Cynthia B. Morrow

Community health assessment

This case-community health assessment-is one of a series of teaching cases in the Case-Based Series in Population-Oriented Prevention (C-POP). It has been developed for use in medical school and residency prevention curricula. The complete set of cases is presented in this supplement to the American Journal of Preventive Medicine. Community health assessment is key to understanding the health problems and priorities of a population. This case outlines a process by which the participants can complete a health assessment of a community using indicator-based methods. Students construct a set of health indicators from a variety of domains, evaluate problems, and report on the health priorities for a community. The students relate identified health issues to underlying behavioral risk factors.

Racial and ethnic disparity in low birth weight in Syracuse, New York

This case-racial and ethnic disparity in low birth weight-is one of a series of teaching cases in the Case-Based Series in Population-Oriented Prevention (C-POP). It has been developed for use in medical school and residency prevention curricula. The complete set of cases is presented in this supplement to the American Journal of Preventive Medicine. Low birth weight is a leading cause of infant mortality. Unfortunately, despite declining rates of infant mortality, racial and ethnic disparities in both low birth weight and infant mortality rates persist. In this teaching case, a clinical vignette is used to draw attention to this public health priority in Syracuse, New York. Students learn essential epidemiology skills such as identifying limitations of sources of data and calculating relative risks, using the example of low birth weight. In performing these skills, students also identify etiologies for such disparity. Finally, students discuss interventions that, when implemented, may decrease infant mortality rates.

Determining local colorectal cancer screening utilization patterns.

Appropriate screening for colorectal cancer saves lives, yet many Americans at average risk for this disease are not being screened. This article presents the results of an inexpensive, manageable telephone survey that can be used by health departments to determine point prevalence estimates for colorectal cancer screening in their community and to determine local barriers to screening. In Onondaga County, this survey demonstrated that only 17% of the eligible population had been screened with annual fecal occult blood test and a flexible sigmoidoscopy. The study also demonstrated that locally the most significant barrier to screening was lack of knowledge of the importance of such testing. Finally, health care professionals were shown to play a pivotal role in improving the health of their patient population by encouraging screening for colorectal cancer.

Bicycle helmet effectiveness in preventing injury and death.

This case--bicycle helmet effectiveness--is one of a series of teaching cases in the Case-Based Series in Population-Oriented Prevention (C-POP). It has been developed for use in medical school and residency prevention curricula. The complete set of cases is presented in this supplement to the American Journal of Preventive Medicine. This case examines the cost-effectiveness of three interventions to increase utilization of bicycle helmets to avert head injuries in individuals aged 18 years and under in Onondaga Count NY. Students are initially presented with data on head injuries, hospitalization, and death related to bicycle use. They then appraise a published study on the effectiveness of bicycle helmets in averting head injury. Finally, students work in groups to determine the cost-effectiveness of each intervention by calculating implementation costs and the specific number of head injuries averted associated with intervention. The three interventions are legislative, school, and community-based campaigns to increase helmet use. Students are provided with budget estimates and assumptions needed to complete the exercise. Cost-effectiveness analysis, cost-benefit analysis, and related concepts are discussed, including provider versus societal perspectives and importance of sensitivity analysis.

Future Applications of Case-Based Teaching in Population-Based Prevention

The Case-Based Series in Population-Oriented Prevention (C-POP) introduced in this supplement to the American Journal of Preventive Medicine provides a set of tools to integrate clinical- and community-based prevention into interactive teaching cases. These cases, which address recommended core competencies in prevention education, have been taught to both medical students and preventive medicine residents. Initial experience with the cases indicates that this method is a promising tool to enhance prevention education in medical schools and primary care residencies. Because prevention education is essential in other fields, such as public health and nursing, extension of this approach to other professional schools is possible. Such extension is feasible because the cases are designed to be adaptable for different levels of education, flexible to be tailored to local situations, and expandable to accommodate changes in the field. In addition, the cases can be made accessible to all educators through a national library and in interactive web-based format. This article describes how the C-POP series can be used to strengthen prevention education for a wide audience of physician and nonphysician learners.

Evaluation of a Preventive Medicine Curriculum Incorporating a Case-Based Approach

BACKGROUND Evaluating the acquisition of skills in prevention is an increasing priority in prevention education. Assessment instruments were developed to measure student skills before and after an education intervention at State University of New York (SUNY)-Upstate Medical University. METHODS The evaluation method used three testing instruments that measure preventive medicine skills. We selected three surrogate topics, each their own instrument: sexually transmitted disease, lead toxicity, and ischemic heart disease. All three instruments measure four key preventive medicine skills areas: (1) using and interpreting data sources; (2) measuring disease frequency, including incidence and prevalence; (3) making inferences and identifying bias in data presentations; and (4) identifying appropriate study design and screening tests. Second-year medical students were assessed before and after our preventive medicine course in spring 2002, using our evaluative instruments. RESULTS Before and after instruction analysis, overall, and by skills area tested revealed a significant increase in student preventive medicine skills (p< or =0.001) in all four categories. On conclusion of the case-based curriculum, students were also asked to rate the cases. The majority (60%) of the students thought the cases were of value to their medical education, and 58% believed that they added to their skills in population prevention. CONCLUSIONS These instruments can measure change in preventive medicine skills before and after a course in preventive medicine.

A case exercise in public health preparedness: a community outbreak of influenza-like illness.

Public health emergency preparedness has been a priority of local and state health departments as well as other community partners for several years. This article provides a tool for teaching a wide audience of learners the essential steps in training for a disease outbreak. This teaching case involves an investigation of and the communitys response to an outbreak of influenza-like illness. Students learn skills in surveillance and hypothesis generation with regard to the outbreak. During the exercise, the learners are divided into teams to develop a response plan. The teams include Command and Coordination, Public Communication, Hospitals and Health Care Providers, Emergency Management and Public Safety, and Public Health. While the teams are developing their response plan, the etiology of the outbreak becomes clear. Once the etiology is known, each of the teams then develops an action plan to minimize the impact of the outbreak.

A critical look at prevention: colorectal cancer screening.

This case-colorectal cancer screening-is one of a series of teaching cases in the Case-Based Series in Population-Oriented Prevention (C-POP). It has been developed for use in medical school and residency prevention curricula. The complete set of cases is presented in this supplement to the American Journal of Preventive Medicine. This preventive medicine teaching case discusses the concepts of diagnostic test evaluation, prevention, and screening using the example of colorectal cancer screening. Features of the case include a health policy exercise concerning community screening programs and an exercise in clinical prevention decision making.

Measuring orientation to population-based prevention

BACKGROUND Assessing orientation to population-based preventive alternatives is useful in the evaluation of preventive medicine curricula. METHODS An instrument was developed using hypothetical situations describing a health issue that could be encountered by a primary care physician. Options to be selected were in three categories: (1) treatment, (2) clinical prevention, or (3) population-based prevention. Respondents allocated 900 points among alternatives for nine situations (100 points per situation). Pilot testing of the instrument was implemented, comparing the responses of public health physicians with two groups (Syracuse and Baltimore) of family medicine physicians. RESULTS For the overall instrument, the scores on the population scale and population-treatment differential showed statistically significant differences between the public health physicians and both groups of family medicine physicians (p<0.01). For medical students taught the Case-Based Series in Population-Oriented Prevention (C-POP), there was an overall increase in the population scale (p<0.0001) and the population-treatment differential (p<0.0004). CONCLUSIONS The development of a scenario-based tool to assess changes in population-based prevention orientation shows preliminary promise for future evaluation efforts involving preventive medicine curricula.

A local health department's journey to the summit: a case study of a decade of quality improvement.

As the interest in quality improvement (QI) efforts in public health agencies gathers momentum, organizations looking to initiate or strengthen QI processes may benefit from learning about existing programs. This article serves as a case study for other agencies to consider as they embark upon their QI journey. Specifically, this article reviews more than a decade of QI efforts in a mid-sized local health department and highlights areas of success (including an annual QI summit), barriers to implementation of QI, and areas needing improvement.