Creating novel case studies
that integrate concepts in pharmacology and public health

Proposal to the Academy of Medical Educators
Jennifer Breckler, PhD and Kent R. Olson, MD
Joint Medical Program
UCB/UCSF

Abstract Summary:
In this project, we will write three case studies for use in a problem-based medical school curriculum. The cases will then be used in small group learning sessions consisting of second-year medical students in the Joint Medical Program (JMP) and public health graduate students at UC Berkeley.
Our aims are:
· To integrate pharmacology with major public health concepts through the development of new case studies to be used in a problem-based curriculum.
· To create and publish a new prototypical type of case-writing that utilizes 'populations' of patients, rather than individual patients.
· To utilize the existing case-based curriculum at the JMP to foster interactions between two groups of future health professionals (i.e. medical students and graduate students in public health), and to evaluate the effects of their interaction on students' learning and understanding of public health and medicine.

Background and Goals
The expectation of public health experts and the community-at-large is that primary care physicians will implement basic concepts of public health in their clinical practice. In order to do so, physicians must first be exposed to and learn core public health concepts. Ideally, public health issues are an integral part of the medical school curriculum, yet public health courses are often entirely separate from the clinical and basic science curricula and more hands-on study of public health issues has largely been restricted to medical students who select joint degree programs (i.e. MD/MPH). After physicians enter clinical practice, the task of educating primary care physicians on public health concepts such as screening and prevention is moderately effective, yet time-consuming, labor-intensive, and previously held conceptions change only gradually (Olive, et al. 1998; Wahlstrom, et al. 1997). A close working relationship between U.S. physicians and public health experts is more important today than ever before, as they encounter a myriad of common problems such as illness clusters, health care access, hospitalization costs, confidentiality of information and the potential for bioterrorism.
The dialogue between public health experts and physicians would preferably begin in pre-clinical medical school training, yet medical students and public health graduate students enroll in separate courses and curricula. In order to create an opportunity for this life-long dialogue, co-enrollment of medical students and public health graduate students (PhD, DrPH or MPH programs) would encourage communication to occur and ideas exchanged. Ideally, the class size should be small, involve problem-based learning, and focus on a clinical problem of general public interest.
These conditions for cooperative learning are met by the Joint Medical Program (JMP), which is an ideal environment in which to experiment with case-based learning. The JMP is housed in the School of Public Health at UC Berkeley. This year, the Joint Medical Program (JMP) has embarked on a new comprehensive 3-year curriculum consisting of problem-based learning, which has replaced the basic science courses formerly taught as separate entities. The use of the proposed new cases in our curriculum supports the notion that integrating basic and clinical sciences throughout all years of medical school benefits the learning of both areas (McCrorie, 2000; Jamieson, 2001). In our program, approximately 85 case studies are being used to teach all areas of basic science and clinical medicine. Each case study is used for an entire week of learning, and involves a single patient with a particular disease or condition. The students work in small tutorials and select their own learning issues for each case. The cases are somewhat contextualized, and thus students occasionally decide to pursue areas of social science; yet for the most part, public health concepts are not emphasized nor are they a priority for student learning.

Research Plan:

Objective #1: The first stage of the project will involve writing the actual case studies. In this project, we wish to write at least three new case studies that will focus on core public health issues which we believe are of major importance to primary care physicians:
1) reporting
2) risk assessment
3) cost benefits of mass treatment
4) prevention and screening

In each case study that we write, we will employ a novel teaching methodology by describing patient 'populations' instead of individual patients. To our knowledge, this is a new concept in medical school case-writing and will generate prototypical cases and a case-writing technique that we plan to submit for publication to journals in medical education. Inherently, the use of a community population as the "patient" will guide the students' attention to treatment or prevention that serve both the affected individuals and the community-at-large. The case populations that we plan to use are based on actual incidents encountered by one of the PI's (K. Olson) in his role as medical director of the regional poison control center.

Objective #2:
The use of problem-based learning (PBL) in teaching pharmacology is not unique (Rangachari, 1997; Antepohl & Herzig, 1999). Yet, existing PBL cases in pharmacology are usually integrated solely with other related basic sciences (i.e. physiology, cell & molecular biology), and there is a strong overlap of pharmacology teaching with clinical medicine. However, to our knowledge, the idea of combining pharmacology with public health concepts in case-writing is new.

Objective #3: Following the creation of these new cases that integrate public health and pharmacology, we will also study the effect of these cases on student learning. The questions we will ask are:

1) What is the effect of introducing public health in clinical cases during the medical curriculum? Controls: UCB/UCSF or UCSF 2nd or 3rd year medical students taking elective courses in public health. We will test JMP students using essay questions for assessment. We will also administer surveys to students in which they will score their enthusiasm for the case, and comprehension and mastery of public health material.
2) What are the reactions of medical students to the novelty of using patient 'populations' in each case, as opposed to individual patients? We will solicit oral and written feedback from students about their reactions to this new type of case study. Students in the JMP are currently using weekly cases involving individual patients, so they will be able to make a direct comparison with our cases. We plan to publish our case studies as prototypes for future case-writers.
3) Does co-enrollment of medical students with public health students enhance or otherwise affect the learning of public health concepts by medical students? We will invite interested public health graduate students from DrPH and MPH programs at UC Berkeley to participate in the PBL sessions with the medical students, using our new cases. We have already spoken with the public health graduate teaching assistant in Public Health 200B, coincidentally an incoming JMP student, who is interested in helping us identify and select these students.

For further information, please contact:

Jennifer Breckler, PhD
Email: jbreck@sfsu.edu

Kent R. Olson, MD
Email: kent.olson@ucsf.edu