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From Primary Care to Public Health: Using Problem-Based Learning and the Ecological Model to Teach Public Health to First Year Medical Students


We investigated whether a public health-oriented Problem-Based Learning case presented to first-year medical students conveyed 12 “Population Health Competencies for Medical Students,” as recommended by the Association of American Medical Colleges and the Regional Medicine-Public Health Education Centers. A public health-oriented Problem-Based Learning case guided by the ecological model paradigm was developed and implemented among two groups of 8 students at the University of California, Berkeley-UCSF Joint Medical Program, in the Fall of 2010. Using directed content analysis, student-generated written reports were coded for the presence of the 12 population health content areas. Students generated a total of 29 reports, of which 20 (69%) contained information relevant to at least one of the 12 population health competencies. Each of the 12 content areas was addressed by at least one report. As physicians-in-training prepare to confront the challenges of integrating prevention and population health with clinical practice, Problem-Based Learning is a promising tool to enhance medical students’ engagement with public health.

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  1. Koo, D., & Thacker, S. (2008). The education of physicians: A CDC perspective. Academic Medicine, 83(4), 399–407.

    PubMed  Article  Google Scholar 

  2. Maeshiro, R., Johnson, I., Koo, D., et al. (2010). Medical education for a healthier population: reflections on the Flexner Report from a public health perspective. Academic Medicine, 85(2), 211–219.

    PubMed  Article  Google Scholar 

  3. Milstein, B., Homer, J., & Briss, P. (2011). Why behavioral and environmental interventions are needed to improve health at lower cost. Health Affairs, 30, 823–830.

    PubMed  Article  Google Scholar 

  4. Association of American Medical Colleges, Centers for Disease Control and Prevention. (2010). Patients and populations: Public health in medical education conference. Washington, DC. Accessed January 23, 2011.

  5. Liaison Committee on Medical Education. (2011). Functions and structure of a medical school: Standards for accreditation of medical education programs leading to the M.D. Degree. Accessed July 14, 2011.

  6. Mann, S. (2011). After reform, more medical schools emphasize public health. Washington, DC: AAMC Reporter.

  7. US Department of Health and Human Services. (2010). Healthy people 2020 objectives. Washington, DC. Accessed January 23, 2011.

  8. Ruis, A., & Golden, R. (2008). The schism between medical and public health education: A historical perspective. Academic Medicine, 83(12), 1153–1157.

    PubMed  Article  CAS  Google Scholar 

  9. Chamberlain, L., Wang, N., Ho, E., Banchoff, A., Braddock, C., I. I. I., & Gesundheit, N. (2008). Integrating collaborative population health projects into a medical student curriculum at Stanford. Academic Medicine, 83(4), 338–344.

    PubMed  Article  Google Scholar 

  10. Epling, J., Morrow, C., Sutphen, S., & Novick, L. (2003). Case-based teaching in preventive medicine: Rationale, development, and implementation. American Journal of Preventive Medicine, 24(4), 85–89.

    PubMed  Article  Google Scholar 

  11. Novick, L. (2003). Introducing a case-based teaching intervention in preventive medicine education. American Journal of Preventive Medicine, 24(4), 83–84.

    Article  Google Scholar 

  12. McCurdy, S. (2003). Preventive medicine teaching cases in the preclinical undergraduate medical curriculum. American Journal of Preventive Medicine, 24(4), 108–110.

    PubMed  Article  Google Scholar 

  13. Bizzocchi, J., & Schell, R. (2009). Rich-narrative case study for online PBL in medical education. Academic Medicine, 84(10), 1412–1418.

    PubMed  Article  Google Scholar 

  14. Kinkade, S. (2005). A snapshot of the status of problem-based learning in US medical schools, 2003–4. Academic Medicine, 80(3), 300–301.

    PubMed  Article  Google Scholar 

  15. Dolmans, D. H., & Schmidt, H. G. (1994). What drives the student in problem-based learning? Medical Education, 28(5), 372–380.

    PubMed  Article  CAS  Google Scholar 

  16. Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs, NJ: Prentice-Hall.

    Google Scholar 

  17. Chowdhury, N., Lien, S., & Yeung, H. (2010). A problem-based learning curriculum to teach Community-Oriented Primary Care (COPC) in medical education. In Patients and populations: Public health in medical education conference. Cleveland, OH. Accessed July 5, 2011.

  18. University of Washington School of Public Health. (2011). MPH in community-oriented public health practice. Seattle, WA. Accessed July 5, 2011.

  19. McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education & Behavior, 15(4), 351–377.

    Article  CAS  Google Scholar 

  20. Kim, S., Phillips, W., Pinsky, L., Brock, D., Phillips, K., & Keary, J. (2006). A conceptual framework for developing teaching cases: A review and synthesis of the literature across disciplines. Medical Education, 40(9), 867–876.

    PubMed  Article  Google Scholar 

  21. Hsieh, H., & Shannon, S. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288.

    PubMed  Article  Google Scholar 

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Authors have no financial conflicts of interest and received no financial support for this research.

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Correspondence to Amin Azzam.

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We have no prior publications related to this work, although we did present key findings in a workshop at the AAMC Western Group on Educational Affairs (WGEA) Conference in May 2011.

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Hoover, C.R., Wong, C.C. & Azzam, A. From Primary Care to Public Health: Using Problem-Based Learning and the Ecological Model to Teach Public Health to First Year Medical Students. J Community Health 37, 647–652 (2012).

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  • Medical education
  • Problem-based learning
  • Medical students
  • Public health
  • Teaching methods