Clerkship changes bad for health system

Opinion

Hey there, time traveller!
This article was published 18/09/2023 (756 days ago), so information in it may no longer be current.

Senior medical students at the University of Manitoba are no longer going to experience real-world public health training during their clinical clerkship, a two-year process that refines their medical knowledge and interpersonal skills using hands-on learning before they graduate.

This change was made by the U of M’s Max Rady College of Medicine despite the devastating health, societal and economic impacts caused by the COVID-19 pandemic.

For full disclosure, we were the University of Manitoba Population Health co-directors of Undergraduate Medical Education (UGME) for the past two years until the end of August 2023.

One of the clear lessons from the pandemic is the importance for health-care providers to have a strong education in public health. If anything, public health training for future doctors should have increased, but the U of M failed this test.

Public health practice is complex, especially during a pandemic. To address the wide scope of opinions and thereby promote public health, it is important for health-care professionals to put the fire-hose flood of information, including misinformation and “alternate facts,” into perspective for their patients and communities. Understanding the “how and why“ of public health decisions and policies is important.

It was after seeing all these lessons play out that the U of M decided to eliminate public health from the family medicine rotation during clerkship, which had been the only place in the clerkship where medical students get training in public health practice that is integrated into their contact with patients. To add insult to injury, medical school leadership did not notify, consult or discuss the decision with the public health content experts responsible for planning and organizing public health teaching at the medical school.

In the former curriculum, after seeing patients in family medicine clinics, senior medical students identified and discussed public health issues related to these clinical interactions. Scenarios included infectious disease outbreaks, environmental health, poverty, homelessness and substance use, all of which require a broad societal approach.

Students were also encouraged to contact the medical officer of health or public health nurse linked with the health region they were placed in for their family medicine rotation. In the new curriculum, students now have no public health exposure in their clinical rotations and no opportunity to advance their understanding of public health practice in a clinical setting.

We worked hard to salvage something relevant out of this decision. After months of work developing a proposal to replace some of the lost public health exposure, we presented a plan. We were told by the medical school that since we had not got back to them earlier, the offered time had been given away and was no longer available.

The decision is particularly disappointing because we believe the alternative is both simple and impactful. The solution is to integrate public health teaching and approaches into each of the clinical rotations in clerkship. This would build public health understanding and practice in all areas of medicine and benefit the health of patients and communities as a result. It would also allow the College of Medicine to become a leader in promoting the value of public health, instead of being a leader in its erosion.

The decision made by U of M’s Max Rady College of Medicine to remove public health exposure from the clerkship is counterintuitive, disappointing and, we would add, misguided.

The conclusion from this decision, combined with the lack of other opportunities for public health training in clerkship, is that the U of M does not value clinical public health training for its medical students.

This will have a negative impact on the health of Manitobans who are cared for by these future physicians. Hopefully, the U of M will review their performance on this recent assignment and learn from it so that the next mark is a better one.

Dr. Sandor Demeter is a Winnipeg physician, an associate professor in the department of community health sciences at the University of Manitoba and a graduate of the Dalla Lana School of Public Health Global Journalism program at the University of Toronto. Dr. Michael Routledge is a Winnipeg public health physician and an assistant professor in the department of community health sciences at the University of Manitoba.