Public health in the undergraduate medical curriculum - can we achieve integration?

Public health is widely regarded by medical students as peripheral or even irrelevant to the acquisition of clinical knowledge and skills. This paper attempts to set out some of the reasons for this, to encourage innovative a pproaches to integrating public health with clinical teaching and to offer a theoretical framework of integrated public health education for curriculu m development and evaluation. The points of convergence between public heal th and clinical practice should not be regarded as self-evident. A practica l demonstration of the application of public health principles to clinical problem solving may be the most effective means of overcoming resistance. A lmost anywhere that clinical services are provided is suitable for this pur pose. Community clinics, health centres or general practices have obvious a ppeal but acute hospitals have important advantages arising from students' preoccupation with clinical medicine. The main aim of integrated public hea lth teaching is to facilitate the students' acquisition of knowledge, skill s and attitudes that promote the effective application of public health app roaches to clinical practice. The interrelationships between clinical pract ice and public health may be represented in the form of a grid. The vertica l headings are the clinical skills that relate to the different stages of t he natural history of disease - from the pre-disease state through diagnosi s, treatment and follow up. The horizontal headings describe four key publi c health dimensions: epidemiology, behaviour/lifestyle, environment and hea lth policy. The text in the boxes suggests appropriate topics for discussio n. The grid is also potentially useful for course documentation and content evaluation.