Lloyd F. Novick

Adolescent suicide prevention

This case-prevention of adolescent suicide-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 teaching case examines the issue of prevention of adolescent and young adult suicide both at an individual and at a population or community level, using data from the Onondaga County Health Department. In the first section of the case, students are asked to determine whether five deaths related to falling or jumping at a local shopping mall should be considered to be suicidal deaths. Students then develop skills in the reporting as well as in the epidemiology of adolescent suicidal deaths in Onondaga County. As the case progresses, students analyze the results of a local surveillance study of suicidal attempts and ideation. The case concludes with students evaluating a hypothetical screening study intended to reduce the risk of suicidal death and discussing a research design to examine the effectiveness of this prevention strategy.

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.

An enhancement strategy for integration of population health into medical school education: employing the framework developed by the Healthy People Curriculum Task Force.

The authors describe an enhancement strategy for integration of population health content into the medical school curriculum at The Brody School of Medicine at East Carolina University conducted in 2005–2006. The Clinical Prevention and Population Health Curriculum Framework developed by the Healthy People Curriculum Task Force served as the planning template for curriculum analysis. Key to success was the incorporation of population health as a “curriculum enhancement,” as opposed to curricular expansion or substitution. Strategies included introduction of a Case-Based Series in Population-Oriented Prevention (C-POP) in the preclinical years; community assessments, home visits, and public health assignments in the family medicine and pediatrics clinical clerkships; and prevention history-taking. The Brody integrated curriculum included a wide range of topics and clinical experiences specific to prevention and population health; however, the coverage was uneven. Hybrid teaching cases were developed from four C-POP cases which were adapted to existing instructional materials. Students learned to define the determinants of health, disease burden in their community settings, and community strengths and obstacles specific to dealing with chronic conditions. Factors contributing to the successful integration of population health included a receptive primary care medical school, use of the Framework, analysis of gaps between the Framework and the existing curriculum, providing enhancements to the existing curriculum, employment of patient cases, and integrating population health into a variety of classroom and community medical learning experiences. This approach, as opposed to a separate and distinct course, seeks to reinforce the interconnectedness of communities, families, and individuals.

Racial and ethnic disparities in infant mortality: risk in social context.

This article presents the multifaceted efforts of Syracuse Healthy Start, a federally funded initiative of the Onondaga County Health Department and over 20 partnering agencies to reduce racial and ethnic disparities in infant mortality. The analyses presented in this article demonstrate that many women--Caucasian, African American, and Hispanic--have serious risks for low birth weight and infant death. In many cases, multiple, simultaneous risks complicate a pregnant womans situation and in other cases the longitudinal cumulative risks impact health across generations. Infant mortality decreased overall, and for both Caucasian and African American infants during the first 3 years of the project.

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.

Swimming upstream? Patient Protection and Affordable Care Act and the cultural ascendancy of public health.

After months of intense political infighting and widespread public interest and commentary, President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA) into law on March 23, 2010.1 The law has been applauded by supporters, and attacked by critics, as the most comprehensive public health care reform in US history. Such attention is not misplaced. Its ultimate impact may very well rival that of Medicare and Medicaid passed more than 40 years ago.2 PPACA’s scope includes provisions aimed at increasing access to medical care, introducing cost containment mechanisms into the public payer system (ie, Medicare and Medicaid), and reforming private insurance. As importantly, PPACA does not focus solely on physician-provided medical care to individual patients. Instead, the statute is suffused with provisions that promise to elevate the status of, and national commitment to, disease prevention, wellness promotion, and population-based interventions. Such an approach is not surprising. After all, Barack Obama’s 2008 “Plan for a Healthy American” boldly declared that covering the uninsured was not enough: “Simply put, in the absence of a radical shift towards prevention and public health, we will not be successful in containing the costs or improving the health of the American people [emphasis added].”3 PPACA’s dramatic inclusion of traditional public health staples and doctrines has led executive director of the American Public Health Association, Georges C. Benjamin,4 to declare that “we are at a transformative moment in our social history. . .health reform provides us the opportunity to reshape the way we care for ourselves by not only expanding access to health services but shifting away from our ‘sick care’ system.” Similarly, Congressman Jim McDermott5 has observed that the public health provisions of PPACA “indicate a move

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.