Get a Dose of Public Health Training as a Medical Student

As part of her dual degree program in medicine and public health at the University of Wisconsin, fourth-year student Nayeli Spahr, 32, devotes much of her time to the Sixteenth Street Community Health Centers.

Here, deep in the underserved south side of Milwaukee, Spahr runs two-hour group well-child visits for 12 immigrant families with babies. The group approach has "eased the time pressure of a 15-minute doctor visit," says Spahr, and encourages the parents to open up about their challenges and share solutions.

"You can address things like social support through medical visits," she says, "if you think a little outside the box."

Medical schools are increasingly doing just that themselves as they scramble to prep students like Spahr to take charge of a health system centered on preventive medicine and population health, or care that's tailored to provide the best outcomes for a population of patients given their environment and culture.

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Across the country, schools are injecting principles of population medicine into their curriculums, putting even first-year students out in the community to tackle real health problems, and teaching future doctors about nutrition and exercise.

The reason for the push: As a reformed health system increasingly rewards better care and preventive care rather than number of procedures, medicine will be less about treating episodes of acute illness and more about managing chronic diseases.

To date, medical education hasn't kept up with calls for change. It's been "building a Pinto for a market that wants a Tesla," says David Nash, founding dean of Thomas Jefferson University's College of Population Health in Philadelphia.

But now all kinds of new ideas are being embraced.

While some schools have simply expanded the curriculum, others have created a certificate program or public health track students can opt to take along with the traditional courses. A number have added dual M.D.-Master of Public Health programs.

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At the University of Wisconsin School of Medicine and Public Health, "we emphasize that we're not just treating disease but preventing it," says Robert Golden, the school's dean. "From the start, we want students thinking not only about patients and families but populations."

In Wisconsin's popular public health case studies, first- and second-year students examine a scenario from multiple perspectives, such as that of a drunk driver who is severely injured. What is the cost to the health system? How do drunken driving and seatbelt laws affect the epidemiology of such accidents?

Third- and fourth-year students do most of their clinical rotations in underserved rural or urban areas, where they might also stage disaster drills or provide health education to diabetic children.

Students can pursue a public health pathway or dual degrees; those who decide to get the MPH typically take a detour between the second and third years of medical school to complete it.

The University of Pittsburgh School of Medicine, which offers a public health concentration, is another pioneer. The first week of school, new students can expect to visit a community in need and then explore factors that affect health, from unemployment to poor air quality.

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Second year brings another powerful learning experience, the poverty simulation. In a large room with areas designated for utility companies, businesses, homes, schools, a jail, a pawn shop, social services agencies and health facilities, faculty and other volunteers play business owners, civil servants, police, teachers, doctors and the odd thief or drug dealer.

Students act the part of members of needy families struggling to get kids to school or daycare and show up at jobs, pay the bills, and get services in the face of various obstacles. Think: The line to pay your gas bill was so long that you are late getting to work, and you lose your job. Or a thief steals your mortgage money, and you have no way to replace it.

The hope is that students who can put themselves in their future patients' shoes will have more empathy, says Jason Morrow, professor of ethics and medical humanities at the University of Texas Health Science Center School of Medicine in San Antonio, which stages the same simulation.

At the same time, schools are paying greater attention to the role of lifestyle choices in disease prevention.

While it's still true that less than a third of medical schools are meeting the minimum number of hours of nutrition education recommended by the National Academy of Sciences, changes are afoot.

Last year in New Orleans, Tulane University's medical school christened a gleaming new teaching kitchen near a community clinic in what used to be one of the city's "food deserts," or places where access to fresh foods is severely limited. There, the students learn "culinary medicine" and members of the community can take cooking classes.

As part of her studies at the University of Miami Miller School of Medicine, Sandy Jiang, 24, has created a wellness curriculum for at-risk youth that will be launched next year.

"It's been great practice for me to take what I'm learning and put it in lay terms so kids can learn why it's better to eat right," says Jiang, a second-year student working toward dual degrees in medicine and public health.

This story is excerpted from the U.S. News "Best Graduate Schools 2017" guidebook, which features in-depth articles, rankings and data.