Early experiences with combined fellowship training in clinical informatics.

Given the ubiquitous nature of information systems in modern health care, interest in the pursuit of formal training in clinical informatics is increasing. This interest is not restricted to generalists-informatics training is increasingly being sought by future subspecialists. The traditional structure of Accreditation Council on Graduate Medical Education subspecialty training requires completion of both clinical and clinical informatics fellowship programs, and understandably lacks appeal due to the time commitment required. One approach to encourage clinical informatics training is to integrate it with clinical fellowships in order to confer dual-board eligibility. In this perspective, we describe 3 successful petitions for combined training in clinical informatics in order to support other programs and the American Board of Preventive Medicine in establishing pathways for training subspecialists in clinical informatics.

Including Lifestyle Medicine in Medical Education: Rationale for American College of Preventive Medicine/American Medical Association Resolution 959.

Introduced by the American College of Preventive Medicine and released by the American Medical Association House of Delegates in 2017, Resolution 959 (I-17) supports policies and mechanisms that incentivize and/or provide funding for the inclusion of lifestyle medicine education and social determinants of health in undergraduate, graduate and continuing medical education. Resolution 959 was passed to help address the current healthcare costs of lifestyle-related, noncommunicable chronic diseases that exert a devastating economic burden on the U.S. healthcare system. Approximately 86% of $2.9 trillion is spent annually on obesity, cardiovascular disease, type 2 diabetes, and some cancers, with very poor return on investment for health outcomes. Lifestyle medicine provides an evidence-based solution to the noncommunicable chronic disease epidemic; however, medical education in lifestyle medicine is minimal to nonexistent. This paper provides the case for healthcare innovation to include lifestyle medicine in the prevention and treatment of noncommunicable chronic diseases. Our medical education system recommendation is to provide lifestyle medicine training for prevention and treatment of noncommunicable chronic diseases. Exemplar lifestyle medicine schools are showcased and guidance for reform is highlighted that can be used to aid lifestyle medicine integration across the medical school education continuum. With a transformation of curriculum and development of new policies to support a focus on lifestyle medicine education in medical education across the continuum, a new healthcare model could be successful against noncommunicable chronic diseases and U.S. citizen wellness could become a reality.

Integrating Population Health Content into FNP Program Curriculum.

In the current healthcare environment, the healthcare industry has become increasingly focused on population health concerns. While advanced practice registered nurses (APRNs) are well prepared to contribute to population health by delivering holistic healthcare to individuals, families, groups, communities, and populations, they are not engaged in initiatives to improve population health commensurate with their numbers, education, training, experience, and role as primary care providers and essential healthcare team leaders and members. This article discusses the rationale for integrating population health into APRN curricula, one program's approach to doing so, and preliminary lessons learned from this effort. The three main lessons learned include population health content should be integrated across the curriculum for all APRN cohorts, supplementary population health content should be considered, and opportunities for integrating didactic population health content should be included across the FNP curriculum.

Community-Engaged Lifestyle Medicine: Building Health Equity Through Preventive Medicine Residency Training.

Vulnerable populations in the U.S. experience persistent disparities in chronic disease and associated lifestyle-based risk factors. Because of environmental, cultural, and health systems barriers affecting vulnerable populations, lifestyle medicine interventions may miss those at highest risk for chronic disease. Numerous reports suggest that graduate medical education (GME) inadequately prepares physicians to promote healthy lifestyles and health equity in vulnerable groups. General Preventive Medicine/Public Health (GPM/PH), the medical specialty dedicated to health promotion and disease prevention in populations, can fill this gap. However, virtually no published reports describe health equity-oriented GPM/PH residency programs. The authors describe implementation of the novel Community-Engaged Lifestyle Medicine at the University of Texas Rio Grande Valley GPM/PH residency program between 2017 and 2018. Community-Engaged Lifestyle Medicine applies community engagement principles to lifestyle medicine practice, training residents in multilevel, intersectoral approaches promoting behavior change and health equity. Community-Engaged Lifestyle Medicine is described in the context of health equity and the local border community, along with associated curricular objectives and experiences. In 2017, the authors assessed first-year Community-Engaged Lifestyle Medicine process outcomes, fidelity to health equity mechanisms, and feasibility in a GPM/PH residency, by mapping Community-Engaged Lifestyle Medicine activities to American Council of Graduate Medical Education and the American College of Lifestyle Medicine competencies. The Community-Engaged Lifestyle Medicine framework was successfully implemented in 2017, meets all American Council of Graduate Medical Education competency domains, and demonstrates fidelity to mechanisms of community engagement, health equity, and the practice of lifestyle medicine. Community-Engaged Lifestyle Medicine represents a feasible and valid framework to promote health equity via GPM/PH and GME training and practice.

Good practices and challenges in addressing poliomyelitis and measles in the European Union.

Background: All European Union (EU) and European Economic Area (EEA) Member States have pledged to ensure political commitment towards sustaining the region's poliomyelitis-free status and eliminating measles. However, there remain significant gaps between policy and practice in many countries. This article reports on an assessment conducted for the European Commission that aimed to support improvements in preparedness and response to poliomyelitis and measles in Europe. Methods: A documentary review was complemented by qualitative interviews with professionals working in International and EU agencies, and in at-risk or recently affected EU/EEA Member States (six each for poliomyelitis and measles). Twenty-six interviews were conducted on poliomyelitis and 24 on measles; the data were subjected to thematic analysis. Preliminary findings were then discussed at a Consensus Workshop with 22 of the interviewees and eight other experts. Results: Generic or disease-specific plans exist in the participating countries and cross-border communications during outbreaks were generally reported as satisfactory. However, surveillance systems are of uneven quality, and clinical expertise for the two diseases is limited by a lack of experience. Serious breaches of protocol have recently been reported from companies producing poliomyelitis vaccines, and vaccine coverage rates for both diseases were also sub-optimal. A set of suggested good practices to address these and other challenges is presented. Conclusions: Poliomyelitis and measles should be brought fully onto the policy agendas of all EU/EEA Member States, and adequate resources provided to address them. Each country must abide by the relevant commitments that they have already made.

Improving nursing students' assessment of fall risk in community-dwelling older adults.

Nationally, approximately one third of older adults fall each year. Falls and resulting injury result in decreased mobility, functional impairment, loss of independence, and increased mortality. Utilization of evidence-based protocols by health care providers to identify older adults at risk of falling is limited, and rates of participation by older adults in prevention activities is low. Because of nursing's increasing role in caring for older adults, development of fall prevention education for nursing students would result in increased awareness of the need for fall prevention in community-dwelling older adults and increased access of older adults to falls risk assessment. There is a need to extend research to inform teaching and learning strategies for fall prevention. After pretesting, a convenience sample of 52 undergraduate nursing students and 22 graduate nursing students completed an online education program and performed a falls risk assessment on an older adult. After completing the clinical assignment, students completed a posttest and self-efficacy survey. Data were analyzed using multivariate statistical tests. Results revealed an increase in knowledge and student self-reporting of efficacy of fall risk assessment skills for the older adult population. This study suggests that nursing students acquired the necessary knowledge and self-efficacy for assessing fall risk of older adults through the combination of an online learning module and participating in actual fall risk assessment of an older adult.

Origins and Evolution of Social Medicine and Contemporary Social Medicine in Korea.

Social medicine is recognized as one of medical specialties in many countries. However, social medicine has never been formally introduced to Korea, presumably because the term and its principles were not accepted for some years in the past in American medicine, which has strongly influenced Korean medicine. This paper describes the origins and evolution of social medicine and briefly discusses contemporary social medicine in Korea. Social medicine was initiated in France and Germany in 1848. Since then, it has expanded globally and developed in diverse ways. Included in core principles of social medicine is that social and economic conditions have important effects on health and disease, and that these relationships must be subjected to scientific investigation. The term 'social medicine' is rarely used in Korea, but many of its subject matters are incorporated into preventive medicine which, besides prevention, deals with population health that is inescapably social. However, the Korean preventive medicine directs little attention to the basic concepts and principles of social medicine, upon which systematic development of social medicine can be based. Thus, it is necessary to supplement the social medicine contents of preventive medicine through formalizing the linkages between the two fields. One way of doing so would be to change the title of 'preventive medicine' course in medical colleges to 'preventive and social medicine,' as in many other countries, and to adjust the course contents accordingly.

Learning About and Using Research Evidence Among Public Health Practitioners.

INTRODUCTION: Funders and accreditation standards increasingly call on state and local public health agencies to use the best available science. Using research evidence is a key process in practicing evidence-based decision making (EBDM). This study explored preferences for and uses of research evidence, and examined correlates regarding frequency of use. METHODS: In 2014, eligible staff from 12 state health departments and their partnering agencies were invited to complete an online self-report questionnaire and achieved an 82% response rate (1,237/1,509). The cross-sectional data analyzed in 2015 were baseline to a study on enhancing EBDM capacity and supports. RESULTS: Webinars/workshops was the most frequently selected method to learn public health findings among those in state and local health departments, whereas academic journals was the top selection by those in universities and healthcare facilities (p<0.001). Several modifiable EBDM practices were associated with more frequent use of research evidence, including direct supervisor expectations for EBDM use and performance evaluation based partially on EBDM use (AOR=2.5, 95% CI=1.9, 3.2 and AOR=2.5, 95% CI=2.1, 2.9, respectively). Increased numbers of EBDM practices were associated with higher odds of frequent research evidence use. Participant characteristics associated with higher research evidence use and adjusted for were job role, education attainment, and gender. CONCLUSIONS: To translate research into public health practice, researchers can tailor evidence on intervention implementation and effectiveness and disease burden to accessible and preferred formats for public health workers and partners. Management practices to support evidence-based disease prevention can be instituted and fostered in public health and partnering agencies.

Training Health Professionals to Deliver Healthy Living Medicine.

The growing incidence and prevalence of unhealthy living behaviors leading to compromised health, along with unhealthy supportive environments, are the primary reasons for the current chronic disease crisis in almost all countries. Over the course of health professions training across disciplines, a large amount about information regarding various aspects of chronic disease is introduced, from pathophysiology to a broad array of approaches to examinations (focused on diagnosis and prognosis) and interventions. Currently, a late primary or secondary prevention focus is the primary educational approach in the health professions. In either scenario, the health professional is often trained to approach their discipline from a catch up approach, with little focus on how an individual's health condition, at the time of presentation, came to be. It is unfortunate that so little educational time and effort are devoted to train future health professionals on how to practice Healthy Living Medicine (HLM) and, deliver healthy living (HL) interventions. The primary goal should be to keep individuals healthy where they live, work and go to school and minimize initiating care in the hospital and outpatient clinical setting. The current review describes current trends in training health professionals in HLM and the delivery of HL interventions.

Family physicians prescribing lifestyle medicine: feasibility of a national training programme.

BACKGROUND: The actual causes of the preponderance of non-communicable chronic diseases are related to unhealthy behaviours, such as poor nutrition, physical inactivity and tobacco use. Our goal was to evaluate the feasibility of training in lifestyle medicine (LM) for family physicians, which could be included in 'Healthy Israel 2020', a national initiative created to enhance the health of Israelis. METHODS: Twenty-six providers participated in a 1-year certificate of completion in LM. A control group included 21 providers who participated in a similar musculoskeletal training programme. Pre/post data were collected in both groups of participants' attitudes and self-efficacy to prescribe LM and personal health behaviours. Mid/post feedback was collected in the study group participants. RESULTS: Physicians in the LM training represented a nationwide distribution and attended >80% of the programmes' meetings. They reported positive outcomes in most areas after the intervention compared with baseline. Five variables reached statistical significance: potential to motivate patients to improve exercise behaviours (p<0.05), confidence in one's knowledge about LM (p=0.01) and counselling (p<0.01), particularly related to exercise (p=0.02) and smoking cessation (p<0.05). The control group demonstrated one significant change: potential to motivate patients to change behaviours to lose weight (p<0.05). CONCLUSIONS: A training programme in LM appears feasible and could have a positive impact on interested family physicians' attitudes and confidence in prescribing LM. Thus, 'Healthy Israel 2020' and other programmes worldwide, which aim to improve health behaviours and decrease the impact of chronic diseases, might consider including family physicians training.

[Knowledge, attitudes, and training needs of residents in Preventive Medicine and Hygiene in Italy, in the context of Primary Health Care]. / Ricognizione dei bisogni formativi dei medici specializzandi di Igiene e Medicina Preventiva nell'ambito dell'Assistenza Primaria: risultati di una survey online.

In June 2015, the working group "Primary Health Care" of the Italian Society of Hygiene Representatives of Hygiene and Preventive Medicine Residents, performed an online questionnaire survey among residents of this specialty in Italy, to analyze their training needs regarding primary health care. In total, 730 residents in 32 schools were invited to participate by email, of whom 40.7% (297/730) completed the questionnaire. Most of the respondents were female (66.7%) and 40.1% were enrolled in a school in northern Italy. Almost half of participating residents were enrolled in the second or third year of the five-year program. Over 65% reported interest in deepening their knowledge in each of the proposed thematic areas of primary healthcare. For each area, less than one quarter of respondents (range 5-22%) considered satisfactory the skillsets acquired in that area. Eighty-seven percent reported that the option to do electives in primary health care during the residency was available to them.

Integrative Medicine in Preventive Medicine Education: Competency and Curriculum Development for Preventive Medicine and Other Specialty Residency Programs.

During 2012, the USDHHS's Health Resources and Services Administration funded 12 accredited preventive medicine residencies to incorporate an evidence-based integrative medicine curriculum into their training programs. It also funded a national coordinating center at the American College of Preventive Medicine, known as the Integrative Medicine in Preventive Medicine Education (IMPriME) Center, to provide technical assistance to the 12 grantees. To help with this task, the IMPriME Center established a multidisciplinary steering committee, versed in integrative medicine, whose primary aim was to develop integrative medicine core competencies for incorporation into preventive medicine graduate medical education training. The competency development process was informed by central integrative medicine definitions and principles, preventive medicine's dual role in clinical and population-based prevention, and the burgeoning evidence base of integrative medicine. The steering committee considered an interdisciplinary integrative medicine contextual framework guided by several themes related to workforce development and population health. A list of nine competencies, mapped to the six general domains of competence approved by the Accreditation Council of Graduate Medical Education, was operationalized through an iterative exercise with the 12 grantees in a process that included mapping each site's competency and curriculum products to the core competencies. The competencies, along with central curricular components informed by grantees' work presented elsewhere in this supplement, are outlined as a roadmap for residency programs aiming to incorporate integrative medicine content into their curricula. This set of competencies adds to the larger efforts of the IMPriME initiative to facilitate and enhance further curriculum development and implementation by not only the current grantees but other stakeholders in graduate medical education around integrative medicine training.

Integrative Medicine in Preventive Medicine Education: Implementation Analysis.

In September 2012, the Health Resources and Services Administration funded 12 preventive medicine residency programs to participate in a 2-year project aimed at incorporating integrative medicine (IM) into their residency training programs. The grantees were asked to incorporate competencies for IM into their respective preventive medicine residency curricula and to provide for faculty development in IM. The analysis conducted in 2014-2015 used the following evidence to assess residency programs' achievements and challenges in implementation: progress and performance measures reports, curriculum mapping of program activities to IM competencies, records of webinar participation, and post-project individual semi-structured phone interviews with the 12 grantee project leaders. Key findings are: (1) IM activities offered to residents increased by 50% during the 2 years; (2) Accessing IM resources already in existence at local grantee sites was the primary facilitator of moving the integration of IM into preventive medicine residencies forward; (3) Among all activities offered residents, rotations were perceived by grantees as by far the most valuable contributor to acquiring IM competencies; (4) Online training was considered a greater contributor to preventive medicine residents' medical knowledge in IM than faculty lectures or courses; (5) Faculty were offered a rich variety of opportunities for professional development in IM, but some programs lacked a system to ensure faculty participation; and (6) Perceived lack of evidence for IM was a barrier to full program implementation at some sites. Grantees expect implemented programs to continue post-funding, but with decreased intensity owing to perceived faculty and curriculum time constraints.

Integrative Medicine in a Preventive Medicine Residency: A Program for the Urban Underserved.

The Preventive Medicine Residency Program collaborated with the Department of Family Medicine's Program for Integrative Medicine and Health Disparities at Boston Medical Center to create a new rotation for preventive medicine residents starting in autumn 2012. Residents participated in integrative medicine group visits and consults, completed an online curriculum in dietary supplements, and participated in seminars all in the context of an urban safety net hospital. This collaboration was made possible by a federal Health Resources and Services Administration grant for integrative medicine in preventive medicine residencies and helped meet a need of the program to increase residents' exposure to clinical preventive medicine and integrative health clinical skills and principles. The collaboration has resulted in a required rotation for all residents that continues after the grant period and has fostered additional collaborations related to integrative medicine across the programs.

[Development of an instrument for the surveillance of quality indicators in specialized training in Preventive Medicine and Public Health]. / Elaboración de una herramienta para la vigilancia de indicadores de calidad de la docencia en la formación especializada de Medicina Preventiva y Salud Pública.

This study describes the process of developing an instrument intended for use in assessing satisfaction with the quality of training in preventive medicine and public health for resident physicians. To develop this instrument, the National Survey of Satisfaction with Medical Residency was adapted by an expert panel consisting of 23 resident physicians in preventive medicine and public health belonging to 9 autonomous communities in Spain. The adaptation of the survey to the specialty rotations included new dimensions and items and was evaluated with a 5-point Likert scale. The most important dimensions were planning and the achievement of specific objectives, supervision, delegation of responsibilities, resources and work environment, personal assessment, encouragement, support, and whether the rotation resulted in a publication or research project, etc. The development and utilization of this tool will enable future trainees in preventive medicine and public health to make an informed choice about their training itineraries.

Global health education in general preventive medicine residencies.

Opportunities for global health training during residency are steadily increasing. For example, surveys show that more than half of residency programs now offer international electives. Residency programs are increasingly recognizing that global health training improves communication skills, fosters awareness of health disparities, and inspires careers in primary care and public health. Although research has focused on global health education in other specialties, there is a paucity of research on global health training in public health and general preventive medicine (GPM). We sought to describe the extent of global health training across GPM residencies, capture the perspectives of program directors regarding competencies residents need for careers in global health, and identify program directors' perceived barriers to providing global health training. The survey was sent electronically to 42 U.S. GPM residency program directors from September to October 2013. Twenty-three completed surveys were returned. Information from residencies that did not complete the study survey was collected through a predefined search protocol. Data analysis was performed from February through July 2014. Among program directors completing the survey, the most common types of reported global health education were courses (n=17), followed by international rotations (n=10). Ten program directors indicated that resident(s) were involved in global health training, research, or service initiatives. Commonly perceived barriers included funding (87%), scheduling (56.5%), and partnership and sustainability (34.8%). Through global health coursework, research, and practicum rotations, GPM residents could acquire skills, knowledge, and attitudes contributing to careers in global health.