Modules

• Year 1
  • Introduction to Year 1 and Year Outcomes
  • Fundamentals of Medicine
  • Cardiorespiratory 1
  • Metabolism 1
  • Locomotor 1
  • Brain and Behaviour 1
  • Human Development 1
  • Medicine in Society 1
  • Clinical Communication Skills
  • Student Selected Component (SSC)
• Year 2
  • Introduction to Year 2 and Year Outcomes
  • Cardiorespiratory 2
  • Metabolism 2
  • Brain and Behaviour 2
  • Human Development 2
  • Human Sciences and Public Health 2
  • Locomotor 2
  • Cancer Week
  • Moving and Handling Training
  • Year 2 Lifesaver Programme
  • Clinical Communication Skills
  • Medicine in Society 2
  • Extended Patient Contact
  • Student Selected Component (SSC)
• Year 3
  • Introduction to Year 3 and Year Outcomes
  • Clinical Science and Professionalism (Weeks 1-3)
  • Cardiovascular, Respiratory and Haematology (CR3)
  • Gastroenterology and Cancer (MET3A)
  • Public Health
  • Endocrinology and Renal Medicine (MET3B)
  • General Practice and Community Care
  • Student Selected Component (SSC)
  • Clinical and Communication Skills
• Year 4
  • Introduction and Year 4 Outcomes
  • Obstetrics and Gynaecology
  • Child Health
  • HIV & Sexual Health
  • Musculoskeletal
  • Health Care of the Elderly
  • Neuroscience
  • Dermatology
  • General Practice and Community Care
  • Psychiatry
  • Ear, Nose and Throat
  • Global Health and Ethics
  • Ophthalmology
  • Clinical & Communication Skills
  • Student Selected Component (SSC)
• Year 5
  • Introduction to Year 5 and Year Outcomes
  • Teaching Week 1
  • Teaching Week 2
  • Anaesthesia & ITU (AN & ITU)
  • Breaking Bad News
  • Clinical Pharmacology & Therapeutics
  • Community Care
  • Doctors as Teachers and Educators (DATE)
  • Emergency Medicine (EMERG MED)
  • General (Internal) Medicine (G(I)M)
  • Immediate Life Support (ILS)
  • Student Assistantship
  • Simulation
  • Surgery
  • Student Selected Component (SSC)
• Year GEP 1
  • Cancer Week
  • Movement and Posture
  • Carriage of Oxygen
  • Human Sciences and Public Health
  • Digestion, Growth and Metabolism
  • Infection and Immunity
  • Ethics
  • Brain and Behaviour
  • Human Development
  • Clinical Communication Skills
  • Medicine in Society (GEP)

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Year 3 PH3: Public Health

• Professor Malcolm Law
• m.r.law@qmul.ac.uk

Teaching Material for this Module

Introduction

The modules aims to provide an introduction to epidemiology and public health showing how these areas of medicine are related to individual and population health sciences.

Key Learning outcomes:

1. Can discuss basic principles of health improvement, including the wider determinants of health, health inequalities, health risks and disease surveillance. (GMC TD 11a)

2. Can assess how health behaviours and outcomes are affected by the diversity of the patient population. (GMC TD 11b)

3. Can describe measurement methods relevant to the improvement of clinical effectiveness and care. (GMC TD 11c)

4. Can explain and apply the basic principles of communicable disease control in hospital and community settings. (GMC TD 11 e)

5. Can evaluate and apply epidemiological data in managing healthcare for the individual and the community. (GMC TD 11 f)

6. Can recognise the role of environmental and occupational hazards in ill-health and discuss ways to mitigate their effects. (GMC TD 11 g)

7. Can discuss the principles and application of primary, secondary and tertiary prevention of disease. (GMC TD 11 i)

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Index

• General Outcomes for the Whole Person

• General Outcomes for the Whole Person
  • Medical knowledge: EPIDEMIOLOGY
    • Cancer epidemiology
      1. Recognise that risk of cancer generally becomes high only after prolonged (decades) exposure to a carcinogen but falls within a few years of removing the exposure.
      2. Understand why some cancers do well (high 5 year survival) and others do not.
      3. Understand why "debulking" cancers does not materially prolong survival.
      4. Recognise that cancer is monoclonal and is a multistage process and hence has many causes.
      5. Recognise that carcinogens have no threshold.
      6. Know the major causes of cancer.
      7. Understand the concept of over-diagnosis.
      8. Appreciate why some cancers are becoming less common and others more so.
    • Malnutrition and other Nutritional Deficiencies
      1. Understand the importance of different nutrients in disease causation.
      2. Understand the factors influencing the development of public health policy in relation to nutrition.
      3. Recognise the key factors that influence nutrition policy (advocates,individuals and government).
    • Obesity
      1. Consider obesity and diabetes as both an individual and a public health problem.
      2. Understand how several screening methods can be combined into a single screening test.
      3. Recognise the major determinants of obesity and diabetes.
      4. Assess the screening performance of a multi-marker screening test (e.g. the Quadruple test).
      5. Understand approaches in the prevention of obesity and diabetes, and appropriate public health policy.
      6. Understand why cholesterol and blood pressure measurement are poor screening tests for cardiovascular disease.
    • Hepatitis
      1. Know that the two major liver killers are alcohol consumption and the Hepatitis C virus.
      2. Understand how to calculate alcohol units.
      3. Know the different types of public health interventions.
      4. Know that the two major liver killers can be eliminated by public health interventions but that there are political challenges.
    • Trials & Research
      1. To know the strengths and weaknesses of different study designs, and choose the most appropriate to answer specific questions.
      2. Recognise the link between epidemiological research and determination of causal mechanisms of disease.
      3. Know the deductive and inferential process of discovering the causes of disease.
      4. To know the reasons for randomisation and blindness in trials.
      5. To distinguish intention-to-treat and on-treatment analyses.
      6. Apply these to breast cancer epidemiology and aetiology and thence to its prevention.
      7. To appreciate the superiority of crossover trials when feasible.
      8. To recognise that P<5% is statistically significant only when testing a prior hypothesis.
      9. To know that different causes of a disease usually interact multiplicatively.
    • Accidents and Suicide
      1. To appreciate that suicide is often impulsive (spur of the moment) and can be prevented by removing the means.
      2. To appreciate that death and disease are often better prevented by "changing the environment" rather than telling people not to do things.
      3. To recognise the high morbidity associated with hip fracture and the ways of preventing it.
    • Coronary Heart Disease (CHD)
      1. Know the risk of IHD and stroke in the UK now and why IHD mortality increased and then decreased over the past century.
      2. Recognise the important modifiable and non-modifiable risk factors.
      3. Understand the relationship with serum cholesterol and blood pressure, and which risk factors make good screening tests.
      4. Understand the basis for a healthy diet preventing future IHD and stroke.
      5. Know the important drugs used to prevent IHD and stroke, their efficacy alone and in combination, and the polypill concept.
      6. Understand the clinical management of acute myocardial infarction and acute ischaemic stroke in an epidemiological context.
    • Epidemiology of Childhealth
      1. Describe common congenital malformations, their prevalence and reasons for high prevalence in some communities.
      2. Explain what a teratogen is, some common teratogens and their action.
  • Medical knowledge: PUBLIC HEALTH and GLOBAL HEALTH (TD 11 a-j)
    • Antenatal Care
      1. Describe the factors affecting the risk of having a baby with Down's syndrome.
      2. State the major health complications associated with Down's syndrome.
      3. Know the antenatal screening programmes available in the UK and elsewhere.
      4. Describe a Multiple of the Median (MoM), how it is calculated and why it is useful in screening for Down's syndrome.
      5. Be able to explain a screening test to a woman considering the test.
      6. Explain why certain family origin groups are at greater risk of developing blood disorders such as sickle cell anaemia.
    • Infectious Diseases
      1. Recognise the importance of exponential growth
      2. Distinguish organisms with and without environmental reservoirs.
      3. Know the determinants of the risk of an infectious disease outbreak in a community.
      4. Know the determinants of case severity.
      5. Recognise that infectious diseases may cause chronic diseases including cancer.
      6. Understand the nature of epidemics.
    • Oral Health
      1. Know that the major dental diseases of caries (tooth decay); periodontal disease (gum and supporting bone); oral cancer are, in the main, preventable chronic conditions.
      2. Know that (oral) health depends on controlling consumption of free sugars, tobacco & alcohol by having a healthy diet, brushing twice daily with fluoridated toothpaste, not smoking.
      3. Understand that material and social deprivation are significantly associated with poor oral health, access and uptake of dental services; children and the elderly are at the forefront of disadvantage.
    • Smoking
      1. Describe the smoking trends among men and women.
      2. Know the diseases caused by smoking.
      3. Understand the relative merits of different methods of helping people stop smoking.
      4. To recognise that the smoking epidemic is only just beginning in developing countries.
    • Vaccination and Immunisation
      1. For the neurone in your brain that stores the word "vaccination" to synapse with the neurone that stores the term "herd immunity".
      2. Be familiar with the present vaccination schedule.
      3. Recognise that realistic levels of vaccine uptake can eliminate infectious diseases nationwide.
      4. Recognise the ultimate objective of eliminating infectious diseases worldwide.
      5. Recognise the importance of striving for high uptake of a vaccine.
      6. Appreciate that vaccines are extremely safe (despite the scare stories).
    • Cancer screening
      1. Define lead time and length time bias.
      2. Understand the difference between mortality and survival.
      3. Understand the reason for randomisation in cancer treatment trials and when to use an intention-to-treat and an on-treatment analysis.
      4. Know the three NHS cancer screening programmes in Britain.
    • Cancer prevention
      1. Know the major risk factors for breast cancer.
      2. Know the agents that have potential to prevent breast cancer.
      3. Understand the effectiveness of tamoxifen.
      4. Recognise the key role of HPV in cervix cancer.
      5. Know the major types of HPV involved in disease.
      6. Understand the merits of HPV testing vs cytology in screening.
      7. Know the two HPV vaccines currently available, and the UK vaccination programme.
      8. Understand the issues about who to vaccinate.
    • Health Systems including the HNS
      1. Compare health care spending in the UK with that of other government departments and of other countries.
      2. Understand the relative merits of cutting NHS costs by reducing numbers of beds in a hospital, reducing length of admission, closing hospitals and merging hospitals.
      3. Know the reasons for the increasing number of admissions.
      4. Know the reasons for the increasing cost of the NHS over time.

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