Preventive medicine 2000: changing contexts and opportunities.

The teaching of preventive medicine in the medical school curriculum occurs both in independent and in interdisciplinary courses and units. A survey was conducted to examine the changes in preventive medicine context, content, and allotted hours that have occurred in the transition from the traditional Flexnerian curriculum to the more interdisciplinary, centrally controlled curriculum. Data on medical school curricula for 1990-91, 1993-94, 1995-96, and 1998-99 were examined for the 126 U.S. and 16 Canadian medical schools. By 1998-99, 35 schools moving to the new interdisciplinary format had retained preventive medicine teaching as a separate course, although the courses usually had incorporated topics that went beyond the traditional ones. In another 35 schools, preventive medicine hours had been lost in the transition; but in 25 of these new courses it was clear that preventive medicine played a very significant role. It can be assumed that the lost hours were more than replaced as preventive medicine concepts permeated these courses. Of greatest importance were the hallmark courses of the six nontraditional curricula that had designated preventive medicine a major-theme course. However, at ten schools, preventive medicine listings disappeared in the move to nontraditional curricula. Preventive medicine educators must step forward to use curricular restructuring to expand the role of preventive medicine in the curricula of their institutions, whether in stand-alone or in interdisciplinary courses. The goal, as always, is to provide future physicians with the knowledge and skills they need to provide proper care to their patients.

Putting it all together: building a four-year curriculum.

A four-year curriculum in preventive medicine would require planning, but all the components are already available. This article outlines a four-part plan: develop the desired objectives or competencies; present the basics in years one and two of the curriculum; in years three and four make health promotion/disease prevention (HPDP) and the population perspective relevant to the practice of medicine; and, finally, develop a mechanism to track the curriculum and then improve it. Core competencies have already been developed, through joint activities of the Association of Teachers of Preventive Medicine (ATPM) and the Bureau of the Health Professions of the Health Resources and Services Administration (HRSA), and articles about teaching preventive medicine in multiple disciplines throughout the curriculum are published elsewhere in this supplement. Schools across the United States and Canada have innovative programs in place that can serve as models, and there are feasible approaches to monitoring the programs.

Evaluation of an educational program in preventive cardiology.

In 1979, an educational program in preventive cardiology (PC), supported by the National Heart, Lung, and Blood Institute (NHLBI) was introduced into the medical school at the University of Tennessee, Memphis (UTM). This report evaluates that program from 1979 to 1984 in terms of student health behaviors, student attitudes toward PC, student knowledge of PC, and the impact of the program on continuing development of educational programs in PC. In 1981, using a 30% random sample, freshmen students in medicine and dentistry at UTM and medical students at a nearby state medical school similar to UTM were surveyed concerning health behaviors, attitudes, and knowledge. The surveys were repeated three years later. Analysis of the data from these pre- and postsurveys showed that UTM medical students improved (P less than .05) their attitudes about the preventability of heart disease and that their PC knowledge scores increased (P less than .0001). Personal health habits and health parameters were generally good and remained so. Although control medical students improved their PC knowledge, this change was not as great as in UTM medical students (P less than .05). The improved attitude toward PC in UTM medical students was not statistically different from changes in control students. Unfortunately, the statistical power of this analysis was low (less than 20%), and important differences between UTM medical students and controls were likely to have been missed. In addition to changes in students, considerable institutional change occurred at UTM as a direct result of this project, leading to the expansion of emphasis on PC (and prevention in general) in the five years since the completion of this NHLBI-funded program.

Subjective age, age identity, and middle-age adults.

A casual model of subjective age among middle-age working adults is proposed. Determinants of subjective age include chronological age, education, health, self-esteem, financial satisfaction, and job satisfaction. Life satisfaction is used as an explanatory outcome. Using a sample of middle-age men, the results indicate that self-esteem and financial satisfaction were important mediators between chronological age and subjective age. In turn, positive and negative characteristics were associated with both a "younger" and "older" subjective age. The results contribute to the further understanding of adult development and the meaning of subjective age.