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Integration of the case-based series in population-oriented prevention into a problem-based medical curriculum

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Abstract

This article describes the pilot testing of the Case-Based Series in Population-Oriented Prevention (C-POP) and accompanying evaluation instruments in a problem-based medical curriculum at the University of Rochester Medical Center. Several of the cases were successfully taught in the curriculum, but the evaluation instruments revealed no change in population-oriented skills or orientation. Issues of implementation and evaluation of the C-POP curriculum are discussed.

Introduction

T he principles and practice of preventive medicine have been increasingly emphasized as an essential part of contemporary undergraduate medical curricula.1 Basic concepts of epidemiology, biostatistics, health services research, and behavioral sciences have growing relevance to the medical student’s understanding of such issues as bioterrorism, emerging epidemics, evidence-based medicine, quality of care, and outcomes research. More practical aspects of population and prevention sciences have an effect on their practice of medicine, including screening, prognosis, etiology of disease, and evaluation of therapies, requiring a knowledge and skill base to read and apply the literature.

Parallel to this emphasis on preventive medicine has been a gradual reform of medical education curricula at many institutions, using teaching methods that are less didactic (e.g., lectures, readings) and more self-directed. One form of these new educational methods is the problem-based learning (PBL) curriculum, in which students work in a group, with a tutor, exploring a problem usually embodied by a case.2 Although case-based, this educational method allows students to develop their own questions and learning objectives, while the tutor guides the students toward the learning objectives established by the course director to support the subject being taught. PBL curricula, initially developed at McMaster University and Southern Illinois University, have now been adopted by 30% to 40% of U.S. medical schools.2 The extent to which the curricula teach exclusively through PBL sessions varies from school to school. A number of curricula are hybrid, in which PBL components are integrated with more traditional didactic components such as lectures and case discussions. The University of Rochester curriculum has adopted this hybrid model.

The University of Rochester School of Medicine and Dentistry initiated a problem-based learning curriculum with the class matriculating in 1999. This new curriculum, now known as the Double Helix Curriculum, offered the opportunity to reexamine the teaching of public health sciences and preventive medicine. In the 2000–2001 and 2001–2002 academic years, the opportunity also presented itself to integrate the Case-Based Series in Population-Oriented Prevention (C-POP), developed by educators at the State University of New York (SUNY)–Upstate Medical University, into the new curriculum.3 This article will describe preventive medicine teaching in the new curriculum, describe a pilot test of the Case-Based Series in Population-Oriented Prevention in this new curriculum, show the results of an evaluation of the pilot study, and discuss the findings with regard to this learning module’s use in a PBL curriculum. An important feature of any educational module would be its flexibility for inclusion in other institutions’ curricula. Our experience will provide some insights into the opportunities to use the C-POP modules in a very different curriculum than the one in which it was developed.

Section snippets

The double helix curriculum of the University of Rochester

The University of Rochester School of Medicine totally reconstructed its medical school curriculum beginning in 1997, with the class entering in 1999 initiating this new format of medical education. The goal of the curricular learning experience is to provide the start for life-long learning for physicians and scientists.4 An important tradition in the University of Rochester curriculum has been the biopsychosocial model of George Engel, in which medical practice takes into account the spectrum

Methods

The C-POP cases were integrated into the Double Helix Curriculum in spring 2002. At that time, curricular time for a course held each morning for 2 weeks became available for additional instruction in epidemiology and evidence-based medicine. The C-POP cases were developed by the faculty of the SUNY–Upstate Medical University and the Onondaga County Department of Health, with the support of grants from the Josiah Macy Jr. Foundation and the Health Resources and Services Administration.3 A

Results

The skill and competency evaluation results from spring 2002 are shown in Table 1. The scores at baseline (T1) appeared high, consistent with their prior coursework in epidemiology and preventive medicine. The results were measured, with scores improving in the STD topic area and decreasing in the lead and heart topic areas. Overall, the composite scores for all categories decreased from 81% at baseline (T1) to 77% at post-test (T2), with a nonsignificant reduction in score (p=0.14).

The

Discussion

A need remains for educational tools that emphasize population-based approaches to prevention, diagnosis, and treatment of important diseases. The Double Helix Curriculum, based on the Biopsychosocial Model of Engel, endeavors to illustrate the role of community, culture, society, and environment on the individual’s health. This model should provide an ideal underpinning for education in population-based prevention. Educational modules that emphasize this approach should integrate well into a

Conclusion

Six modules of the Case-Based Series in Population-Oriented Prevention were pilot-tested in a problem-based learning curriculum at the University of Rochester School of Medicine and Dentistry. Most functioned well but were even more effective when individually selected as laboratory exercises in specific places in the new curriculum. Nonetheless, they are readily implemented into a PBL curriculum. There is a growing need for such educational tools in population-oriented health curricula.

Acknowledgments

The Case-Based Series in Population-Oriented Prevention (C-POP) is funded by grants from the Josiah Macy, Jr. Foundation and the Health Resources and Services Administration, U.S. Department of Health and Human Services.

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