title: Integration of community health teaching in the undergraduate medicine curriculum at the University of Toronto.
abstract: BACKGROUND
  In 1999, Determinants of Community Health was introduced at the Faculty of Medicine, University of Toronto. The course spanned all 4 years of the undergraduate curriculum and focused on addressing individual patient and community needs, prevention and population health, and diverse learning contexts.
  
  
  OBJECTIVE
  To demonstrate the value of an integrated, longitudinal approach to the efficiency of delivering a public health curriculum.
  
  
  METHODS
  Time-series comparing the curricular change over two periods of time.
  
  
  METHODS
  Undergraduate medical students from 1993 to 2009.
  
  
  METHODS
  Using a spiral curriculum, the educational materials are integrated across all 4 years, based on the concept of medical decision making in a community context.
  
  
  METHODS
  This study compares measures of student satisfaction and national rankings of the University of Toronto with the other 16 Canadian medical schools for the "Population Health, Ethical, Legal, and Organizational aspects of the practice of medicine" component of the Medical Council of Canada Qualifying Examination Part 1.
  
  
  RESULTS
  The University of Toronto has been ranked either first or second place nationally, in comparison to lower rankings in previous years (p<0.02 on the Kruskal-Wallis test). Student ratings indicated the course was comparable to others in the curriculum.
  
  
  CONCLUSIONS
  For the same amount of curricular time, an integrated spiral curriculum for teaching public health appears to be more effective than traditional approaches.
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. ian.johnson@oahpp.ca
authors.forename: Ian L
authors.initials: IL
authors.lastname: Johnson
authors.forename: Fran E
authors.initials: FE
authors.lastname: Scott
authors.forename: Niall P
authors.initials: NP
authors.lastname: Byrne
authors.forename: Katherine A
authors.initials: KA
authors.lastname: MacRury
authors.forename: Jay
authors.initials: J
authors.lastname: Rosenfield
mesh_terms: D002170:Canada; D003153:Community Health Services / Q000458:organization & administration*; D003479:Curriculum / Q000639:trends; D003657:Decision Making; D004504:Education, Medical, Undergraduate / Q000458:organization & administration* / Q000639:trends; D006801:Humans; D009864:Ontario; D011634:Public Health / Q000193:education*; D013337:Students, Medical / Q000523:psychology / Q000706:statistics & numerical data; D013997:Time Factors