1. The Extent & Methods of Public Health Instruction in Family Medicine Residencies Jacob Prunuske, MD, MSPH Linda Chang, PharmD, MPH, BCPS Ranit Mishori, MD, MHS Christopher Morley, PhD, MA, CAS

2. This slide set has been modified from the original presentation. Pictures have been removed to assure compliance with copyright laws.

3. Faculty Disclosure We have no financial interests/arrangements that would be considered a conflict of interest

4. Introduction The US has made significant gains in health over the past century, however, despite our progress, a number of significant public health challenges remain. We face an epidemic of obesity and other chronic diseases and health problems associated with lifestyle, built environment, & cultural norms…

5. ACA We face challenges associated with addressing disaster response, health disparities, pandemic preparedness, environmental health hazards, antibiotic resistance, gun violence, an aging population, climate change, and the impacts of health policy & law; all issues that must be addressed on a population level in addition to managing their impact on individual patients.

6. IOM Recommends Public Health (PH) Instruction in Medical Schools Basic PH training in population-based prevention for all med students “Significant proportion” of med school graduates fully trained in PH at an MPH level All med students need training in leadership, emergency preparedness, & clinical and community preventive services IOM. Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century. Washington, DC: National Academies Press; 2002. IOM. Training physicians for public health careers. Washington, DC: National Academies Press; 2007.

7. The Need for PH Training in Residency Med school graduates report “Inadequate” instruction –Health policy 40% –Occupational medicine 37% –Health care systems 35% –Environmental health 34% –Role of community health & social service agencies 24% –Public health 22% AAMC. GQ Medical School Graduation Questionnaire 2012.

8. Project Goal The instructional methods, curricular time, and factors associated with public health instruction in Family Medicine residencies nationally are unknown. We sought to address this knowledge gap…

9. Methods CERA PD Survey (Spring 2012) Two matrix-type questions Ten PH content areas –Hours of instruction –Methods of delivery

10. Results 212/431 (49.2%) responded to CERA PD survey 156/431 (36.2%) completed at least 1 PH item

11. Mean 228 ± 216 hours Range 10 – 1290 Median 163 hours Total Hours of PH Instruction

12. Mean Hours PH Instruction

13. PD Gender Female respondents (N = 40) –Mean 327 ± 324 hours –Range 26 – 1290, median 229 hours Male respondents (N= 103) –Mean 189 ± 141 hours –Range 10 – 752, median 148 hours Wilcoxon-rank sum p=0.023

14. No Association between PH Hours & Residency City Size City SizeNMeanMedian < 30,00032167 ± 103139 30,000 - 75,00035247 ± 203190 75,000 - 150,0005182 ± 160154 150,000 - 500,00030280 ± 300194 500,000 - 1 million20264 ± 269224 > 1 million22195 ± 167153

15. PH Hours/Program Type Program TypeNmeanmedian University-Based23231 ± 277128 Community-Based, University-Affiliated98238 ± 221158 Community-Based, Non-Affiliated12198 ±106173 Military5128 ± 9180

16. Informatics, Genomics, Env. Health69.2% Policy, Advocacy, Law & Ethics65.2% Social Sciences63.4% Health Services Administration59.9% Biostatistics and/or Epidemiology59.6% Global health57.5% Cultural Competence55.2% Community-Based Part. Research42.0% Behavioral Sciences36.6% Communication36.6% Proportion PH Instructional Hours Delivered Didactically

17. Limitations Recall bias No assessment of instructional quality Lower response rate –End-of-survey fatigue –Inability to save & return

18. Conclusions Significant time devoted to PH instruction, but potentially less time devoted to areas of greatest need Majority of PH content taught didactically Gender influenced reporting, may reflect true programmatic differences Program type may be associated with PH instruction, with more PH instruction in University- based or affiliated programs Wide variability may reflect lack of standardized competencies, variable program emphasis

19. Next Steps Concept mapping Consensus building to identify competencies most suited for residency training

20. Thanks CERA Survey Team STFM Foundation Group Project Fund