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Innovation in Public Health Education for Medical Students  
at Ramathibodi, Mahidol University 
Borwornsom Leerapan, MD PhD  
Department of Community Medicine 
Faculty of Medicine Ramathibodi Hospital, Mahidol University 
WHO-SEARO Regional Meeting, Pattaya, Thailand 
12 December 2013 
Pix source: Pinaree Chen, 2nd World Prize (under 9 year-old), One Health Art Contest PMAC 2013  
Our Innovations? 
#1: Changes of learning objectives 
–  What exactly are “public health” concepts and skills that
our medical students really need nowadays?  
#2: Changes of learning experiences:  
–  How do we deliver public health education to our  
“Gen Y/Z” medical students?  
#3: Changes in evaluation:  
–  How do we know our students “succeed or fail”? 
What’s “public health” here?” 

Pix source: online.wsj.com 
Some Background: Thailand in 1970s 

Pix Source: www.nationalguard.mil 
Some Background: Thailand in 1970s 
•  In 1967, the Rockefeller Foundation assisted the Faculty of
Medicine Ramathibodi Hospital, Mahidol University to found  
the Center of Community Medicine 
•  Dr.Aree Valyasevi, Former Dean and Chairman of Pediatrics,
Dr.Rachit Buri, Former Dean and Chairman of Medicine
Department, and Dr.Prem Buri, Former Chairman of Surgery
Department set up the teaching “Community Medicine” for
medical and nursing students at Ayudhthaya province,
especially focusing on community survey and diagnosis. 
Public Health Challenges 
•  Thailand in 1970s:  
– Limited resources in rural healthcare  
•  Thailand in 2000s:  
– Issues of quality, equity, and efficiency in health systems  
	
  
	
  
st
21

Century Medical Education 

Pix source: Frenk et al. (2010) 
Mapping Medicine & Public Health 

Source: Hoffman et al. (2012). A Review of Conceptual Barriers and Opportunities Facing Health Systems Research to Inform a Strategy from WHO. 
Academic Home 
Community Medicine Center 

Department of Community Medicine

(1967) 

(from August 2010 on) 
How to teach it to “Gen Y/Z”? 

Pix source: online.wsj.com 
Our Community Medicine Courses 
•  3rd-Year Community Medicine (required, 5 credits): concept of health and health
determinants, health system & health service system, physician roles, health
education, health promotion, community capacity, community diagnosis,
epidemiology, biostatistics 
•  4th-Year Community Medicine I (required, 5 credits): district health system,
hospital services system, health systems research, health economics  
•  5th-Year Primary Care Medicine II (3rd-yr, 5 credits): evidence-based medicine,
concepts of primary care, health promotion: health policy and roles of NGOs 
•  6th-Year: Family and Community Medicine (required, 4 credits): skills in
community hospitals, health systems research projects 
•  Health Services System in Community Hospital (elective, 2 credits): health
service system in community hospital 
What Level of Our Teaching? 
Wisdom	
  

•  Why	
  

Knowledge	
  

•  How	
  

Informa8on	
  

•  What,	
  Who,	
  When,	
  Where	
  

Data	
  

•  Number,	
  Text,	
  Picture,	
  Sound,	
  etc.	
  
Fighting ADHD in Medical School 

Recommended treatment: 
•  Ritalin 
•  Active engagement 
Pix Source: www.thersa.org/events/rsaanimate/animate/rsa-animate-changing-paradigms 
Active Engagement in Group Work 
Active Engagement Outside Classroom 
Active Engagement in the Field 
Active Engagement in Community 
Active Engagement in SDH 
Active Engagement in Ambulatory Care 
Active Engagement in Knowledge Management 
Teaching Methods 
• 
• 
• 
• 
• 
• 
• 
• 
• 

Self-directed learning 
Team-based learning 
Problem-based learning  
Task-based learning 
Case conference, discussion, oral & poster presentation 
Fieldwork in community settings 
Working in community hospitals 
Site visits: factory, clinic, NGO, etc. 
Research projects: epidemiological research, health policy and
systems research, clinical tracer, routine-to-research (R2R*), etc. 
How to “evaluate” our teaching? 

Pix source: online.wsj.com 
Evaluation Methods 
•  Formative evaluation; 
–  Feedback to student’s logbook 
–  Feedback of group process  
–  Assessment of report & presentation 
–  Assessment of individual behaviors in the field trip 
–  Assessment of individual and group performance 
–  Peer assessment 

•  Summative evaluation;  
–  Examination: MCQ, SAQ, short essay, individual report, oral
examination 
–  Assessment of research, projects, and case study 
Using Social Media for Formative Evaluation 
Student’s Satisfaction by Departments 

Note: 5-level scale of evaluation  
st
21

Century Medical Education 

•  We want to develop “change agents” who knows how to get
people in health systems involved in solving their own problems.	
  
•  Now, the question is “how” to evaluate change agents? 
Pix source: Frenk et al. (2010) 
Work in Progress 
•  Teachers’ Capacity Building: 
– Periodic medical education workshops for the faculty
members and supporting staffs 
– Monthly meetings for knowledge management, course
evaluation, and course development 
Future Challenges 
• 
• 
• 
• 
• 
• 
• 
• 
• 
	
  

Change agents?? 
Time constraints (esp. in teaching blocks) 
Longitudinal and integrated community clerkship  
Shortage of qualified staffs 
Urbanized settings 
Global health issues 
Standardization of courses among schools 
Safety issues in the fieldwork 
Budget issues for the fieldwork 
Q & A 
borwornsom.lee@mahidol.ac.th 
rassamee.tan@mahidol.ac.th 
boonmee.sat@mahidol.ac.th 

Pix source: online.wsj.com 

http://www.slideshare.net/borwornsom 

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Innovation in public health education at Ramathibodi medical school 2013.12.12

  • 1. Innovation in Public Health Education for Medical Students   at Ramathibodi, Mahidol University  Borwornsom Leerapan, MD PhD   Department of Community Medicine  Faculty of Medicine Ramathibodi Hospital, Mahidol University  WHO-SEARO Regional Meeting, Pattaya, Thailand  12 December 2013  Pix source: Pinaree Chen, 2nd World Prize (under 9 year-old), One Health Art Contest PMAC 2013  
  • 2. Our Innovations?  #1: Changes of learning objectives  –  What exactly are “public health” concepts and skills that our medical students really need nowadays?   #2: Changes of learning experiences:   –  How do we deliver public health education to our   “Gen Y/Z” medical students?   #3: Changes in evaluation:   –  How do we know our students “succeed or fail”? 
  • 3. What’s “public health” here?”  Pix source: online.wsj.com 
  • 4. Some Background: Thailand in 1970s  Pix Source: www.nationalguard.mil 
  • 5. Some Background: Thailand in 1970s  •  In 1967, the Rockefeller Foundation assisted the Faculty of Medicine Ramathibodi Hospital, Mahidol University to found   the Center of Community Medicine  •  Dr.Aree Valyasevi, Former Dean and Chairman of Pediatrics, Dr.Rachit Buri, Former Dean and Chairman of Medicine Department, and Dr.Prem Buri, Former Chairman of Surgery Department set up the teaching “Community Medicine” for medical and nursing students at Ayudhthaya province, especially focusing on community survey and diagnosis. 
  • 6. Public Health Challenges  •  Thailand in 1970s:   – Limited resources in rural healthcare   •  Thailand in 2000s:   – Issues of quality, equity, and efficiency in health systems      
  • 7. st 21 Century Medical Education  Pix source: Frenk et al. (2010) 
  • 8. Mapping Medicine & Public Health  Source: Hoffman et al. (2012). A Review of Conceptual Barriers and Opportunities Facing Health Systems Research to Inform a Strategy from WHO. 
  • 9. Academic Home  Community Medicine Center  Department of Community Medicine (1967)  (from August 2010 on) 
  • 10. How to teach it to “Gen Y/Z”?  Pix source: online.wsj.com 
  • 11. Our Community Medicine Courses  •  3rd-Year Community Medicine (required, 5 credits): concept of health and health determinants, health system & health service system, physician roles, health education, health promotion, community capacity, community diagnosis, epidemiology, biostatistics  •  4th-Year Community Medicine I (required, 5 credits): district health system, hospital services system, health systems research, health economics   •  5th-Year Primary Care Medicine II (3rd-yr, 5 credits): evidence-based medicine, concepts of primary care, health promotion: health policy and roles of NGOs  •  6th-Year: Family and Community Medicine (required, 4 credits): skills in community hospitals, health systems research projects  •  Health Services System in Community Hospital (elective, 2 credits): health service system in community hospital 
  • 12. What Level of Our Teaching?  Wisdom   •  Why   Knowledge   •  How   Informa8on   •  What,  Who,  When,  Where   Data   •  Number,  Text,  Picture,  Sound,  etc.  
  • 13. Fighting ADHD in Medical School  Recommended treatment:  •  Ritalin  •  Active engagement  Pix Source: www.thersa.org/events/rsaanimate/animate/rsa-animate-changing-paradigms 
  • 14. Active Engagement in Group Work 
  • 16. Active Engagement in the Field 
  • 17. Active Engagement in Community 
  • 19. Active Engagement in Ambulatory Care 
  • 20. Active Engagement in Knowledge Management 
  • 21. Teaching Methods  •  •  •  •  •  •  •  •  •  Self-directed learning  Team-based learning  Problem-based learning   Task-based learning  Case conference, discussion, oral & poster presentation  Fieldwork in community settings  Working in community hospitals  Site visits: factory, clinic, NGO, etc.  Research projects: epidemiological research, health policy and systems research, clinical tracer, routine-to-research (R2R*), etc. 
  • 22. How to “evaluate” our teaching?  Pix source: online.wsj.com 
  • 23. Evaluation Methods  •  Formative evaluation;  –  Feedback to student’s logbook  –  Feedback of group process   –  Assessment of report & presentation  –  Assessment of individual behaviors in the field trip  –  Assessment of individual and group performance  –  Peer assessment  •  Summative evaluation;   –  Examination: MCQ, SAQ, short essay, individual report, oral examination  –  Assessment of research, projects, and case study 
  • 24. Using Social Media for Formative Evaluation 
  • 25. Student’s Satisfaction by Departments  Note: 5-level scale of evaluation  
  • 26. st 21 Century Medical Education  •  We want to develop “change agents” who knows how to get people in health systems involved in solving their own problems.   •  Now, the question is “how” to evaluate change agents?  Pix source: Frenk et al. (2010) 
  • 27. Work in Progress  •  Teachers’ Capacity Building:  – Periodic medical education workshops for the faculty members and supporting staffs  – Monthly meetings for knowledge management, course evaluation, and course development 
  • 28. Future Challenges  •  •  •  •  •  •  •  •  •    Change agents??  Time constraints (esp. in teaching blocks)  Longitudinal and integrated community clerkship   Shortage of qualified staffs  Urbanized settings  Global health issues  Standardization of courses among schools  Safety issues in the fieldwork  Budget issues for the fieldwork 
  • 29. Q & A  borwornsom.lee@mahidol.ac.th  rassamee.tan@mahidol.ac.th  boonmee.sat@mahidol.ac.th  Pix source: online.wsj.com  http://www.slideshare.net/borwornsom