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Preventive medicine and health education are among the strategies used in coping with chronic diseases. However, it is yet to be determined what effect do personal and organizational aspects have on its' implementation in primary care.A cross-sectional survey was conducted in order to assess and compare preventive medicine and health education activities in three types of primary care models: solo working independent physicians, nurse-physician collaborations and teamwork (nurses, dietitians and social workers working alongside a physician). Questionnaires were emailed to 1203 health professionals between September and November 2015, working at Maccabi Healthcare Services, the second largest Israeli healthcare organization. Self-reported rates of health education groups conducted, proactive appointments scheduling and self-empowerment techniques use during routine appointments, were compared among the three models. Independent variables included clinic size as well as health professionals' occupation, health behaviors and training. A series of multivariate linear regressions were performed in order to identify predictors of preventive medicine and health education implementation. Computerized health records (CHR) validated our self-report data through data regarding patients' health behaviours and outcomes, including health education group registration, adherence to occult blood tests and influenza vaccinations as well as blood lipid levels.Responders included physicians, nurses, dietitians and social workers working at 921 clinics (n = 516, response rate = 31%). Higher rates of proactive appointments scheduling and health education groups were found in the Teamwork and Collaboration models, compared to the Independent Physician Model. Occupation (nurses and dietitians), group facilitation training and personal screening adherence were identified as preventive medicine and health education implementation predictors. Group registration, occult blood tests, healthy population's well-controlled blood lipids as well as influenza vaccinations among chronically ill patients were all significantly higher in the Teamwork and Collaboration models, compared to the Independent Physician Model.The Teamwork and Collaboration models presented higher rates of preventive medicine and health education implementation as well as higher rates of patients' positive health behaviours documented in these models. This suggests multidisciplinary primary care models may contribute to population's health by enhancing preventive medicine and health education implementation alongside health professionals' characteristics.

The shortage of clinical preceptors compromises the current and future supply of healthcare providers and patient access to primary care. This article describes how an interprofessional coalition in South Carolina formed and sought government support to address the preceptor shortage. Some states have legislated preceptor tax credits and/or deductions to support the clinical education of future primary care healthcare providers. As a result of the coalition's work, a bill to establish similar incentives is pending in the South Carolina legislature.

Purpose A national study was conducted in 2010 that described the status of interprofessional education and interprofessional prevention education in the United States. This manuscript compares the results from the 2010 survey with those of an expanded survey in 2015. Method The original 10 questions comprising the 2010 survey were retained in 2015 and re-sequenced to facilitate completion. An additional 15 questions were added to the survey to capture information about issues not assessed by the first survey - language and program changes in IP-Education, IP-Practice and IP-Prevention Education, and demographic variables of interest. Respondents were again drawn from the membership list of the Association of Academic Health Centers. Results The respondent group of 156 represents 36 of the 42 states that have Association of Academic Health Centers (AAHC) member institutions, and 103 of the 125 AAHC member institutions that were eligible to receive surveys responded representing 82.4% of eligible AAHC institutions. Reported activity is higher in the area of course offerings with the least activity reported in the area of infrastructure. Data from the responses to the IP-Prevention Education questions, by contrast, indicate that there has been a decrease in IP-Prevention Education between 2010 and 2015. Conclusion The trend in growth of IP-Education and IP-Practice is encouraging and deserves to be tracked to assess whether the positive direction continues and whether the prevalence of dedicated personnel and infrastructure (centers and offices) continue to increase. Relative to IP–Prevention Education, increased assessment needs to be given to the proposed linking of IP-Education with prevention education.

Given the emphasis on prevention in U.S. health care reform efforts, the importance of interprofessional education (IPE) that prepares health professions students to be part of effective health care teams is greater than ever. This study examined the prevalence and nature of IPE and interprofessional (IP) prevention education in U.S. academic health centers.The authors extracted a 10-item survey from the longer published IPE Assessment and Planning Instrument. In September 2010, they sent the survey to 346 health professions leaders in health sciences schools and colleges at 100 academic health centers. These institutions were identified via the online membership list of the Association of Academic Health Centers. The authors conducted descriptive statistical analysis and cross-tabulations.Surveys were completed by 127 contacts at 68 universities in 31 states and the District of Columbia. IPE was more prevalent than IP prevention education in all categories of measurement. Respondents affirmed existence of IPE in courses (85.0%) and in clinical rotations/internships (80.3%). The majority reported personnel with responsibility for IPE (68.5%) or prevention education (59.8%) at their institutional unit, and 59.8% reported an IPE office or center.This study provides evidence that IPE and IP prevention education exist in academic health centers, but additional attention should be paid to the development of IP prevention education. Sample syllabi, job descriptions, and policies may be available to support adoption of IPE and IP prevention education. Further effort is needed to increase the integration of IP and prevention education into practice.

The 2014 Clinical Prevention and Population Health Curriculum Framework in this issue of the American Journal of Preventive Medicine is described as a resource for preparing health professionals to achieve the Triple Aim: improving the patient experience of care, reducing the per capita cost of care, and improving the health of the population. The strengths of the Framework in guiding health professions education are described and the consensus-based process that included members from major health professional organizations to develop the Framework is discussed. Links are provided to examples illustrating the Framework’s use in health professions educational settings.

South Carolina Dental Association members were surveyed on telehealth knowledge, need, and interest in using it for access to care improvements.Dependent variables were Medicaid patient population size (less than or greater than 10%), career stage (early to middle and advanced), and National Health Service Corps participation (yes or no). Practice and provider characteristics were screener questions. Data were collected electronically and analyzed with SAS. Descriptive and bivariate analyses were conducted.Most (69.3%) reported some or no teledentistry knowledge. Distribution of needing consults was: endodontics (40.2%), oral-maxillofacial surgery (37.9%), orthodontia (30.7%), periodontics (28.4%), and pediatrics (12.5%). Consultations for diagnosis (72.9%), emergencies (56.7%), and continuing education (53.3%) were most frequently identified telehealth uses. Medicaid patient population size was the only dependent measure with statistical significance. Compared to 10% Medicaid,10% was more likely to (1) frequently need consults for orthodontics (25.5% vs 43.4%, P = .0043) and pediatrics (5.9% vs 29.0%, P .0001); (2) use telehealth for children with special health care needs (44.1% vs 65.8%, P = .0017), complex health conditions (54.3% vs 78.1%, P = .0004), conditions exacerbated by unmet dental needs (44.6% vs 65.8%, P = .0022); and (3) use telehealth for extending practice to underserved populations (14.6% vs 33.8%, P = .0004).Despite need for telehealth knowledge improvement, sufficient interest exists. Further study will determine if demand for teledentistry is in balance with consultant availability. It has been suggested that access to care improvements require capacity expansions in private practices. States will need to engage dental communities determine if teledentistry is an effective solution.

The Education for Health framework is designed as an educational roadmap for Healthy People 2020. It aims to connect the educational phases and suggests overall educational strategies needed to educate health professionals and the public to achieve a healthier America. The framework seeks to develop a seamless approach to prevention and population health education from Pre-K through graduate school. The framework is built on national movements in health literacy, undergraduate public health education and evidence-based thinking. It envisions a coordinated set of learning objectives divided into Pre-K through Grade 12, 2-year and 4-year colleges, and graduate education in the health professions as well as for health education for the community-at-large. The Healthy People Curriculum Task Force, a consortium of eight health professions education associations, has developed the framework and connected the framework with new and revised educational objectives of Healthy People 2020. The Task Force envisions a decade-long process to define and implement specific learning outcomes that can be integrated across the educational continuum. Interprofessional prevention education, in which health professionals learn and practice together, is seen by the Task Force as a key method for implementation. Understanding the roles played by a range of clinical health professions is also essential to communication and understanding. Healthy People 2020 and its new and revised educational objectives provide a vehicle for promoting the discussion and experimentation that will be needed to achieve an integrated and seamless approach to education for health for the American public as well as for health professionals.

Bioterrorism has emerged as a serious public health threat in the United States and continues to warrant significant public health concern. In the event of a bioterrorist attack, hospitals and healthcare providers will play a primary role in the community’s response. However, recent research has suggested that hospitals are unprepared to respond to a bioterrorism event lacking personnel, equipment, knowledge, and experience. The current article highlights the gaps between need and implementation of disaster preparedness programs in healthcare settings; presents a program designed to address these limitations in a cost-effective, portable, accessible training package; and analyzes data from a basic evaluation of the program. The program is a 4.5-day training developed by the a state Area Health Education Consortium (AHEC) to help prepare hospitals for a bioterrorist attack by training personnel in the creation of a decontamination team responsible for decontaminating patients before they enter the hospital. A basic evaluation of the program found that participants who complete the training reported high ratings of competency related to decontamination procedures, their confidence in future performance, and the training overall. Results suggest that the training program holds promise in beginning to address hospital preparedness gaps.

The South Carolina Area Health Education Consortium (SC AHEC) was funded in 2003 to train healthcare professionals in disaster preparedness and response. During the 5 years of funding, its Disaster Preparedness and Response Training Network evolved from disaster awareness training to competency-based instruction and performance assessment. With funding from the assistant secretary for preparedness and response (ASPR), a project with implications for national dissemination was developed to evaluate 2 aspects of preparedness training for community-based healthcare professionals. The SC AHEC designed disaster preparedness curricula and lesson plans, using a consensus-building technique, and then (1) distributed sample curricula and resources through the national Area Health Education Center system to assess an approach for providing preparedness training and (2) delivered a standardized preparedness curriculum to key influential thought leaders from 4 states to evaluate the effectiveness and acceptability of the curriculum. As a result of this project, the SC AHEC recommends that preparedness training for community-based practitioners needs to be concise and professionally relevant. It should be integrated into existing healthcare professions education programs and continuing education offerings. The project also demonstrated that although AHECs may be interested and well suited to incorporate preparedness training as part of their mission, more work needs to be done if they are to assume a prominent role in disaster preparedness training. Language: en

Background. Teaching cancer prevention and detection is important in health professional education. It is desirable to select a comprehensive framework for teaching oral cancer (OC) prevention and detection skills. Methods. The PRECEDE-PROCEED model was used to design a randomized pretest and posttest study of the OC prevention and detection skills of dental students (n = 104). OC knowledge, opinions, and competencies were evaluated. Results. Second year students in the intervention group were more competent than those in the control group. Conclusions. The novel use of PRECEDE-PROCEED sets a precedent for designing a standardized OC curriculum for a wide range of health professional disciplines. J Cancer Educ. 2007;22:250–253.

The Clinical Prevention and Population Health Curriculum Framework is the initial product of the Healthy People Curriculum Task Force convened by the Association of Teachers of Preventive Medicine and the Association of Academic Health Centers. The Task Force includes representatives of allopathic and osteopathic medicine, nursing and nurse practitioners, dentistry, pharmacy, and physician assistants. The Task Force aims to accomplish the Healthy People 2010 goal of increasing the prevention content of clinical health professional education. The Curriculum Framework provides a structure for organizing curriculum, monitoring curriculum, and communicating within and among professions. The Framework contains four components: evidence base for practice, clinical preventive services-health promotion, health systems and health policy, and community aspects of practice. The full Framework includes 19 domains. The title "Clinical Prevention and Population Health" has been carefully chosen to include both individual- and population-oriented prevention efforts. It is recommended that all participating clinical health professions use this title when referring to this area of curriculum. The Task Force recommends that each profession systematically determine whether appropriate items in the Curriculum Framework are included in its standardized examinations for licensure and certification and for program accreditation.

The crisis of the rising cost of health care in the United States is stimulating major changes in the way care is being delivered. New models such as patient-centered medical homes and accountable care organizations are being developed with the expectation that health care professionals will address and improve the health of populations. Electronic health records and interprofessional teams will be critical to achieving the goal of better health. It is now time to bring together educators and clinicians at academic health centers, public health educators and practitioners, along with researchers, representatives from the health care delivery and financing systems, and community partners to reengineer health professions education to prepare health professions students for the health care system of the future.

Computer-generated reminders for patients and physicians can increase provision of preventive services. On July 1, 1989, the Department of Family Medicine at the Medical University of South Carolina extended a computerized prevention reminder system to all physicians and adult patients in the department's clinical practice. The prevention program consisted of computer-generated physician reminders for any deficiencies in five preventive services at the time of patient visits, a personalized patient reminder letter sent just before a patient's birthday, and educational interventions. We defined adherence using a population-based approach, that is, the percentage of all eligible patients who had received the preventive services within the recommended period of time. The data revealed that the percentage of patients who received preventive services either increased or remained stable during the 12-month study period, which ended July 1, 1990. Adherence was greater for women, for older patients, and for those with Medicare/Medicaid and HMO insurance. We noted higher rates of adherence for all five preventive services, compared with baseline rates of adherence recorded on July 1, 1988. A population-based approach to prevention allows physicians to become more active in providing preventive care to patients. Computer-based reminder and tracking systems can integrate population-based prevention into practice.

Healthy People 2020 includes an objective to increase the proportion of elementary, middle, and senior high schools that provide comprehensive school health education to prevent health problems in the following areas: unintentional injury; violence; suicide; tobacco use and addiction; alcohol or other drug use; unintended pregnancy, HIV/AIDS, and sexually transmitted infections (STI); unhealthy dietary patterns; and inadequate physical activity. These specific goals are part of the efforts of Healthy People 2020 to increase the proportion of elementary, middle, and senior high schools that have health education goals or objectives that address the knowledge and skills articulated in the National Health Education Standards. A focus on Pre-K through 12 health education is a prerequisite for the implementation of a coordinated, seamless approach to health education as advocated by the Healthy People Curriculum Task Force and incorporated into the Education for Health framework. To help accomplish these goals, this article views the role of education as part of the broader socioecologic model of health. A comprehensive literature review was undertaken to identify evidence-based, peer-reviewed programs, strategies, and resources. The results of this review are presented organized as sexual health, mental and emotional health, injury prevention, tobacco and substance abuse, and exercise and healthy eating. Evidence-based implementation strategies, often considered the missing link, are recommended to help achieve the Healthy People 2020 objective of increasing the prevalence of comprehensive school health education programs designed to reduce health risks for children. (Am J Prev Med 2011;40(2):207-219) © 2011 American Journal of Preventive Medicine

Across the health disciplines, clinical prevention and population health activities increasingly are recognized as integral to the practice of their professions. Most of the major clinical health professions organizations have begun incorporating clinical prevention and population health activities and services into educational curricula, the accreditation process, and training to affect clinical practice. Students in each health profession need to understand the roles played by those in other health professions. This understanding is a prerequisite for better communication and collaboration among the professions and for accomplishing the educational objectives included in Healthy People 2020 and organized using the Education for Health framework. To help accomplish these goals, this article summarizes each health profession's contributions to the field of prevention and population health, explains how the profession contributes to interprofessional education or practice, reviews specific challenges faced in the provision of these types of services, and highlights future opportunities to expand the provision of these services. Several general themes emerge from a review of the different health professions' contributions to this area. First, having well-trained prevention and population health professionals outside of the traditional public health field is important because prevention and population health activities occur in almost all healthcare settings. Second, because health professionals work in interprofessional teams in the clinical setting, training and educating all health professionals within interprofessional models would be prudent. Third, in order to expand services, reimbursement for health promotion counseling, preventive medicine, and disease management assistance needs to be appropriate for each of the professions.

Healthy People 2010 included an objective to "increase the proportion of . . . health profes- sional training schools whose basic curriculum for healthcare providers includes the core competencies in health promotion and disease prevention." Interprofessional prevention education has been seen by the Healthy People Curriculum Task Force as a key strategy for achieving this objective and strengthening prevention content in health professions education programs. To fulfill these aims, the Association for Prevention Teaching and Research sponsored the Institute for Interprofessional Prevention Education in 2007 and in 2008. The institutes were based on the premise that if clinicians from different professions are to function effectively in teams, health professions students need to learn with, from, and about students from other professions. The institutes assembled interprofessional teams of educators from academic health centers across the country and provided instruction in approaches for improving interpro- fessional prevention education. Interprofessional education also plays a key role in implementation of Healthy People 2020 Education for Health framework. The delivery of preventive services provides a nearly level playing field in which multiple professions each make important contributions. Prevention education should take place during that phase of the educational continuum in which the attitudes, skills, and knowledge necessary for both effective teamwork and prevention are incorporated into the "DNA" of future health professionals. Evaluation of the teams' educational initiatives holds important lessons. These include allowing ample time for planning, obtaining student input during planning, paying explicit attention to teamwork, and taking account of cultural differences across professions.

The Education for Health framework is designed as an educational roadmap for Healthy People 2020. It aims to connect the educational phases and suggests overall educational strategies needed to educate health professionals and the public to achieve a healthier America. The framework seeks to develop a seamless approach to prevention and population health education from Pre-K through graduate school. The framework is built on national movements in health literacy, undergraduate public health education and evidence-based thinking. It envisions a coordinated set of learning objectives divided into Pre-K through Grade 12, 2-year and 4-year colleges, and graduate education in the health professions as well as for health education for the community-at-large. The Healthy People Curriculum Task Force, a consortium of eight health professions education associations, has developed the framework and connected the framework with new and revised educational objectives of Healthy People 2020. The Task Force envisions a decade-long process to define and implement specific learning outcomes that can be integrated across the educational continuum. Interprofessional prevention education, in which health professionals learn and practice together, is seen by the Task Force as a key method for implementation. Understanding the roles played by a range of clinical health professions is also essential to communication and understanding. Healthy People 2020 and its new and revised educational objectives provide a vehicle for promoting the discussion and experimentation that will be needed to achieve an integrated and seamless approach to education for health for the American public as well as for health professionals.

The Institute of Medicine has recommended that all undergraduates have access to public health education. An evidence-based public health framework including curricula such as "Public Health 101" and "Epidemiology 101" was recommended for all colleges and universities by arts and sciences, public health, and clinical health professions educators as part of the Consensus Conference on Undergraduate Public Health Education. These courses should foster critical thinking whereby students learn to broadly frame options, critically analyze data, and understand the uncertainties that remain. College-level competencies or learning outcomes in research literature reading, determinants of health, basic understanding of health care systems, and the synergies between health care and public health can provide preparation for medical education. Formally tested competencies could substitute for a growing list of prerequisite courses. Grounded in principles similar to those of evidence-based medicine, evidence-based public health includes problem description, causation, evidence-based recommendations for intervention, and implementation considering key issues of when, who, and how to intervene. Curriculum frameworks for structuring "Public Health 101" and "Epidemiology 101" are provided by the Consensus Conference that lay the foundation for teaching evidence-based public health as well as evidence-based medicine. Medical school preparation based on this foundation should enable the Clinical Prevention and Population Health Curriculum Framework, including the evidence base for practice and health systems and health policy, to be fully integrated into the four years of medical school. A faculty development program, curriculum guide, interest group, and clear student interest are facilitating rapid acceptance of the need for these curricula.

Although communications competency is recommended by the American Dental Education Association, only a few (n=5) dental schools report evaluating students’ skills using a competency examination for communication. This study used an objective structured clinical examination (OSCE) to evaluate dental students’ competency in interpersonal and tobacco cessation communication skills. All students were evaluated on their interpersonal communication skills at baseline and at six months post-OSCE by standardized patients and on their tobacco cessation communication skills by two independent raters. First- and second-year dental students (n=104) were randomized to a control or intervention group. One month after the baseline OSCE, students in the intervention group participated in a two-hour training session in which faculty members communicated with a standardized patient during a head and neck examination and counseled the patient about tobacco cessation. There were no statistically significant differences from baseline to post-test between the intervention and control group students as measured by the OSCE. However, among first-year students, both the intervention (n=23) and control (n=21) groups significantly increased in tobacco cessation communication scores. Second-year students in both intervention (n=24) and control (n=28) groups declined in interpersonal communication skills from baseline to post-test. Overall, this one-shot intervention was not successful, and results suggest that a comprehensive communication skills training course may be more beneficial than a single, brief training session for improving dental students’ communication skills.

PURPOSE African Americans are at increased risk for diabetes mellitus and hypertension, and rural residents have historically had decreased access to care. It is unclear whether living in a rural area and being African American confers added risks for diagnosis and control of diabetes and hypertension. The purpose of this study was to examine the prevalence of diagnosed diabetes and hypertension, as well as control of both conditions, among rural and urban African Americans and whites. METHODS We conducted an analysis of the Third National Health and Nutrition Examination Survey (1988-1994). Non-Hispanic African Americans and non-Hispanic white adults 20 years and older were classifi ed according to rural or urban residence (n = 11,755). Investigated outcomes were previously diagnosed diabetes mellitus and hypertension and control of diabetes and hypertension. RESULTS The prevalence of diagnosed diabetes was 4.5% for urban whites, 6.5% for rural whites, 6.0% for urban African Americans, and 9.5% for rural African Americans. Among patients with diagnosed diabetes, 33% of rural whites, 43% of urban whites, 45% of urban African American, and 61% of rural African Americans had glycosylated hemoglobin (HbA1c) levels of 8% or higher (P

The Clinical Prevention and Population Health Curriculum Framework is the initial product of the Healthy People Curriculum Task Force convened by the Association of Teachers of Preventive Medicine and the Association of Academic Health Centers. The Task Force includes representatives of allopathic and osteopathic medicine, nursing and nurse practitioners, dentistry, pharmacy, and physician assistants. The Task Force aims to accomplish the Healthy People 2010 goal of increasing the prevention content of clinical health professional education. The Curriculum Framework provides a structure for organizing curriculum, monitoring curriculum, and communicating within and among professions. The Framework contains four components: evidence base for practice, clinical preventive services-health promotion, health systems and health policy, and community aspects of practice. The full Framework includes 19 domains. The title "Clinical Prevention and Population Health" has been carefully chosen to include both individual- and population-oriented prevention efforts. It is recommended that all participating clinical health professions use this title when referring to this area of curriculum. The Task Force recommends that each profession systematically determine whether appropriate items in the Curriculum Framework are included in its standardized examinations for licensure and certification and for program accreditation.

Evidence suggests that rural experiences can positively influence students' preferences for rural practice. This study examined changes in students' perceptions toward rural primary care following a required rural clerkship.Third-year students completed pre- and post-clerkship questionnaire items assessing their beliefs about primary care physicians who practice in rural communities in comparison with their urban/suburban counterparts. A factor analysis was performed, and pre- and post-clerkship scale means were calculated to determine differences.A total of 428 (88%) students completed these questionnaires. There was a significant increase in students' perceptions of rural primary care physicians' primary care service features and medical expertise. Students perceived the physicians' work demands more positively, and there was no change in students' perceptions of the physicians' income potential.Results suggest that the rural primary care clerkship positively influenced students' perceptions toward rural primary care.

The importance of wellness and prevention in medical education is well documented. This report discusses the educational innovations in wellness and prevention that were implemented as part of the Undergraduate Medical Education for the 21st Century (UME-21) project.Eight partner schools and four of the 10 associate partner schools provided specific information about learning objectives, content, and methods used in incorporating wellness and prevention into the curriculum. Based on these reports, common learning objectives and core content were identified.Many schools emphasized that integration of content across courses and throughout the preclinical and clinical years was important in incorporating wellness and prevention content into existing curricula. A variety of instructional methods were used, including didactic lectures, workshops, smallgroup sessions, case studies, computer-based instructional modules, patient simulators, and standardized patient encounters. Based on partner reports, after completing the UME-21 project, students demonstrated gains in knowledge, clinical skills, and positive attitudes toward preventive care and wellness. The project outcome data indicated that student instruction in and exposure to preventive care was increased during the project. However, these increases were not significant when compared to their peers from non-UME-21 schools.Although partner schools used different methods to incorporate wellness and prevention, the UME-21 project was an effective project in improving the educational experience in this content area for students from institutions that included this area in their educational innovations.

The knowledge, skills, and attitudes associated with prevention cut across clinical disciplines. Thus, they are often subsets of disciplines not otherwise present in the traditional curriculum (e.g., epidemiology or statistics) or considered the province of many disciplines (e.g., risk reduction or cancer screening). Evaluation of elements of prevention education can often become lost in the myriad other outcomes that are assessed in students, or they are intermingled with other content and skills. This article highlights the value of assessing students' competence in prevention knowledge, skills, and attitudes, provides general guidance for programs interested in evaluating their prevention instructional efforts, and gives specific examples of possible methods for evaluating prevention education. While it is important to tailor assessment methods to local institutional objectives, it is possible to share assessment methods and materials regionally and nationally. Sharing problems, as well as successes, encountered in developing appropriate assessment methods will advance the field of evaluation of prevention curricula.

The Prevention Curriculum Assistance Program (PCAP) was initiated to help U.S. medical schools examine the extent to which they are evaluating the learning of medical students about disease prevention/health promotion. A survey was sent to all 144 allopathic and osteopathic medical schools, with an overall response rate of 68%. The results revealed more emphasis on teaching and evaluating the learning of medical students in the areas of clinical preventive services and quantitative methods, and less emphasis on the community dimensions of medical practice and health services organization and delivery. Written tests and unstructured observation are the most common methods of evaluation. Fewer than half of all respondents were satisfied with the quality of their assessment of student achievement in any of the four domains of prevention education. More than 30% expressed a desire to receive assistance with designing curricula and/ or evaluation methods in each of the four content areas examined. Several indicated their willingness to assist colleagues who want to improve their prevention curricula and/or measurement strategies. This study identified a need for more attention and support for prevention education and evaluation programs. Curriculum leaders can help by designating prevention a priority area and appointing faculty to be responsible for monitoring the content and quality of prevention teaching throughout the curriculum. Resources such as the Internet can be utilized to establish a network whereby medical schools can collaborate to improve their educational programs and evaluation methods in prevention.

Despite increasing recognition of the importance of preventive services, such services are not provided in primary care practice as often as recommended. One of the most important reasons is the lack of a systematic, organized approach within practices. The American Cancer Society Ad Hoc Advisory Group on Preventive Health Care Reminder Systems reviewed evidence-based reports and expert opinion to summarize current knowledge about office systems for clinical preventive services. This article describes the process of developing an office system for preventive care, beginning with writing a practice policy, auditing charts for baseline performance, developing and implementing a plan for efficient delivery of preventive care, involving office staff, and monitoring progress. Strategies for dissemination of this approach to a wide range of primary care practices may involve professional medical organizations and managed care companies.

OBJECTIVE To improve the computer-generated preventive services patient reminder letter used by a department of family medicine at a medical university in South Carolina. DESIGN A qualitative method chosen because of its demonstrated efficacy in generating in-depth attitude and opinion data was used for 12 focus groups (111 participants) in which participants were asked to evaluate the reminder letter and other preventive services reminder materials. Information from these groups was used to design a revised patient reminder system that was tested in six additional focus groups (50 participants). SETTING University-based family medicine center. PARTICIPANTS Adults 19 years of age or older of whom approximately one half were selected from a random sample of family medicine center patients and the remainder from volunteers recruited from the general community by newspaper advertisement. INTERVENTIONS None. MAIN OUTCOME MEASURES Participants' perceptions and attitudes about the reminder letter and other materials as well as suggestions for improving the preventive services reminder system. RESULTS The revised patient reminder materials resulted in a warmer, more personal letter sent to patients at the time of their birthdays in an envelope containing a prevention message. A leaflet describing the rationale for preventive services and answering common questions about prevention and a booklet describing the preventive services available at the family medicine center were also developed. CONCLUSION This study illustrated the benefits of incorporating patients' perspectives in the design of preventive services reminders.

The accompanying article describes the Clinical Prevention and Population Health Curriculum Framework (Framework), unanimously approved by the Healthy People Curriculum Task Force representing seven clinical health professions. The Task Force was convened by the Association of Teachers of Preventive Medicine and the Association of Academic Health Centers with support from the Department of Health and Human Services’ Office of Disease Prevention and Health Promotion and Health Resources and Services Administration. It represents a unique collaborative effort aimed at developing a common framework and common strategy for improving clinical health professional education. To understand the construction of this document, its selection of content, and its future potential, it is important to appreciate the strategy and goals behind its development. The required level of core content in this area was assumed to be similar enough across key health professions that a common curriculum framework could be developed while still allowing each profession to tailor its own curriculum. The goal of the Framework is to provide a structure for (1) communication and collaboration within and among health professions, (2) organizing curriculum, and (3) monitoring curriculum. A consistent title and common terminology were considered essential to facilitate communication among the professions. It is strongly recommended that all participating clinical health professions adopt the terminology “clinical prevention and population health” to describe this content area. It is also recommended that the four components be called evidence base for practice, clinical preventive services– health promotion, health systems and health policy, and community aspects of practice. The four components of the Framework are designed to provide a common structure for the curriculum. The 19 domains organized under these four components serve as a checklist for monitoring curriculum and potentially for ensuring that students’ knowledge is appropriately examined using standardized testing methods. A number of compromises were inherent in the process of developing the Framework. The first compromise was between incorporating the Framework content into the overall curriculum versus teaching the materials as discrete courses. The Framework encourages inclusion of components of the Framework throughout the degree program, but also stresses the need for integration and synthesis of the materials near the end of the health professional degree program using case studies, experiential learning, or other active participation teaching methods. A second compromise was between providing basic knowledge and skills and providing an introduction to more advanced or specialized content areas. Basic knowledge and skills are emphasized. Introductions to selected issues relevant to all health professionals such as health policy, global health, and environmental health are included in the Framework. Hard choices were made to ensure that the curriculum is realistic and acceptable to the participating clinical health professions. It was decided to exclude other important but more specialized curricula such as leadership skills, administrative knowledge, and program planning and evaluation.