One of the most important responsibilities of primary care physicians is to promote health and prevent disease in a cost-effective manner. Appropriate care by internists includes not only recognition and treatment of disease but also the incorporation of the principles of preventive health care into clinical practice. Especially important are those interventions that lead to prevention of cardiovascular disease, early detection and treatment of potentially curable cancers and optimizing care for chronic illnesses.
Students should be able to define, describe and discuss:
- Primary, secondary and tertiary prevention.
- The criteria for determining whether or not a screening test should be incorporated into the periodic health assessment of adults and the influence of age and clinical status on the approach to prevention individual patients.
- The general types of preventive health care issues that should be addressed on a routine basis in adult patients – e.g., cancer screening; prevention of infectious diseases, coronary artery disease, osteoporosis, and injuries; and identification of substance abuse.
- The risks, benefits methods and recommendations for immunizing adults against hepatitis B, influenza, pneumococcal infection, tetanus-diphtheria and measles-mumps-rubella
- The general categories of high-risk patients in whom routine preventative health care must be modified or enhanced – e.g., family history, travel to an underdeveloped area.
- The major areas of controversy in screening.
- The sensitivity, specificity and positive predictive value of a screening test
Students should demonstrate specific skills, including:
- History-Taking Skills: Students should be able to address preventive health care issues as a routine part of their assessment of patients and obtain and document a medical history including sexual history that identifies patients at risk for developing coronary artery disease, cancer and sexually transmitted infections. The history should include
- dietary intake of fats and cholesterol
- exercise and activity levels
- substance use and its effects
- psychosocial stresses and environmental risks
- specific cancer risks (family history, exposures, warning symptoms)
- high risk sexual practices
- immunization status appropriate for adults including
- DT for all adults
- Influenza vaccine and pneumococcal vaccine for the elderly and those with chronic illness
- Rubella for sero-negative women of child-bearing age
- Hepatitis B vaccine for medical personnel and other at-risk groups
- Physical Exam Skills: Students should be able to perform breast, testicular and digital rectal examinations.
- Laboratory Interpretation: Students should be able to interpret and appropriately apply clinically basic screening tests. This includes sensitivity, specificity and positive predictive value information to varying clinical situations.
- Communication Skills: Students should be able to counsel patients about recommended preventive health care procedures and beneficial life style behaviors, including safe-sex practices, smoking cessation, diet, and exercise. Students should encourage patients to share responsibility for disease prevention. Students should use information about screening test quality (safety, cost, risk of false positives) to guide patients in shared decision making about ordering screening tests.
- Self Directed Learning Skills: Students should be able to locate recently published recommendations as well as original data regarding measures that should be incorporated into the periodic health assessment of adults.
- 1. Clerkship Seminar, “Preventive Medicine”, Laura Rogers, MD
- 2. Prevention for the 21st century: setting the context through undergraduate medical education. Pomrehn PR, Davis MV, Chen DW, Barker W. Acad Med (2000 Jul) 75(7 Suppl):S5-13.
- 3. Internal Medicine Clerkship Guide, Paauw et al, Mosby 2003, 140-147