Historically, clerkships have been the fundamental means by which medical students learn and practice the skills required of a physician, including information gathering, therapeutic planning, and interventions. The experiential learning and formative feedback from preceptors in clerkships are an effective means of teaching and learning procedural skills in undergraduate medical education, but rarely expand the skills from the level of the individual patient to that of the community 1-3
. However, such an expansion has been recommended by serious entities. The World Health Organization, for example, has recommended changes in medical education that emphasize public health and preventive medicine training 4
. The Pew Health Professions Commission has challenged health professions schools to ensure that their students are competent in community-based care 5, 6
. At the same time, the Association of American Medical Colleges, in its Medical School Objectives Report (MSOP) has made several recommendations for educational outcomes, among which is cultivating physicians who are dutiful
and who “collaborate and use systematic approaches for promoting, maintaining, and improving the health of individuals and populations” 7
. Future physicians are expected not only to be adept clinicians, but also to understand and work within the family, community, and cultural contexts in which their patients live.
Medical students cannot acquire these insights and skills through didactic learning alone, but when didactic learning about population health is combined with the practical experience offered in typical clinical clerkships (e.g., in medicine, pediatrics, etc.), they can learn how to apply prevention knowledge in real-life settings. Yet such clerkships blending population health knowledge with practical experience are seldom offered and rarely required, indicating a paucity of opportunities and protected time for experiential learning of community health skills. Illustrating this problem, 32.1% of graduating medical students in 2006 reported that inadequate time during medical school was devoted to the role of community health and social service agencies, 32.1% noted this for public health, 21.4% for community medicine, 19.5% for clinical epidemiology, and 14.3% for health promotion and disease prevention 8
. In addition, a large proportion of students reported that inadequate time during medical school was devoted to health policy, health services financing, environmental health, global health issues, biological/chemical terrorism, and disaster management.
Many different clinical and basic science disciplines should share responsibility and commitment for education in community health 7
. Such education is inherently collaborative and requires the involvement of multiple disciplines. The intended outcome, as reported in the MSOP, is that “a population health perspective encompasses the ability to assess the health needs of a specific population, implement and evaluate interventions to improve the health of that population, and provide care for individual patients in the context of the culture, health status, and health needs of the populations of which that patient is a member 7
.” Many health professions schools are developing programs to address issues of population-based health and interdisciplinary teamwork while providing students with community-based experiences and a broader understanding of the social and cultural milieu of health and disease 9-14
. Many of these community-based programs have emphasized prevention at the clinical and individual level in order to provide students with experience in community-oriented primary care and, particularly, in underserved rural and urban communities 15, 16
. Fewer programs have addressed the social and environmental factors that contribute to the excess burden of disease and disability in these communities. The University of Rochester School of Medicine and Dentistry (URSMD) decided to create a novel clerkship to address these gaps in medical education.
In this article we describe the development of a community health improvement clerkship, which specifically addresses the need for medical students to review population science concepts, hone social group interaction skills rather than individual-level interaction skills, and apply knowledge and expertise in a practical setting. We will describe the development of this clerkship, its current content and operation, and some early evaluation results.
The most important anticipated outcome from this clerkship is physicians who will actively incorporate community health principles and practice in their future careers as health care leaders. We also hope for improved health in underserved, underrepresented populations, enhanced multidisciplinary collaboration in health prevention, and an increased number of medical students who decide to pursue careers that formally integrate population health research and practice.