Ann Wylie

Establishing health promotion in the modern medical curriculum: a case study

Background: The subject of health promotion has yet to be established as core content in undergraduate medical curricula, despite calls from the medical education community and from regulatory bodies such as the UKs General Medical Council more than a decade ago. At the same time, concerns about the decline in popularity of teaching public health have been raised. Aims: The challenges associated with teaching both disciplines—health promotion and public health—are complex and linked, but, for health promotion, we argue that two factors are paramount: the nature of the discipline, and how it is presented as being relevant to undergraduate medical curricula, in particular those with integrated courses. Methods: Using the approach taken at one medical school as a case study, this paper discusses the factors surrounding health-promotion curricular development. It explores these challenges, including the relevance of health promotion to medical students, medical teachers, and medical practitioners. Results: These developments are linked to process and content and, therefore, to learning outcomes. Conclusions: There is a paucity of information from medical schools about their approaches to health promotion curricula content and teaching. This paper may provide schools with ideas for the development of their own health promotion content.

Realising the potential for an Olympic legacy; teaching medical students about sport and exercise medicine and exercise prescribing.

Background Physicians are increasingly being called upon to promote physical activity (PA) among patients. However, a paucity of exercise medicine teaching in the UK undergraduate medical curricula prevents students from acquiring the necessary knowledge and skills to do so. To address this issue, Kings College London School of Medicine introduced an exercise medicine strand of teaching. This study evaluated the acceptability of exercise promotion behaviour change lectures and explored the knowledge and attitudes of the students who received it. Methods Students were invited to complete a 6-item online questionnaire prior to and after exercise medicine lectures. The questionnaire assessed beliefs regarding the importance of PA in disease prevention and management, in addition to their confidence in advising patients on PA recommendations. A focus group (n=7) explored students’ attitudes towards and knowledge of PA promotion and exercise prescribing. Results In total, 121 (15%) first-year and second-year MBBS students completed the questionnaire. Students’ beliefs regarding the importance of PA in managing disease and their confidence in PA promotion among patients increased after the teaching (p<0.001). More students were able to correctly identify the Chief Medical Officer recommended adult PA guidelines (p<0.05). Students were enthusiastic about the exercise medicine teaching, strongly supportive of its continued inclusion in the curriculum and advocated its importance for patients and themselves as future doctors. Conclusions Behaviour change teaching successfully improved students’ knowledge of and confidence regarding PA promotion. These improvements are a step forward and may increase the rates and success of physician PA counselling in the future.

Medical Curricula and Preventing Childhood Obesity: Pooling the Resources of Medical Students and Primary Care to Inform Curricula

AIMS The study aimed to firstly provide a small self-selecting group of medical students with the opportunity to explore current approaches and opportunities addressing the prevention of childhood obesity and, secondly, to consider what aspects could be part of the taught curriculum. METHODS Medical students in their third and fourth year were invited to self-design special study modules (SSMs) exploring interventions and processes addressing the growing concern about childhood obesity. One student looked at the role of the primary care teams, two looked at community-based opportunities to improve physical activity in urban areas where there is significant deprivation and one student explored the complex role of the media as a social determinant of dietary patterns and sedentary behaviour. FINDINGS Primary care health professionals questioned their role in regard to raising the topic of obesity in the consultation and had limited awareness of current NICE guidelines and local interventions for referral. Local authority physical activity programmes have an important role in preventing and tackling obesity and although the media are regulated, there is limited impact on reducing obesity. Conversely, the influence of the media is complex and enables medical students and teachers to be aware of some of the social determinants influencing health-related behaviour. IMPLICATIONS About a third of UK GP practices have some role in medical undergraduate education. It will therefore be inevitable that students will encounter GPs working with prevention and management of childhood obesity, however limited, and this will increasingly be part of the teaching agenda, whether formal and planned or opportunistic. Curricula could include being familiar with the evidence that informs NICE guidelines, observing these guidelines being implemented and their limitations, awareness of local schemes for referral to prevent or treat obesity and the influence of wider determinants on diet and physical activity behaviour, including the media.

Evaluation of SHINE — Make Every Child Count: a school‐based community intervention programme

Many barriers to health and emotional well‐being for children are prevalent within inner‐city communities, and often result in negative consequences for education. Health promotion strategies have previously cited mentoring schemes as interventions through which targeted pastoral support can be effectively provided to children. This paper draws on detailed focus group interviews in order to evaluate SHINE ‐ Make Every Child Count, a student‐led charity operating five mentoring programmes across the London boroughs of Southwark and Lambeth. Following content analysis, this paper identifies six themes associated with mentor support: rapport; emotional well‐being and development; social behaviour; enabling; emerging ambition; and attitudinal development. Results show participant children have gained considerable enjoyment from mentor support. Successful friendships are built and emotional well‐being supported, with children actively including mentors as part of their support network. Children recognise the i...

Health promotion in medical education: lessons from a major undergraduate curriculum implementation

Abstract Despite the economic, environmental and patient-related imperatives to prepare medical students to become health promoting doctors, health promotion remains relatively deprioritised in medical curricula. This paper uses an in-depth case study of a health promotion curriculum implementation at a large UK medical school to provide insights into the experiences of teachers and learners across a range of topics, pedagogies, and teaching & assessment modalities. Topics included smoking cessation, behavioural change approaches to obesity, exercise prescribing, social prescribing, maternal and child health, public and global health; with pedagogies ranging from e-learning to practice-based project work. Qualitative methods including focus groups, analysis of reflective learning submissions, and evaluation data are used to illuminate motivations, frustrations, practicalities, successes and limiting factors. Over this three year implementation, a range of challenges have been highlighted including: how adequately to prepare and support clinical teachers; the need to establish relevance and importance to strategic learners; the need for experiential learning in clinical environments to support classroom-based activities; and the need to rebalance competing aspects of the curriculum. Conclusions are drawn about heterogeneous deep learning over standardised surface learning, and the impacts, both positive and negative, of different assessment modalities on these types of learning.

Piloting quality improvement projects in undergraduate medical education

grate a short synopsis of key concepts to solidify the knowledge learned. The active learning environment of TBL supports the logic and principles of EBP through application of learned knowledge and from peer-topeer teaching. Our TBL intervention proved effective at improving residents’ EBP knowledge and self-efficacy, but not self-reported practice. This may be because of the short duration of the module or the lack of integration in the clinical setting. Future experiences using TBL with EBP will need to move to the clinical setting, where point of care clinical questions are more readily available and where modelling of on-the-job practice may be more effective.

Enabling tomorrow’s doctors to address obesity in a GP consultation: an action research project

Abstract Obesity is a leading risk factor for morbidity and mortality, however, guidelines for prevention and management are relatively recently established. Little is known about what needs to be in place to put these into practice. This research provides an insight into how senior medical students consult with obese patients in general practice, the range of their learning needs, and the impact of various educational strategies that aim to bring their practice closer to current evidence-based guidelines. It centres on a series of compulsory but formative reflective case studies written by final year students at one large medical school on their GP rotation as they consult independently with obese patients with ‘next room’ GP tutor support. Analysis of these case studies was used to inform a three-year educational action research project. By systematically identifying and addressing learning needs, including barriers and enablers to best practice, we have demonstrated how senior medical students, and their GP tutors, can acquire the role legitimacy and role competency required for effective practice.