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and have a growing understanding and appreciation of the influence of the environment on health and the need for action.

Developing an inventory also provides a critical opportunity to identify and assess faculty interest and expertise in environmental health. The importance of personal contacts in creating learning opportunities cannot be over-stated. Allies and interest may be found in unexpected places—from the biochemist by profession who wants to build more clinical relevance into his/her course to the busy family practitioner who is stymied by patients with symptoms related to indoor air quality.

Once an inventory establishes a need within a given institution, sources of support must be identified. Influential support, such as from a departmental chair, a prominent investigator, a favorite instructor, or a highly regarded clinician, can be very helpful. Members of the student body should not be overlooked; they are often powerful advocates for environmental issues and for understanding their effects on health. It is also important to know the location and basis of opposition, because such understanding can expedite discussions and facilitate resolutions.

In order for tomorrow’s physicians to have the knowledge, skills, and attitudes needed to practice medicine in a society in which the environment is of increasing concern, environmental medicine must be integrated into medical school education. Toward this end, the committee recommends that all graduating medical students master the six competencies (described in Chapter 2 of this report) that encompass the requisite core knowledge and skills. Where and when these competencies will best be learned depends on the structure and format of each individual school’s specific curriculum. (As has been said numerous times by committee member Brownie Anderson, “If you’ve seen one medical school, you’ve seen one medical school.”) Regardless of the specific structure and format, however, the fundamental content of the medical curriculum is relatively consistent and amenable to the integration or enhancement of environmental medicine concepts and information.

Rather than defining and carving out new blocks or courses in an already crowded curriculum, the committee favors an integrative approach to enhancing the environmental and occupational health content in undergraduate medical education. This is not only the most expeditious way to achieve the competency objectives, but it also seems to be the most appropriate given the pervasive nature of the effects of the environment on health. Integration also highlights the relevance of environmental and occupational medicine to basic science and clinical studies, and provides a vehicle for enhancing faculty awareness of the issues. Moreover, instructors should be able to integrate environmental medicine into existing disciplines and medical school courses and clerkships fairly easily.

To show how the six competencies can be integrated into existing programs, this chapter discusses each one in terms of likely access points in the curriculum and possible teaching strategies. The competencies can be grouped into those that are more knowledge oriented (competencies 1–3) and those that focus more on skills (competencies 3–6; competency 3 overlaps both groups)—similar to the basic science/preclinical and



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