The extent and methods of public health instruction in family medicine clerkships

Background and objectives: The Institute of Medicine recommends integrating public health (PH) and primary care to advance community health. The status of PH integration into family medicine clerkships (FMC) is unknown. We sought to determine the extent and methods of required PH instruction in FMC METHODS: We used the Council of Academic Family Medicine Educational Research Alliance (CERA) survey of FMC directors RESULTS: From 36%-59% of FMC directors responded to individual PH questions, reporting a mean of 36.3 hours (range 1-258) of PH instruction in the clerkship. The majority of PH instructional time relates to behavioral sciences, communication, and cultural competence. Forty-nine percent of PH instructional hours are experiential. Ninety percent of respondents agree that PH training is important for medical students; 67.5% of respondents agree that PH training is appropriate for the FMC. Respondents from public schools reported more PH training than respondents from private schools (43.85 ± 9.25 hours versus 21.29 ± 3.82 hours). There was no difference between hours of instruction reported by FMC directors with shorter (≤ 4 weeks) and longer (> 4 weeks) clerkships (40.8 ± 13.7 hours versus 33.7 ± 6.4 hours). Among respondents leaving comments, 24/36 (66.7%) cited insufficient time, 6/36 (16.7%) cited lack of funding, and others identified lack of faculty or preceptor expertise and lack of student interest as barriers to PH instruction CONCLUSIONS: There is variability in how FMC are addressing PH instruction. Future research should qualitatively explore pedagogical methods and seek consensus on the competencies and best practices in PH instruction most suited to FMC.