Throughout medical school, students are taught about great physicians and their contributions to medicine and society. Among them are John Snow, famous for his shoe-leather epidemiology; Alfred Sommers, renowned for reducing childhood mortality with his research on vitamin A; and most recently, Mona Hanna-Attisha, whose studies revealed dangerous levels of lead in the Flint, Michigan, water supply. These physicians are notable not only for their clinical skills, but also for their commitment to public health.
Despite frequent affiliations between medical schools and public health programs, medical education itself does not have a strong public health focus. While the USMLEs require basic knowledge of biostatistics and epidemiology, these topics only represent one facet of public health. Medical students rarely have the opportunity to contemplate the impact of changes in health policy or screening guidelines on their own patients. Instead, they rely primarily on clinical education rather than incorporating public health knowledge that could improve skills as future physicians, scientists, and patient advocates.
If medical students were asked to think carefully about pre- and post-test probabilities of diagnostic studies, would it change what they order and reduce healthcare spending? If they were taught about epidemiologic surveillance systems, would the medical community be able to contain epidemics more efficiently? If they believed that medicine exists on a continuum, with public health on one end and individualized care on the other, would they use public health knowledge to directly benefit the patients sitting in front of them, and would they use the patients sitting in front of them to contribute further to public health?
While the answer to these questions is not definitively “yes,” there is certainly no harm in imbuing students with the practical knowledge that has aided some of the most influential physicians in the past. Reflecting deeply upon these issues, we encourage a stronger public health focus in current medical education, both via academic instruction in the preclinical years as well as critical appraisal of relevant issues on the wards. Perhaps students who are more cognizant of public health tools, including implications of screening tests, insurance coverage, and health information systems, will be better prepared to advocate for their patients’ health, not only improving quality of life, but ultimately saving lives.
Ruchi S. Doshi, Sheila Razdan, and Andrea V. Yonge are medical students.
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