Building bridges : the relationship of medical education to health promotion

Abstract

This research interviewed, and examined curriculum documentation produced by, all those who coordinated the courses and attachments that make up the undergraduate medical curriculum at the University of Southampton, and interviewed some other key individuals, to examine where the goals, content and processes of medical education overlap with those of health promotion, and where they diverge.

The main areas of overlap were the interest shown by most of the specialities in: patient centredness, especially communication skills, which were essentially self empowerment; holism which looked at the patient in their social and pyschological entirety; and prevention, including the giving of lifestyle advice. Some specialities were also interested in: 'relative health', i.e. helping patients to feel as 'well' as possible; behaviour change and psychological approaches; epidemiology and risk; and critical appraisal and evidence base. There was some recognition of the importance of teaching students about their own health, and particularly some concern and teaching about student stress.

The main divergencies were a lack of interest in positive health; a strong tendency to identify health promotion simply with prevention; the marginalisation a psycho-social perspective, and in particular a lack of interest in broader social perspectives; and a dismissal of the reflective and interpretive epistemologies of the psycho-social sciences as commonsense. The parts of the curriculum that were most likely to support the concepts and principles of health promotion tended to be seen as of lower status than those that concentrated on 'high tech', interventionist medicine.

This research suggests that those who would develop health promotion in medical education should build positive links with the areas of overlap rather than starting from a negative and confrontational perspective, and use language and concepts familiar to medicine, while emphasising the relevance of their discipline to medical contexts. They should attempt to integrate health promotion across the curriculum, especially in the clinical specialities, and concentrate particularly on developing health promotion in the parts of the curriculum likely to provide a supportive environment for it.

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