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Medical and Public Practice and Academic : Promising Partnerships Regional Medicine Public Centers—Two Cycles

Rika Maeshiro rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr

The partnering of the academic medicine and public services in academic settings). Although not identi- health communities to improve the health of popula- cal to the Core Functions or Essential Services of public tions seems natural; however, collaboration between health, “education, research, and service” to improve the two groups has not been standard practice. This health appear to be shared objectives in the portfo- series of articles will highlight examples of what are lios of public health practice and academic medicine. hopefully a growing number of successful partnerships This month’s column will review recent collaborations between academic medicine and public health practice aimed at improving medical student education in pop- that are intended to improve health status. Readers are ulation health, focusing particularly on the establish- encouraged to contribute their experiences in public ment of Regional Medicine–Public Health Education health practice–academic medicine partnerships from Centers (RMPHECs). the perspectives of public health practitioners and/or Incorporating prevention- and population-based medical educators. health into the medical has been a challenge The Association of American Medical Colleges to US for decades. Advocates for im- (AAMC) is a nonprofit association dedicated to improv- proving public health content in medical education be- ing the nation’s health by enhancing the effectiveness lieve that a better-informed workforce will of academic medicine. When the AAMC was founded respond more effectively to the needs of their patients, in 1876 to help reform medical education, the asso- their communities, and their public health colleagues, ciation represented only medical schools. Currently, the AAMC represents the accredited allopathic med- ical schools in the (125) and (17); Corresponding author: Rika Maeshiro, MD, MPH, Association of American nearly 400 major teaching , including 98 af- Medical Colleges, 2450 N Street, NW, Washington, DC 20037 (e-mail: filiated health systems and 68 Veterans Affairs medi- [email protected]). cal centers; 94 academic and professional societies that Editors Note: I am very pleased to announce that starting with this July issue of represent 109,000 faculty members; and the nation’s the Journal of Public Health Management and Practice, we have a new column: Medical and Public Health Education. The column editor is Rika Maeshiro, MD, 67,000 medical students and 104,000 in res- MPH, Assistant Vice President for Public Health and Prevention, Association of idency training programs. AAMC’s three main mis- American Medical Colleges (AAMC). This column will focus on future physicians, sion areas mirror those of our constituents: Medical a critical element for the public health workforce, and the interaction between Education (educating the physician and medical sci- medical practitioners and public health. AAMC is increasingly active in enhancing entist workforce); Medical Research (discovering new the and preventive curriculum for medical students. This has the dual potential of increasing the number of practicing physicians who are oriented medical knowledge and developing innovative tech- to population-based prevention and also increasing the number of students who nologies for the prevention, diagnosis and treatment will consider preventive medicine as a career choice. We are particularly fortunate of disease); and Patient Care (providing healthcare that Rika Maeshiro has agreed to edit the column. Contributions from our readers for this column are welcome and can be directed to [email protected] qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq

J Public Health Management Practice, 2006, 12(5), 493–495 Rika Maeshiro, MD, MPH, is Assistant Vice President for Public Health and C 2006 Lippincott Williams & Wilkins, Inc. Prevention, Association of American Medical Colleges, Washington, DC.

493 494 ❘ Journal of Public Health Management and Practice translating into improved population health. Recent ef- portunity. As in the pilot RMPHEC activity, a critical forts at the AAMC to enhance population health con- and required component of the current program is the tent in education began in 1998, when partnering of medical schools with public health prac- the second Medical School Objectives Project Report, titioners in local or state health departments. Collab- Contemporary Issues in Medicine: Medical Informatics and orating with additional community or public health Population Health,1 recommended that all medical stu- entities, such as area health education centers, centers dents receive training in ; ; for public health preparedness, community-based or- disease prevention/; healthcare or- ganizations, and schools of public health, was also en- ganization, management, and financing; and environ- couraged. Despite a short 4-week deadline, 47 of 125 mental and public health as part of their population eligible schools (more than 33%) submitted applica- health education. In 2000, the AAMC entered into a tions, and several more had expressed interest but could cooperative agreement with the Centers for Disease not meet the timetable. The proposals came from a Control and Prevention (CDC), in which one explicit wide spectrum of medical schools: public and private, objective was to improve the teaching of prevention and research-intensive and community-focused, large and public health at academic medical centers. The AAMC small schools, and from across the country. also contributed to the development of the Clinical Pre- In their proposals, schools were required to de- vention and Population Health Curriculum Framework2 re- scribe their current educational activities in popula- leased in 2004 through the multidisciplinary Healthy tion health, public health, prevention, and prepared- People Curriculum Task Force sponsored by the Asso- ness and to identify preexisting collaborative efforts ciation for Prevention Teaching and Research (formally between the medical school and public health entities. the Association of Teachers of Preventive Medicine) Schools then identified gaps in their educational pro- and the Association of Academic Health Centers. This gram. Selection criteria included evidence of active par- Framework identifies topics in four components (Evi- ticipation of a medical school and public health entity; dence Base of Practice; Clinical Preventive Services— senior administrative support from participating insti- Health Promotion; Health Systems and ; tutions; evidence that the proposal would provide ed- and Community Aspects of Practice) that are consid- ucational experiences for all medical students (ie, not ered “core” to the education of all health professions. only those with preexisting interests in public health); Over the last two decades, the annual Graduation Ques- and the feasibility of successful implementation. Staff tionnaire (GQ) has reflected improvement in medical from the AAMC and the CDC reviewed all applica- school graduates’ perception of their instruction in the tions. Unfortunately, the amount of funding was not preventive care topics, but according to the GQ and sufficient to award all of the many qualified and inno- the Liaison Committee on Medical Education’s (the ac- vative proposals. Eleven schools were funded by May crediting body for allopathic medical schools) annual 2006: survey, educational progress has been slower on topics Case Western Reserve School of Medicine related to health systems/health policy, Harvard Medical School and . Mercer University School of Medicine To help accelerate the adoption of effective popu- Southern Illinois University School of Medicine lation health education in medical schools, in 2003, Stanford University School of Medicine through the CDC cooperative agreement, the AAMC The Brody School of Medicine at East Carolina established seven pilot Regional Medicine–Public University Health Education Centers (RMPHEC), which were de- University of California, Davis School of Medicine scribed previously in this journal.3 Although the pi- University of Colorado School of Medicine lot program was originally envisioned as a multi- University of New Mexico School of Medicine year project, funding beyond the first year was not University of Rochester School of Medicine and available, and the pilot program ended after 1 year. Convinced that these Centers were a valuable and ef- University of Vermont College of Medicine fective method of encouraging changes in medical ed- ucation, the AAMC and the CDC embarked on a sec- The awarded schools represented well the pool of ond phase of this project in early 2006, using funds diverse institutions that had applied for this opportu- that had been left over from prior years’ cooperative nity. The principal investigators included new grantees agreement activities. A Call for Proposals was devel- as well as veterans from the pilot RMPHEC program. oped that requested applications from schools to “fully They include faculty members, associate deans, as well integrate population health into the medical school cur- as one dean. Two of the principal investigators are for- riculum.” All accredited US allopathic medical schools, mer state and/or local health officers. Altogether, at including those that had participated in the pilot least 22 health jurisdictions are participating partners RMPHEC project, were eligible to compete for this op- in the RMPHECs. Public Health Practice and Academic Medicine ❘ 495

In general, the awarded proposals addressed cur- the potential for continued funding for this activity ricular changes in both preclinical and clinical course- through the cooperative agreement is uncertain. Alter- work. The clinical curriculum can be difficult to in- nate sources of funding are being explored. Meanwhile, fluence because students may be at a variety of sites interest appears to be growing in this activity. The com- and are under the supervision of relatively independent mittee for the Institute of Medicine’s “Training Physi- clinical departments. Ironically, medical students may cians for Public Health Careers” project heard about the best appreciate the importance of public health when RMPHEC project during their first public hearing and they witness its relevance in a clinical setting. Success- were intrigued to learn that medical schools are in fact ful proposals identified experiential learning opportu- increasingly interested in these topics. nities that incorporate population health content in a We hope that improving public health/population diverse array of basic science and clinical disciplines health education for future physicians will contribute and planned for the active participation of their public to improved health outcomes in their patients and their health agency colleagues in the development of their communities, and will benefit public health agencies curricula. and academic medical centers. We would like to pre- Each of the awarded institutions described unique sume that any physician would be a better practitioner attributes of their schools and communities and/or pro- with an enhanced appreciation of the public health posed creative educational approaches. Case Western system and their roles and responsibilities within the and Harvard are in the midst of a broad curricular re- systems, and we would like to think that communi- vision process at their schools, and plan to leverage ties would be healthier when their medical providers this opportunity to strengthen population health work in better coordination with their public health sys- education at their institutions. The University of Cali- tems. Evaluating these educational initiatives to assess fornia at Davis, Stanford, and the University of Vermont their impact is not an easy task and requires thoughtful addressed critical faculty-related issues—the need to consideration from the academic medicine and public acknowledge and compensate public health practition- health practice communities. For the RMPHEC project, ers who serve as faculty to medical students and the we may wish to assess how the initiative affected need to educate medical school faculty about the clini- the students at the 11 institutions, as well as poten- cal relevance of public health. To emphasize this partic- tial influences on the grantee schools, the participating ular point to both medical faculty and students, South- health departments, nongrantee schools, patients, and ern Illinois University will offer a consulting service in communities. which the public health/population health experts will In spite of the challenges of evaluation, the con- “round” with existing ward teams to encourage the dis- temporary health threats that confront both the public cussion of population health and prevention topics that health and medical care systems seem to demand that are relevant to the patients on the ward team’s service. we are better coordinated. On the basis of the robust The University of New Mexico will be requiring that all response to the RMPHEC call for proposals, the aca- of their medical school graduates complete the require- demic medical community is embracing the importance ments for certificates in public health. Case-based cur- of public health and the value of working with (and ricula that integrate population health principles into learning from) state and local public health colleagues. clinical scenarios (such as , suicide pre- Philosophically,the missions of academic medicine and vention, cancer screening, assess- public health practice do not—and probably should ments, and bioterrorism) and use actual local public not—differ substantially.The education of future physi- health data are implemented at Brody and the Univer- cians may be a timely opportunity to benefit from the sity of Rochester. Mercer and the University of Col- possibilities of this partnership. orado are two of the schools that will integrate pop- ulation health skills into their evaluation of students’ clinical skills. The 11 grantees received $50,000 each for a planning REFERENCES “year” in 2006. (The “year” is 5–7 months in length, be- cause of the timing of the Call for Proposals and official 1. Association of American Medical Colleges. Contemporary award letters and the federal fiscal year.) The project Issues in Medicine: Medical Informatics and Population Health. Washington, DC: Association of American Medical Colleges; was conceived to have four funding cycles–one plan- 1998. ning year followed by three implementation years, in 2. Allan J, Barwick TA, Cashman S, et al. Clinical prevention and which the schools that complete their prior year’s work population health: curriculum framework for health profes- successfully will be awarded $50,000 for the following sions. Am J Prev Med. 2004;27(5):471–476. implementation years (for a possible $200,000 to each 3. Novick LF. The teaching health department. J Public Health institution by the end of the project term). Currently, Manage Pract. 2004;10(4):275–276.