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of graduation is clearly very important. But will the graduates retain these competencies over time? The long-term effect is much harder to evaluate. One approach, supported by this committee, is for the National Board of Medical Examiners and the Federal Licensing Examination to incorporate into their certifying examinations the six competencies described in this report.

Probably the most meaningful way of evaluating program effect would be to assess medical graduates’ actual use of the six competencies in their post-graduation practice. Are they finding it possible to put their environmental medicine training into practice—and if not, why not. This kind of assessment, which might be done through a survey of graduates, could be carried out only after the training had been in place for some time.

Other potential program effects that might be examined in individual medical schools include changes in faculty attitudes, activities, and competencies related to environmental medicine; changes in administrative awareness and support for environmental medicine; and changes in the medical school’s patient services and community activities related to environmental medicine.



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