Following is the tenth vignette in a series on the revised medical curriculum, to be launched in August.

From Patients to Populations: Broadening Clinical Objectives

Photo courtesy of J. Finkelstein Jonathan Finkelstein Photo by Graham Ramsay Steven Simon

“If your goal is to stop the epidemic of obesity among low-income children, putting one kid on a diet won’t do very much,” said Jonathan Finkelstein, HMS associate professor of ambulatory care and prevention. Treating individual cases sometimes is not enough; to maximize health, physicians need to think simultaneously about individuals and populations. Therein lies the rationale for Clinical Epidemiology and Population Health—to be taught during the new January block by Finkelstein, head of the Medical School’s Center for Public and Population Health Medical Education, and Steven Simon, HMS assistant professor of ambulatory care and prevention. This course will reshape the teaching of Clinical Epidemiology (led by Simon in prior years), integrating content on population health and disease prevention.

Students will continue to focus on learning how to interpret and critically appraise research studies and apply the results to the care of individual patients in the doctor’s office. But additionally, said Simon, they’ll also be “thinking about the health of populations—how to use evidence from research studies and data available in real time to manage populations. As a doctor, the two or three thousand patients you care for constitute one population. But we’ll also try to get students to think about the neighborhood, the community, and the ethnic group as populations, and understand how physicians and the public health system can intervene at those levels.” He said future doctors will have to pivot from treating the patient as an individual to thinking about that patient as part of a group and providing care as both an individual physician and a member of a health care (and public health) system.

Indeed, Finkelstein said the Centers for Disease Control and Prevention and the Association of American Medical Colleges funded his center because “we’ve been a medical culture that’s focused on one-patient-at-a-time medicine, and there are lots of problems in medicine that are really population-level problems.” Anyone who has read the articles about the possibility of an influenza pandemic knows what he’s talking about—and, not coincidentally, that may be one of the case studies in the new class. In such an outbreak, physicians will need to treat sick patients, but may also need to consider issues of disease transmission, the most effective use of available medicines and other treatments, and optimal strategies for prevention. A new approach requires new teaching strategies. The new course will be case-based and feature “some lectures, some tutorials, and in addition, group projects that will allow students to grapple with population-health issues,” according to Finkelstein.

If topics like “bird flu” have a ripped-from-the-headlines quality, that’s because they have pedagogical value. “We can engage students most effectively by using compelling examples that exemplify the population-health challenges of this century, and physicians’ roles in addressing them,” said Simon. To fully understand the continuum of individual and population health, mastery of basic quantitative skills will be key. “We’re not teaching students to be statisticians or even researchers. We’re trying to help them understand uncertainty in both clinical medicine and population sciences—to be savvy consumers of research in ways that improve the care they provide.”

The duo is coordinating with directors whose courses cover related topics, including ethics, health policy, and social medicine. Their course will precede the course on social medicine, for example, and Finkelstein hopes to set his students up with the statistical and epidemiological skills they will need to understand the global health issues taught there.

—Rich Barlow

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