The concept of a teaching health department is not new in public health education. Early examples include the Columbia University School of Public Health working with the Washington Heights Health District of the New York City Department of Health and Johns Hopkins University working with the Baltimore City Health Department. Now, two new initiatives funded by the Centers for Disease Control and Prevention (CDC) are again emphasizing the importance of health departments in teaching students of medicine and public health. One of these, based on a Cooperative Agreement between the CDC and the Association of American Medical Colleges (AAMC), requires linkages for educational purposes between state or local health departments and schools of medicine. Similarly, an Academic Health (ADH) project, funded by the CDC and the Association of Schools of Public Health (ASPH), creates a similar collaboration between departments of health and schools of public health.
Seven medical schools have each received an award of $50,000 to help support the establishment of "centers" for public health education to work together on educational agendas (Box 1). Initially, the educational focus is medical students with a future focus on resident and practitioner education. These Regional Public Health-Medicine Educational Centers are responsive to population-based education in the medical community, including working with the public health community on the Healthy People 2010 objectives, identifying community health priorities and enhancing emergency preparedness to respond to naturally acquired emerging infections or bioterrorism.
The critical element for each of the centers is the active collaboration between health departments and schools of medicine. Together, they expand the content and the relevance of public health education. Other entities may also be included in the center, such as Area Health Education Centers, centers for bioterrorism or public health preparedness, community-based organizations, or schools of public health.
Health departments can make a substantial contribution to medical student education. At my teaching institution, SUNY Upstate Medical University, all medical students make community site visits accompanied by public health staff from the Onondaga County Health Department. Students visit the home of either a child with an elevated level (lead toxicity) or a pre- or postpartum adolescent. The environment and social circumstances they observe in the community provide a new and different perspective, compared to seeing these same individuals in clinical settings. A broad array of health determinants and issues of compliance are identified. Our curriculum also contains a series of population-based health teaching cases drawn from health department clinical situations. These cases are coupled with community data, and students must work together to find public health solutions to problems including sexually transmitted diseases, infant mortality, a tuberculosis outbreak in a community shelter, and so forth.1 Finally, students have the opportunity to do supervised electives with our health department.
Fourteen schools of public health will be funded at approximately $100,000 for planning activities in the ADH project (Box 2). The 2002 Institute of Medicine (IOM) reports Who Will Keep the Public Healthy?2 and The Future of the Public's Health in the 21st Century3 and the earlier publication, The Future of Public Health by the IOM in 1988, all emphasize the importance of linking education at schools of public health with practice realities. As the Request for Applications (RFA) for the current AHD program points out, progress in collaboration between these educational entities and local and state health departments have been less than satisfactory. Yet, improved collaboration will benefit both health departments and academia in education, service, and population-based research. This is the goal of the ADH project.
These new initiatives by the AAMC and ASPH represent a welcome realization that health departments have a wealth of educational resources available including extensive fieldwork and broad array of population health responsibilities. At the same time, careful organization of the educational experience is needed so that the teaching health department can meet specific educational objectives and provide supervision in field experience, electives, and preceptorships. The AAMC and ASPH are making a sound investment in the potential to reinvigorate and restructure the role of the teaching health department with a focus on population health and actual practice. The Centers for Disease Control and Prevention has shown foresight in funding these models. Evaluation of the initial success and continued support for positive results will be most important to future medical practitioners and the public health workforce.
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