Environmental Medicine Integrating a Missing Element into Medical Education (1995) / Chapter Skim
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3 Implementation Strategies
3 Implementation Strategies
Pages 22-43
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From page 22... ...
, any implementation strategy must address the need to expand and enhance the cadre of medical school faculty with this expertise. Without at least one champion to advance the cause of environmental medicine in curriculum committees and departments, even modest efforts to create an environmental focus in existing courses and clerkships are unlikely to succeed.
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From page 23... ...
Integration also highlights the relevance of environmental and occupational medicine to basic science and clinical studies, and provides a vehicle for enhancing faculty awareness of the issues. Moreover, instructors should be able to integrate environmental medicine into existing disciplines and medical school courses and clerkships fairly easily.
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From page 24... ...
Competency 2. Graduating medical students should be able to recognize the signs, symptoms, diseases, anil sources of exposure relating to common environmental agents and conditions.
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From page 25... ...
Introduction to Clinical Medicine Courses Some courses naturally lend themselves to teaching important concepts in environmental and occupational medicine. For example, "Introduction to Clinical Medicine" courses provide specific opportunities for introducing information on diseaseexposure relationships and could easily emphasize environmental and occupational exposures.
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Competency 3 Competency 3. Graduating medical students shovel be able to elicit an appropriately detailed environmental exposure history, including a work history, from all patients.
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From page 27... ...
A variety of interactive computer programs have been developed that focus on clinical problems in environmental and occupational medicine, and these problems can be used to enhance students' environmental and occupational history-taking skills. Students can work through computer-based cases, which can be loaded onto the computers generally used by them.
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From page 28... ...
Residency programs hold conferences for their house staff, which rotating medical students normally attend. Again, case-based discussions can stress the importance of environmental and occupational histories and exposure information in contributing to the differential diagnosis, treatment, and management of patients.
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From page 29... ...
For example, a clinical correlation on lead poisoning used to supplement material on heme synthesis can include information on the Centers for Disease Control and Prevention (CDC) guidelines, federal, state, and local agencies with toll-free hotlines, the name and telephone number of the medical school's expert on lead poisoning, and sources of patient education material on lead.
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From page 30... ...
Competency 5 Competency 5. Graduating medical students should be able to discuss environmental risks with their patients and provide understandable information about riskreduction strategies in ways that exhibit sensitivity to patients' health beliefs and concerns.
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From page 31... ...
Environmental and occupational factors can be easily included when teaching students how to characterize risk and identify preventive measures to reduce both population and individual risks. Journal articles that report epidemiologic studies of environmental and occupational diseases can be used to stimulate discussion of prevention and risk reduction (see Box 71.
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From page 32... ...
Competency 6 Competency 6. Graduating medical students should be able to understand the ethical and legal responsibilities of seeing patients with environmental and occupational health problems or concerns.
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From page 33... ...
Community and Preventive Medicine and Public Health Courses Courses in community and preventive medicine and public health provide opportunities to introduce students to legal and ethical concepts relating to environmental and occupational health. For example, community laws relating to waste disposal, recycling, or smoking in public places can be discussed, as can state and federal disease reporting laws, and toxic substance exposure registries.
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From page 34... ...
ENHANCING FACULTY AWARENESS As noted at the beginning of this chapter, any effort to integrate environmental health into the medical school curriculum requires faculty interest, commitment, and competence. Because the existing pool of medical school faculty with expertise in environmental medicine is exceedingly small, both long- and short-term strategies for expanding basic and clinical science faculty resources in this area must be pursued.
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From page 35... ...
After college, adequate training support and stipends would make it easier for medical students and residents to pursue advanced training in occupational and environmental medicine, as would environmentally-focused research fellowships and traineeships for graduate students in the basic sciences. Beyond this, however, these newly trained professionals must be assured of continued support for their environmental health research and teaching activities.
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From page 36... ...
This can be accomplished, in part, through presentations at departmental conferences and rounds, formal faculty development programs, the development and provision of brief, clinically relevant teaching materials for use in specific clerkships, and personal mentoring of interested junior faculty. Additionally, faculty with expertise in occupational and environmental medicine can serve as educational role models perhaps offering to attend an occasional morning report or afternoon case rounds.
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From page 37... ...
Alternatively, preceptor orientation could include written materials and one of several existing videotapes that demonstrate how to take a sufficiently detailed history in a given clinical setting. In general, efforts to enhance faculty awareness of environmental medicine should focus on those who teach and practice primarily in ambulatory settings, particularly those with a primary care practice.
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From page 38... ...
Integrating the Curriculum Environmental medicine may already be addressed in unexpected places in the curriculum. Thus, it will be helpful for medical schools to inventory the content of their educational programs throughout the four years of medical education and assess their relevance to the objectives suggested in this report.
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From page 39... ...
In all cases, the underlying goals should be the same- to teach students about causation, history-taking, and disease prevention. Developing Faculty In order to ensure adequate attention to environmental medicine in medical education, an enhanced awareness of the importance and integral nature of environmental medicine is needed among all faculty, as well as an increase in the number of medical school faculty with expertise in environmental medicine.
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From page 40... ...
resources; and expanding continuing medical education activities in this area. Continuing Education At the outset the committee restricted its discussions and recommendations to undergraduate medical education, but it soon became apparent that environmental and occupational medicine should be a part of the full continuum of medical education, including postgraduate training and the continuing education of practitioners.
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From page 41... ...
Evaluating Progress Even when undertaken with the best of intentions, curricular reforms can easily become more symbolic than substantive if they are not "kept honest" through careful evaluation. The committee strongly recommends that medical schools develop a plan for evaluating their progress in implementation as they begin to integrate environmental and occupational medicine into their curricula.
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From page 42... ...
Because practical constraints often make experimental design infeasible, setting up a valid effectiveness study can be a real methodological challenge. Fortunately, a variety of quasi-exper~mental designs have been worked out to approximate the logic of experimental control in evaluating program effectiveness.
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From page 43... ...
This kind of assessment, which might be done through a survey of graduates, could be carried out only after the training had been in place for some time. Other potential program effects that might be examined in individual medical schools include changes in faculty attitudes, activities, and competencies related to environmental medicine; changes in administrative awareness and support for environmental medicine; and changes in the medical school's patient services and community activities related to environmental medicine.
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