Preventive medicine 2000: Changing contexts and opportunities

The teaching of preventive medicine in the medical school curriculum occurs both in independent and in interdisciplinary courses and units. A survey was conducted to examine the changes in preventive medicine context, content, and allotted hours that have occurred in the transition from the traditional Flexnerian curriculum to the more interdisciplinary, centrally controlled curriculum. Data on medical school curricula for 1990-91, 1993-94, 1995-96, and 1998-99 were examined for the 126 U.S. and 16 Canadian medical schools. By 1998-99, 35 schools moving to the new interdisciplinary format had retained preventive medicine teaching as a separate course, although the courses usually had incorporated topics that went beyond the traditional ones. In another 35 schools, preventive medicine hours had been lost in the transition; but in 25 of these new courses it was clear that preventive medicine played a very significant role. It can be assumed that the lost hours were more than replaced as preventive medicine concepts permeated these courses. Of greatest importance were the hallmark courses of the six nontraditional curricula that had designated preventive medicine a major-theme course. However, at ten schools, preventive medicine listings disappeared in the move to nontraditional curricula. Preventive medicine educators must step forward to use curricular restructuring to expand the role of preventive medicine in the curricula of their institutions, whether in stand-alone or in interdisciplinary courses. The goal, as always, is to provide future physicians with the knowledge and skills they need to provide proper care to their patients.