Problem- and evidence-based public health – beyond the classroom

Abstract

Evidence-based practice (EBP) and problem-based learning (PBL) are two relatively new learning philosophies in medical education, which the New Medical Curriculum of the University of Hong Kong Medical Centre has adopted since 1997.

Evidence-based practice is the conscientious and explicit use of current best evidence, in conjunction with clinical experience and bedside acumen, in making decisions about patient care. It has been specifically targeted as a key area in which future doctors should acquire special competency by both the World Federation for Medical Education and the Association of American Medical Colleges. In addition, andragogy informs us that students must understand the underlying reasons for learning about a particular topic, be responsible for their own learning, leverage past experience as a resource, connect their readiness to learn with the exigency of real-life situations and orient their learning by concrete life tasks. In medical education, these principles find expression in problem-based learning.

To explore how these theoretical constructs can be applied to the learning of public health medicine, we have recently redesigned our teaching format as well as students’ learning vehicles. Specifically, this Case Study involves an overview of the organisation of public health learning activities throughout the five-year undergraduate medical curriculum. To illustrate the application of the principles of EBP and PBL, we present the curriculum content for Year 3 medical students as an example. Specifically, the content relates to the personal health effects and public health consequences of air pollution and tobacco smoking.

The new teaching format consists of three learning vehicles, namely a problem-based public health (PBPH) case, an EBP tutorial, and a group output to be presented in a whole-class session. The PBPH case is similar to a traditional PBL case. The EBP tutorial is a self-directed, integrative exercise where students apply previously learned concepts to synthesise their own conclusions about a particular topic. On completion of both tutorial-based learning activities, students produce a collaborative “output”, the exact nature of which is determined by the groups themselves. Student outputs have included letters to the editor of the lay press as well as scientific journals, multimedia advertisements and posters, staged radio phone-in programmes and drama skits. Examples of these are presented during the Case Study.

From course evaluations and focus group discussions, these learning activities have been well received by both students and tutors, who are invited to discuss their respective perspectives in the Case Study.