Teaching medical students about disease prevention and health promotion.

Abstract

ago were teaching a variety of subjects, including biostatistics, epidemiology, public health, sanitation, and industrial and occupational health, as well as whatever content was left over from a variety of other departments. In 1963, I was asked to head a new department at the University of Kansas, which I called Preventive Medicine and Community Health. I was permitted to take over and retain a number of functions that I considered important laboratories for teaching-the clinics, the Employee and Student Health Services, and the Hospital Infection Control Committee. From 1963 to 1969, the department's operation was based on several ground rules, including, Thou shalt begin early to sensitize medical students to relevant concepts/content. We offered a 10-week elective for first-year medical students in a Multidisciplinary Home Care Unit. On Friday afternoons first-year students, a multidisciplinary staff, and students from other disciplines-including nursing and occupational and physical therapy-made home visits to chronically ill patients. After these visits, we returned to the unit for a seminar in which the content of the basic sciences was integrated with management and social issues concerned with the care of these patients. Becauise of expressed concern by the basic science faculty that this experience of playing doctor would be detrimental, w e conducted a randomized clinical trial of the elective. Volunteers (80 percent of the class) were randomly allocated to treatment (home care) or control groups. We post-tested the entire class with an exam designed to test the concepts of home care, knowledge of applied physiology and biochemistry, and orientations to patients. Home care students scored better on most of these dimensions (1). Another ground rule was: Thou shalt reinforce each year. In the second year, we had required curriculum time for lectures and laboratory exercises. For example, in one of these exercises, students calctulated the cost of care of patients in the university hospital by using the bills of discharged patients. In the third year, in lieu of Saturday morning classes, students were required to fill in three preventive medicine case suLmmaries on patients assigned to them on each of the major cliinical rotations medicine, surgery, and pediatrics. The sttudents were required to Tearsheet requests to Charles E. Lewis, MD, Chief of the Division of General Internal Medicine and Health Services Research, University of California at Los Angeles School of Medicine, B-558 UCLA Factor Bldg., Los Angeles, Calif. 90024.