issues in geriatrics longitudinally throughout the curriculum and may opt to participate in the Area of Concentration on Geriatric Medicine.
To help students prepare to communicate and connect with individuals of Limited English Proficiency, they are taught best practices for utilizing language interpreter services. In addition, the Passport to Care program provides students with elective language and cultural curricular opportunities that reach beyond the required curriculum. Through classroom-based and online instruction, students can study Spanish, French and Italian.
Obesity
UPSOM integrates obesity and nutrition as a longitudinal curricular theme. In the first two years, the topics of nutrition, overweight and obesity are discussed in the context of the impacts on overall wellbeing.
In the Behavioral Medicine course students learn about the structural causes, epidemiology and impacts of of obesity. During this session, they are encouraged to think about solutions for individual patients and for populations, including changes in public policy. Subsequent course sessions address diet and nutrition; psychosocial, behavioral, and therapeutic issues in obesity; complementary and alternative approaches to weight loss; and surgical treatments. Students in this course also get a first-hand look at the challenges of weight loss, from patients who have experienced or are experiencing overweight or obesity.
During the second year Digestion and Nutrition course, students learn about clinical aspects of obesity and weight management. During the third year Surgery Clerkship, fractions of the class rotate on the bariatric surgery service each month.
The importance of this topic is reinforced in all four years by including obesity counseling and therapy as explicit items in experience logs submitted during the first and second year Clinical Experience Courses, and in the clinical clerkships.
For more about how medical schools are incorporating obesity education into curricula, refer to the AAMC Medical School Objectives Project Report: The Prevention and Treatment of Overweight and Obesity.
Prevention
Topics in prevention are addressed and re-emphasized throughout the curriculum. For example, in the first year Clinical Experiences course, students learn firsthand about the importance of and the challenges to helping patients with prevention during their three months of clinical experiences. In addition to one month each in primary care and rehabilitation settings, every student has a series of clinical experiences in an underresourced or service learning site. These experiences, which span the Spring term of first year through Fall second year, provide a key opportunity for students to establish a context for understanding the importance of population and public health concurrent with the didactic learning on these subjects. Among the activities in this course is a student project on developing patient educational materials.
Topics in prevention are also addressed in an ongoing fashion through the curriculum. For example, immunization for preventable illness is taught in the context of the Medical Microbiology course and re-emphasized during the Pediatrics, Family Medicine, and Obstetrics and Gynecology clerkships. Anticipatory guidance and preventive concepts such as the use of bicycle helmets and seatbelts and firearm safety, are initially addressed in the Clinical Experiences course but are later emphasized during the pediatrics aspects of the clerkship year.
Alcohol and substance use counseling using a motivational interviewing approach is taught during the beginning of the Psychiatry Clerkship, so that students are prepared to apply the SBIRT (Screening, Brief Intervention, Referral to Treatment).
Outcomes
Population medicine, public health and prevention have been incorporated as fundamental curriculum themes throughout the UPSOM curriculum. The evolution of our patients, communities and populations will continue to drive innovation in this domain as we prepare for care of an aging population, diversity in our communities, evolving public health threats and a changing world in general, and healthcare finance.