ENVIRONMENTAL MEDICINE - ITS INTRODUCTION INTO A MEDICAL-SCHOOL PRIMARY-CARE REQUIREMENT

One hundred and twelve medical students participating in a required 6- week primary-care rotation completed a pretest of environmental medici ne knowledge and attitudes at the start of the rotation and a similar posttest on the last day of the rotation. Control group students were to participate in the usual weekly didactic sessions of the clerkship. Intervention students were given a booklet describing environmental c onsiderations in clinical medicine and introducing them to the concept of risk assessment, three computer-assisted instruction cases, and a problem-based learning (PBL) exercise involving role-play. Because vol untary compliance with evaluation forms was poor during year one, duri ng the second year students in the intervention group were required to return evaluation forms in order to sit for the course final examinat ion. Knowledge and attitudes of both intervention apd control groups w ere compared at baseline and at the end of the rotation. Students in t he intervention group also completed process evaluations of the interv ention materials. Students in both intervention and control groups inc reased knowledge gains significantly during the second year of the int ervention, while neither group improved during year 1. This may have b een due to a 'spill-over' effect among primary-care teachers implement ing the intervention. Students ranked both environmental and occupatio nal medicine of least importance in their training compared with eight other aspects of medicine, and this ranking did not improve with inte rvention. The PBL exercise was well received by the students. Of 28 ev aluations, 27 ranked the session in the highest 3 of a 5-part Likert s cale for worthwhile content, and 24 would recommend the session to a f riend. When asked to list the most important things learned, 23 mentio ned learning to look for additional information, and 12 mentioned real izing that the doctor does not know everything (and should admit that) .