Determinants of Community Health 1 - DOC 111Y
DOCH 1 Course Director Dr. Fran Scott
DOCH 1 Associate Course Directors Dr. Ingrid Tyler and Dr. Fok-Han Leung
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Course Activities |
Hours |
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Lectures |
71 |
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Tutorials |
19 |
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Field Work |
38 |
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Self-study |
8 |
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TOTAL |
136 |
The Determinants of Community Health (DOCH) course in first year introduces students to a population and community health perspective on medical practice, an important subject that receives considerable attention throughout the program, including in DOCH-2, the Year 3 Transition to Clerkship course, and the Year 4 Transition to Residency course.
DOCH fosters the development of future physicians’ response to changing community and societal needs and concerns. These physicians will have the necessary knowledge, skills, and attitudes to form appropriate alliances with patients, other healthcare professionals, and community agencies to the benefit of the individual patient and community as a whole. Their practice will be population-health-oriented and evidence-based. They will be aware of factors and resources needed to promote health and wellness and will be able to integrate this knowledge effectively into clinical practice.
DOCH-1 objectives are closely linked with the CanMEDS roles and the Medical Council of Canada (MCC) “Medical Expert” Objectives in Population Health.
DOCH-1 integrates the academic material of population health with community based field experiences. The overall goals of the course are for students to become familiar with the social and physical determinants of health for both individual patients and for communities as a whole, the Canadian healthcare system, and health promotion and protection strategies. The course is scheduled for one half-day per week on Wednesday afternoons for all of first year.
First Semester: The first semester focuses on four main areas. Students learn about health and illness, the determinants of health, the principles of population health, and the structure of the health care system in Canada. Students learn the basic tools of population health, including the techniques of descriptive epidemiology (the study of the distribution of health events and their determinants in a population) and concepts of community health. Students start the year with pair-based independent field visits where they discover challenges to health in communities with higher needs. Students go on field placements in Toronto and Mississauga schools in order to apply the principles of population health to the children enrolled there. With respect to the health care system, students visit patients who receive services in their home with the Community Care Access Centres. Through these placements, students understand the relationship between health and the social and physical determinants of health.
Second Semester: The second semester focuses on strategies to improve health: health promotion and health protection. The initial portion of the term is devoted to learning and applying the principles of health promotion in a community setting. Placements occur with a wide range of agencies that provide specialized services to a particular high-needs group (for example, services to seniors) or provide health promotion services to the population for a particular area (for example, community health centres). Students report on these experiences through an essay as well as a campus-based poster presentation. In the health protection block at the end of the semester, students focus on occupational and environmental health.
COURSE OBJECTIVES|
DOCH 1 OBJECTIVES
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CanMEDS Role
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Main Topic Area |
Skills to be developed |
Linkage with MCC |
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Medical Expert |
Determinants of Health |
a. interpret social/physical/economic context and apply this to the patient and the community b. identify and interpret risk factors as they affect patients and the community |
Medical Expert Population Health 78-1 |
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Health Promotion, Health Protection, Disease Prevention |
a. understand health promotion health protection and disease prevention strategies b. be able to identify how these strategies are applied in the community |
Medical Expert Population Health 78-3 |
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Occupational and Environmental Health |
a. describe the importance of occupation and environment on health b. recognize the different roles of physicians in addressing occupational and environmental health issues |
Medical Expert Population Health Environment 78-6 Outbreak Management 78-5 |
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Communicator |
Multiprofessionalism |
a. communicate effectively in essay writing and in oral presentations |
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Collaborator |
Multiprofessionalism |
a. appreciate the concept of health care team and be able to collaborate effectively with other professionals |
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Manager |
Health Care System |
a. recognize the changing nature of the health care system b. assess and discuss patient and community needs in the face of changes to the health care system c. appreciate the need to use resources efficiently |
Medical Expert Population Health 78-4 Administration of Effective Health Programs at the Population Level |
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Health Advocate |
Community Diversity |
a. describe diversity as it relates to community health b. apply the principles of social justice c. have self awareness of diversity and its implications for the health of a community |
Medical Expert Population Health 78-7 |
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Scholar |
Epidemiological Methods |
b. interpret epidemiological findings in terms of the population and patients c. identify community risks and needs |
Medical Expert Population Health 78-2 Assessing and Measuring Health Status at the Population Level |
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Professional |
Professionalism |
a. learn and practice professional codes and ethics b. recognize when to seek advice and assistance c. recognize the complexity of various physician roles (e.g. listener, advocate, healer, etc.) and the correct application of each |
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TEACHING METHODS
DOCH 1 employs a variety of teaching modalities including lectures, academy-based tutorial sessions, field visits, reading, and self-study modules.
Lecture sessions present the theory and principles of population and public health. Lecture sessions are three hours long, and may include guest speakers, presentations by patient advocates, and practice examination questions.
Field visits are voluntarily provided by schools, community care access centres, and community-based health promotion agencies, to offer students practical learning experiences and the context in which to apply the material learned from lectures. Students attend field placements sites in pairs.
Academy-based tutorial sessions integrate principles delivered in lectures with field experiences. Tutorials provide opportunities for students to discuss questions, issues, and observations about the DOCH-1 material in a small-group format and to receive formative feedback from the physician and allied health professional co-tutors.
Course readings have been carefully chosen to supplement the lecture and tutorial material. Readings may present concepts in a slightly different way, which broadens the students’ learning experience.
Self-study, including the Epidemiology module and dedicated DOCH self-study time, give students the opportunity to review DOCH material in depth, pursue areas of interest related to DOCH in greater detail, and practice their self-management skills.
REQUIRED TEXT
The required text for the Determinants of Community Health course is the PHEN Primer on Population Health, a virtual textbook accessed at http://www.afmc-phprimer.ca/. The PHEN Primer on Population Health is a resource created under the sponsorship of the Association of Faculties of Medicine of Canada (AFMC) by the Public Health Educator’s Network (PHEN), and made possible through funds provided by the Public Health Agency of Canada. The PHEN includes representatives from 17 Medical Faculties in Canada who have worked collaboratively with experts, students, teachers and other stakeholders to review the Primer on Population Health. This text covers the objectives of population health from the Medical Council of Canada, it presents a perspective on population-health and it demonstrates the relevance of concepts of population health to health professionals engaged in clinical care. Additional readings may come from variety of sources including “Public Health and Preventive Medicine in Canada” by Chandrakant P. Shah, 5th edition, Excelsior Press, 2003 and selected web-sites and other on-line sources.
ASSESSMENT
The following assessments are included in DOCH-1:
|
Assignment |
Mark |
| "In the Shoes..." of Determinants of Health Presentation (Sept 2012) |
Credit / No credit |
| Presentations on School (population health) and CCAC (health system) Field Visits in Semester 1 (November and December 2012 |
20 % |
| Semester 1 examination (January 2013) |
25 % |
| Media Exercise (March 2013) |
Credit / No credit |
| Essay that integrates knowledge from the health promotion module (April 2013) |
20 % |
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Agency Poster Presentation (May 2013) |
10% |
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Semester 2 examination (May 2013) |
25 % |
| Professionalism (based on entire year's performance) |
Credit / No credit |
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Total |
100% |
Students must pass each component of the course in order to receive credit for the course. For all of the components, students must achieve at least 60% to pass. Students who achieve less than 70% on any one component may be required to complete extra work.
Note re. Professionalism assessment Because medicine is a profession, students in medical school must conduct themselves in a professional manner. In DOCH, professional conduct is expected from all students at all times—in the classroom, in Medical Education offices, during tutorials, and on field visits. Professionalism is an important component of this course and students must pass this component to achieve credit for this course. The standards on professional conduct as stated by the UME program are available on the UME website. Demonstration of professional behaviour will be noted in all areas of the course.
EVALUATION of the DOCH 1 Course
Evaluation by students: This course has been developed with extensive student input. Student feedback is requested on a weekly basis to allow for in-term adjustments and at the end of each semester.
Evaluation by tutors, lecturers, and agencies: The course depends on the skills and knowledge of our excellent lecturers, tutors, and preceptors who deliver a substantial proportion of the course, and their comments and feedback are important. Evaluation forms are provided to them at the end of each semester.
Review by the DOCH 1 Course Committee: All of these sources of information are summarized and presented to the Committee to evaluate the course. It is important that the course be evaluated from a number of perspectives and thus different aspects are assessed at different times and by different methods.
PROCEDURES FOR EXTRA WORK AND REMEDIATION
The requirements for extra work are determined by the course director in consultation with the Preclerkship Director. Extra work exercises are tailored to the identified areas of deficit.
When a relatively minor deficit is noted, then normally the student will be asked to provide written explanations of concepts related to incorrectly answered questions on examinations.
More significant deficits may require the student to review the relevant topics in detail, with guidance to be provided by the Course Director or others as needed, and then to undergo formal reexamination of the material. The standard for successful completion of such a re-examination is to be decided by the course director in consultation with the Preclerkship Director. Generally, this standard will be the same as the standard required for a clear pass in the course. If the student is not successful in reaching this standard, then they will be presented to the Board of Examiners, for consideration of formal remediation.
In cases where a student has frankly failed to meet the requirements for credit in the course, the student will be presented to the Board of Examiners for consideration of remediation as described in the Guidelines for the Assessment of Medical Trainees - Preclerkship. If the Board of Examiners agrees that remediation is required, then the remediation activities and assessment procedures will be determined by the course director in consultation with the Preclerkship Director. The student will be required to review the relevant topics in detail, with tutoring to be provided by the Course Director or others as needed, and then to undergo formal re-examination of the material. The standard for successful completion of this re-examination is to be decided by the course director in consultation with the Preclerkship Director. Generally, this standard will be the same as the standard required for a clear pass in the course.