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environmental exposures. They are useful teaching aids and can also be completed for continuing medical education credit. Some state and county programs, also supported by ATSDR, offer funding and assistance to health departments for developing educational materials and activities in environmental medicine for health care professionals.

Other opportunities for obtaining continuing education and clinical treatment information include those that are available through the American College of Occupational and Environmental Medicine, which offers a continuing education course entitled “Core Curriculum in Environmental Medicine,” and the Association of Occupational and Environmental Clinics, which is a national network of clinical facilities with expertise in environmental and occupational medicine.

Details on these and many other programs offering assistance, opportunities, and information in environmental medicine are presented in Appendix D, and we urge consultation with them.

CONCLUSIONS AND RECOMMENDATIONS

There is considerable agreement that the traditions of medical education need to be adapted to a rapidly evolving social, political, and environmental context, and that there is also a need for more integration of basic and clinical sciences, increased mastery of biological concepts, increased attention to the social and behavioral aspects of health and disease, and greater use of ambulatory and community clinical experiences in the learning process. Although deep structural resistance to such change is inherent in the organization of medical schools, the current climate of expectation with respect to an increased emphasis on prevention in health care, a paradigm shift in the knowledge base, and the successes of the limited numbers of programs that support the integration and enhancement of environmental medicine in medical education are favorable to progress toward these goals. Insofar as the prospect of integrating environmental medicine into the medical school curriculum constitutes a response to the calls for curriculum reform, the climate offers opportunities for taking immediate action to enhance the content of environmental medicine in both medical education and practice. In addition, continued support and expansion of programs that currently support research and training are needed to ensure the progressive enhancement of competency in environmental medicine in medical education and practice. This should build on the success of current programs and include adequate funding to support reasonable growth and progress in curriculum development, faculty development, and continuing education.



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