Integration of community health teaching in the undergraduate medicine curriculum at the University of Toronto.

Background: In 1999, Determinants of Community Health was introduced at the Faculty of Medicine, University of Toronto. The course spanned all 4 years of the undergraduate curriculum and focused on addressing individual patient and community needs, prevention and population health, and diverse learning contexts.

Purpose: To demonstrate the value of an integrated, longitudinal approach to the efficiency of delivering a public health curriculum.

Design: Time-series comparing the curricular change over two periods of time.

Setting/participants: Undergraduate medical students from 1993 to 2009.

Intervention: Using a spiral curriculum, the educational materials are integrated across all 4 years, based on the concept of medical decision making in a community context.

Main Outcome Measures: This study compares measures of student satisfaction and national rankings of the University of Toronto with the other 16 Canadian medical schools for the "Population Health, Ethical, Legal, and Organizational aspects of the practice of medicine" component of the Medical Council of Canada Qualifying Examination Part 1.

Results: The University of Toronto has been ranked either first or second place nationally, in comparison to lower rankings in previous years (p<0.02 on the Kruskal-Wallis test). Student ratings indicated the course was comparable to others in the curriculum.

Conclusions: For the same amount of curricular time, an integrated spiral curriculum for teaching public health appears to be more effective than traditional approaches.