1. Maeshiro, Rika MD, MPH

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In 1941, the Commonwealth Fund published a report titled Teaching Preventive Medicine to Medical Students (and subtitled "With Special Reference to the Use of Health Department Facilities"), a report by Hugh Leavell, MD, DrPH1. Between 1939 and 1940, Leavell, a city health officer and medical school department head, surveyed 77 US allopathic medical schools, 10 Canadian medical schools, and the 87 health departments in the cities or countries in which the schools resided. To better understand the collaborations between the medical schools and health departments, he focussed on three questions:


1. To what extent can facilities of the health department be used and useful for teaching medical students?


2. To what extent is the health officer justified in making facilities of the health department available for teaching medical students?


3. What advantages may be expected to accrue to the health department and to the medical school from a joint teaching relationship?



Leavell concluded that nearly all medical schools used health departments to some degree and that medical schools were most likely to invite health department staff to lecture to their classes or to participate in field trips led by health department officials. When students were assigned to spend extended time at health departments, they were most likely to participate in fieldwork with health department personnel. The health officers who were surveyed generally agreed that the health department had an obligation to contribute to the education of medical students. Leavell believed that both medical schools and health departments benefited from the teaching partnerships-the health department provided opportunities for students to witness public health/preventive medicine in practice and health departments could enjoy the "inquiring attitude(s)" provided by the students. Eleven years ago, a similar study sponsored by the Health Resources and Services Administration found that 63 percent of allopathic medical schools that responded to the survey offered their students educational opportunities at public health departments.2


This issue of the Journal of Public Health Management and Practice features several articles that highlight the benefits of partnerships between health departments and academic institutions. Although collaborations between schools or graduate programs in public health may seem most natural for health departments, medical schools have also had a long history of working with state and/or local public health agencies. To enhance medical student education in public health/population health, the Association of American Medical Colleges (AAMC) has explicitly encouraged such alliances through two initiatives in recent years. AAMC plans to continue these efforts and to embark on additional collaborations with colleagues in the public health practice community in the future.


As noted previously in this journal, seven schools (Mercer University School of Medicine, Morehouse School of Medicine, Northeastern Ohio Universities College of Medicine, SUNY Upstate Medical University, Texas Tech School of Medicine, University of Kansas School of Medicine, and University of New Mexico School of Medicine) were awarded $50,000 through AAMC's cooperative agreement with the Centers for Disease Control and Prevention to establish Regional Medicine-Public Health Education Centers in 2003.3 Applicants were required to partner with at least one state or local health department for the purposes of educational activities that would impact all medical students (ie, not only those with particular interests in public health or those in dual-degree MD-MPH programs). With the funding, Regional Medicine-Public Health Education Center schools improved the integration of public health and population health themes throughout their curricula and developed new field opportunities for their students at public health agencies. This summer, the Pfizer US Public Health Group offered funding to the Regional Medicine-Public Health Education Center schools through AAMC to provide stipend and administrative support for medical students to participate in summer projects at local or state public health agencies. Students' project topics included efforts to improve seatbelt use in minority populations, researching the use of a banned pesticide in border areas, an assessment of a local Healthy Start program, a Geographical Information Systems study of local infectious disease data, and a study of local palliative care needs and resources. The evaluation of the Pfizer/AAMC Public Health Summer Program is still in progress, but with the majority of feedback from schools and students available, the projects appear to have been successful from the medical student, public health agency mentor, and medical school perspectives.


In the coming year, as part of the commitment to improve public health/population health education at medical schools, AAMC will continue efforts to facilitate partnerships between medical schools and health departments. In addition to plans to further develop the Regional Medicine-Public Health Education Center program, AAMC would like to convene a group of state and local public health practitioners to learn what they feel are the most important aspects of public health/population health for future physicians to learn, and how they think health departments and medical schools could benefit from partnerships. Experts from medical schools, schools of public health, and graduate programs in public health have commented on the importance of public health/population health in medical student education, but the opinions of public health practitioners have not been formally assessed. Their perspectives on what practicing physicians should understand about the public health systems in which they practice and that serve their patients may provide important insights into improving the coordination between the clinical and public health communities.


The questions Leavell raised more than 60 years ago are worth considering in the context of contemporary public health challenges, which range from public health preparedness to combating the obesity epidemic. Today's health departments face complex responsibilities with limited resources. These agencies may find that the "inquiring attitudes of medical students" are no longer sufficient motivation to take on the additional responsibilities of teaching medical students. Medical schools can offer assistance with agency efforts to fulfill the essential services of public health, particularly in activities that "inform, educate, and empower people about health issues"; "link people to needed personal health services and assure the provision of healthcare when otherwise unavailable"; "assure a competent public and personal healthcare workforce"; and "research for new insights and innovative solutions to health problems." Experience has shown that assuring all parties benefit in academia-health department collaborations is critical to the sustainability of the partnerships. The public health practice and academic medicine communities share commitments and obligations to improve the health of the public. Through enhanced coordination and collaborations in education, service, and research, the beneficiaries will include the health departments, the medical schools, and perhaps most importantly, the communities that they both serve.




1. Leavell HR. Teaching Preventive Medicine to Medical Students With a Special Reference to the Use of Health Department Facilities. New York, NY: The Commonwealth Fund; 1941. [Context Link]


2. Melville SK, Coghlin J. Population-Based Medical Education: Linkages Between Schools of Medicine and Public Health Agencies. Washington, DC: US Dept of Health and Human Services; 1995. [Context Link]


3. Novick LF. The teaching health department. J Public Health Manag Pract. 2004;10(4):275-276. [Context Link]