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Those of us who teach undergraduate medical students are well aware of the innate resistance of most embryonic doctors to anything that seems “irrelevant” to clinical practice. Overcoming this resistance has long preoccupied public health teachers throughout the world yet few have managed to come up with a sure fire method. The result has been a continuation of the relative neglect of preventive medicine training in many parts of the world, especially in the older established, traditional medical schools. Is it possible that this is one reason for the scandalous indifference of most medical practitioners and researchers to injury prevention?
In the UK, the General Medical Council (GMC), which has a statutory responsibility for medical education, acknowledged the lowly status of public health and in 1993 called for a major realignment of the undergraduate medical curriculum.1 In its report Tomorrow's Doctors, the GMC's Education Committee proposed a greatly increased role for public health in the curriculum in a manner consistent with the underlying aim of interdisciplinary integration in teaching. This has presented British public health educators with a golden opportunity to raise the profile of the subject, although it remains unclear how many have seized it.
In Glasgow, we have been experimenting with an innovative attempt to integrate the teaching of two disciplines—public health and paediatrics—within the eight week clinical attachment of senior medical students to the Royal Hospital for Sick Children, Yorkhill. This comprises a “clinical epidemiology ward round” that involves the illustration of the application of public health (especially epidemiological) principles and knowledge to clinical paediatric practice.2 The response of the students has been a mixture of bemusement and approval but our evaluation concluded that the experiment had succeeded. We are currently exploring ways of extending the idea into other clinical areas.
Injury prevention should be an ideal candidate for this type of integrated educational approach. Rather than presenting and constantly reiterating its somewhat dry theoretical basis, we could consider incorporating strong preventive elements into teaching being delivered in appropriate clinical settings. Among these are accident and emergency departments, fracture clinics, neurosurgical units, burns treatment centres, and intensive care wards. One potential obstacle is a mismatch between the orientation of the teacher and the location of the teaching. An orthopaedic surgeon, for example, may have little interest in prevention while a public health physician may not have ready access to a clinical facility. This can perhaps be overcome either through a highly selective recruitment of highly motivated and informed clinical teachers for this purpose or by organising joint teaching by clinical and public health staff.
Before taking the plunge into unfamiliar waters, I would be interested to hear of the experiences of colleagues in experimenting with such an approach to injury prevention education. If you have tried teaching medical students about injury prevention in a clinical setting, what did you do and how well do you think you succeeded?