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Defining the content of a curriculum in environmental medicine is far easier than ensuring its implementation and integration into existing medical education programs. The latter requires effective leadership and faculty resources, commitment, and skills in addition to an educational climate and format open to experimentation, adaptation, and change.

Developing a curriculum in environmental medicine also requires thoughtful specification—in concrete and, preferably, behavioral terms—of what graduating medical students should know, be able to do, and be sensitive to in the area of environmental health. These “competencies” should also reflect related societal and patient needs. In emphasizing competencies, the committee is expressing its belief that specifying what should be taught is not as useful as describing what students should know and be able to do at the completion of training.

Past recommendations for creating or enhancing a medical school curriculum in environmental health often focused on occupational health. Although many of the underlying principles and concepts of environmental and occupational health are the same, there are also significant differences, some of which may require additional or different learning objectives. Such differences include the absolute level of risk, sources and routes of exposure, possibilities for intervention and environmental manipulation, and a number of administrative, legal, and political issues (Cullen and Figueroa, 1990). Another major difference between environmental and occupational health is the broader range of populations at risk in the former. The expanded focus of environmental health provides the opportunity to involve more clinical specialties in the teaching of environmental health, such as pediatrics, obstetrics/gynecology, and geriatrics.

Current discussions about a curriculum in environmental medicine reveal considerable agreement about certain fundamental components. In its 1988 report, IOM suggested (pp. 47–48) that didactic and clinical training in occupational and environmental medicine provide:

  • solid grounding in epidemiology and toxicology;

  • an understanding of the concept of risk and its application to groups and individuals;

  • a method of obtaining an occupational and environmental health screening history;

  • concepts of dose response and other factors that contribute to exposure and host response;

  • knowledge and skill in finding and using information about environmental and occupational diseases; and

  • sensitivity to special medical, ethical, legal, and economic factors in caring for patients with environmental and occupational diseases.

Other groups have echoed these suggestions and have added several others, such as a focus on risk assessment and risk communication in medical education (American College



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