Evaluating the teaching of clinical preventive medicine - A multidimensional approach

Background: A study was undertaken to determine the amount, methods, and adequacy of instruction in clinical preventive medicine topics in the medical school curriculum at the University of California, San Francisco (UCSF) in the 1996-1997 academic year. Methods: A protocol of 35 clinical preventive medicine topics was developed. The preclinical (Years I and 2) curriculum was evaluated by reviewing all syllabi and other printed materials for the presence and quantity of instruction in the specific clinical preventive medicine topics. The clinical curriculum (Years 3 and 4) was evaluated by asking students on completion of eight clinical clerkships to answer a questionnaire. Clerkship directors were also asked to answer the same questionnaire, Results: In the preclinical curriculum, clinical preventive medicine topics were found to receive 63.3 hours of instruction (4.2% of total instruction hours). Counseling and screening topics received the most hours (31.3 and 20.5, respectively) with immunization/prophylaxis and prenatal care receiving considerably less (4.0 and 2.4 hours, respectively). Ln the clinical curriculum, students reported receiving an average of 118.5 hours of instruction in preventive medicine (5.9% of total instruction hours). Clerkship directors reported more than twice as many hours of instruction (330.8) as students. Overall, only 50% of students reported that a topic had been covered in a clerkship when the clerkship director reported that it had been covered. Both students and clerkship directors reported that exposure to clinical preventive medicine topics was in general inadequate. Conclusions: Instruction in clinical preventive medicine constituted a relatively modest percentage of the total instruction time in both the preclinical and clinical curriculums at UCSF. Some topics were only minimally covered in the curriculum, and instruction during the clinical years was variable across students and clerkships. The disparity in the amount of instruction in clinical preventive medicine reported by students and faculty illustrates the importance of using multiple methods, including student input, to evaluate curriculum content.