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curricular time. This will require that administrators who recognize the importance of the curriculum support ongoing faculty development and provide adequate rewards for the teaching faculty. All this may necessitate activities at many other levels, for example, expanded initiatives by federal agencies, residency review committees, and professional organizations. Practice barriers, such as lack of reimbursement for preventive services, will also require attention.

With these many counterpressures and demanding complexities in mind, we present a practical and simple approach to integrating environmental medicine into the medical curriculum. 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 approach to achieving the competency-based objectives, but it seems to be the most appropriate as well given the pervasive and fundamental nature of environmental effects 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 those issues. As described in this report, instructors should be able to integrate environmental medicine into existing medical school courses and clerkships fairly easily.

To ensure the progressive enhancement of competency in environmental medicine in medical education and practice, the committee makes recommendations for the continued funding and expansion of programs that currently support research and training, such as Academic Awards and Center Grants. This enhancement should build on the success of current programs and include adequate funding to support reasonable progress in curriculum development, faculty development, and continuing education. In addition to the current activities, the committee recommends that consideration be given to establishing (1) a database of curricular materials for faculty and students, and (2) a speakers bureau in environmental medicine. Information about these activities and resources should be disseminated with vigor to help ensure the integration of environmental medicine into medical education and practice.

To facilitate integration and enhancement of environmental medicine in medical education, the report includes four appendixes that provide 55 case studies and other detailed information on available educational resources and teaching aids. Of particular utility will be the indexes in Appendix C, which guide the reader to cases in environmental medicine based on: (1) chemical agents and conditions, (2) medical school courses and clerkships/clinical rotations, (3) sentinel pathophysiological conditions, and (4) clinical signs, symptoms, and presenting complaints. The appendixes and case studies can and should be used to facilitate the integration of environmental medicine into both education and practice.



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