Our data suggest that at least 14 schools did not have an existing PHIG prior to the availability of AFMC coordination and PHAC funding. Most schools continued to operate their PHIGs, once they were created, using AFMC funding. Two schools continued to participate in AFMC-supported PHIG activities throughout the year without requiring AFMC funding. A total of 16 out of 17 Canadian medical schools had established PHIGs in the last school year studied.
Description of PHIGs’ structures and activities
The total number of PHIG members ranged from 3 to 100 (median = 33) per school. On the basis of the reports we analyzed, we determined that, for the majority of PHIGs, both the membership and leadership consist of undergraduate medical students. The leadership structure of PHIGs generally consists of a small group of individuals who share the tasks and responsibilities necessary to organize events.
PHIG activities and budgeting.
We defined an activity loosely, and we included a range of “activities” from a single event conducted at a point in time (e.g., a lecture) to an ongoing project, including many steps or events, that was completed over a period of time (e.g., creation and maintenance of a mentor list). Table 1 conveys the types of activities conducted by all PHIGs combined across all four years. Academic activities such as lectures, seminars, and workshops were by far the most common (total count = 100), followed by career exploration and networking events featuring public health physicians (total count = 38). Other frequently conducted activities included public awareness campaigns related to infectious diseases and global health issues (total count = 34). Some PHIGs also conducted academic support activities, such as providing grant funding to enroll in a public health and preventive medicine elective, organizing a conference on infectious diseases, or providing financial support to be able to attend a graduate student public health conference held by other organizations (total count = 12). Approximately half (51.9%, n = 109/210) of the total number of activities organized by PHIGs across all schools over all four years, according to the documents submitted, entailed interprofessional participation.
The most common challenge noted in PHIG reports was low attendance at sponsored events. The major reasons for low attendance related to logistical issues, such as scheduling meetings and events that work well for PHIG members, speakers, and the student body (total count = 43).
Some of the strengths that PHIG reports frequently mentioned included having engaging speakers at events (total count = 6) and developing strong networks with other student groups, faculty, and public health organizations (total count = 20).
The most commonly allocated budget items were office supplies, such as photocopying and printing materials (total count = 79), followed by food and refreshments for events (total count = 48).
PHIG strategies for recruitment and sustainability.
Recruitment strategies are important to start and maintain PHIGs in medical schools. The two most commonly cited recruitment methods were (1) networking and/or collaborating with other medical student and public health groups (total count = 38) and (2) networking with faculty members and residents (total count = 30). Other common advertising techniques included e-mailing announcements to the student body (total count = 10) and displaying posters on campus to promote events (total count = 7).
A common strategy for PHIG sustainability was a focus on recruitment of PHIG members. The most commonly described strategies included creating and maintaining a plan of executive transition (total count = 34) and securing funds (total count = 29). Executive transition often consisted of, first, the membership electing an executive team for the following academic year and, then, the outgoing executive team training the incoming executive team. Specific examples of securing funds include applying for additional funding from a school’s medical student society and, simply, conducting fundraising activities (e.g., bake sales).
Although PHIGs are targeted toward medical faculties and, as mentioned, the membership of the majority of PHIGs comprised medical students, some schools appeared to have established highly interdisciplinary PHIGs. For example, graduate students in public health led one PHIG, and other executive teams included PHIG members from health disciplines outside of medicine.
PHIGs and the AFMC objectives
Through our analysis, we were able to assign the reported PHIG activities to the four objectives that constitute the AFMC’s stated overall purpose for PHIGs, and in so doing, we determined that the groups were actually accomplishing the goals the AFMC intended for them
1. To provide students with information about the importance of incorporating population and public health concepts into all areas of practice. The majority of activities (84.7%, n = 178) held by PHIGs incorporated public health themes. For example, information nights were common; these often included presentations by public health physicians and/or lectures on population health concepts. Some PHIGs organized practice-based sessions such as skills nights, during which physicians led workshops on counseling patients on healthy lifestyles. We determined that, through the breadth of their activities, PHIGs met the AFMC objective of conveying to students the importance of integrating public health concepts into medical practice; however, it is important to note that, given the extracurricular nature of these events, this increased exposure to public health may be limited to those students with a preexisting interest in population and public health who are more likely to attend PHIG events.
2. To expose students both to community activities that demonstrate population and public health concepts and to professionals in the field of public health. PHIGs at all schools held at least one lecture by an individual or individuals who had made public health their career, and most PHIGs held networking events featuring public health physicians. As well, the PHIG of at least one school started a formal mentorship program whereby students were paired with a public health physician mentor. Again, we determined that through the breadth of their activities, PHIGs met the AFMC objective of exposing students to public health through both practitioners and community activities; however, as with objective 1, this exposure is limited to those who take advantage of the offerings.
3. To provide an opportunity for students to learn, to network, and to develop leadership skills. As mentioned, the most common PHIG activities (n = 100) were academic and provided learning opportunities for students. These included interprofessional events, which increased the opportunity for student networking. The development of leadership skills was limited to executive committee members who were involved in planning activities and setting the annual budget. We determined that by fostering the development of PHIGs, AFMC has supported learning, networking, and skills development among students.
4. To provide an opportunity for students to explore public health and preventive medicine as a career option. Career exploration initiatives, such as observerships and the development of mentor lists, were the second most common type of activity (n = 38) coordinated by the PHIGs. Furthermore, through their participation in various activities, particularly lectures by public health physicians, students were exposed to public health and preventive medicine as a career option; thus, we have concluded that this objective was met.
Findings and implications
We are encouraged by our finding that all 17 Canadian medical schools had at least one established PHIG between 2007–2008 and 2010–2011, which suggests that Canadian medical students are interested in public health. Furthermore, as illustrated by Figures 1 and 2, the increasing trend in the number of PHIGs per year and the finding that a majority of schools have applied for funding for all four years together suggest that an increasing number of schools are establishing PHIGs and that, once established, the PHIGs remain active. AFMC coordination increased medical student involvement in at least 14 schools. Our findings indicate that the oversight provided by AFMC, along with the funding offered by PHAC to PHIGs, is associated with increased medical student involvement in public health initiatives and awareness-raising activities. Further, the inclusion of members of other disciplines in PHIG initiatives is consistent with the vision AFMC set out for the groups and may lead to improved interdisciplinary understanding and relationships between medical students and other health professionals.
However, not all schools have been able to sustain PHIGs in every academic year, which may be due to lack of new leadership or competing priorities.20 This lack of continuity may also reflect differences in public health interest levels among medical student cohorts. The PHIGs at schools with several campuses faced challenges in recruiting enough representatives to cover all campuses. As more medical schools establish remote campuses in the future, this may continue to be a challenge.
This study, describing the purpose, structure, and activities of PHIGs in Canadian medical schools, may be informative to leaders of other institutions who may be interested in initiating similar groups.
Limitations and future research
However, many questions are left unanswered. Because of the limitations of our data source (i.e., PHIG documents submitted by PHIG executives), the extent of faculty involvement in each PHIG and how faculty may have influenced the nature or success of the activities is unknown. Faculty engagement may be an important factor in creating interest in a PHIG, especially given previous research indicating that the lack of effective public health role models in medical schools is a barrier to promoting interest in public health.12
Discrepancies in the way the schools reported results also added to the difficulties interpreting the data. The funding applications, interim reports, and annual reports that we analyzed did not include standard categories (i.e., specific reporting requirements) for counting members, describing activities, or accounting for budgetary elements, which resulted in significant variations in reporting. For example, we had difficulty assessing the number of PHIG members because some PHIGs counted only executive members whereas other PHIGs counted all individuals attending their events.
Last, although we were able both to assign the groups’ reported activities to one or more of the AFMC’s stated PHIG objectives and to conclude that the groups were meeting their objectives, we recognize that this was not an evaluative study. Carefully designed evaluations examining the impact of PHIGs on medical students’ knowledge, skills, attitudes, and behaviors relating to public health—as well as their impact of on career choice—would add to the literature on PHIGs.
We report the first descriptive study on undergraduate medical PHIGs in Canada. We found that PHIGs are important student-led initiatives that increase medical student awareness about public health and promote interprofessional collaboration. We also determined that, on the basis of the reported activities of PHIGs, this initiative has met its objectives by fostering students’ extracurricular involvement related to public health and preventive medicine, including the opportunity to explore this area as a career option, in all medical schools across Canada. PHIGs may also be an effective method of increasing public health interest amongst undergraduate medical students in other countries.
Other disclosures: J.J. and J.A. have both been past members of the Association of Faculties of Medicine of Canada (AFMC)-funded public health interest group at the University of Toronto. B.S. and M.S. are employees of the AFMC. I.J. and D.D. are, respectively, previous and current members of the Public Health Educators Network.
Ethical approval: Formal ethical approval was not sought for this program evaluation activity because this documentary analysis falls under article 2.5 of the Tri-Council Policy Statement and therefore does not require approval.21 No identifying information is included in this article.
1. Régo PM, Dick ML. Teaching and learning population and preventive health: Challenges for modern medical curricula. Med Educ. 2005;39:202–213
2. Gillam S, Bagade A. Undergraduate public health education in UK medical schools—Struggling to deliver. Med Educ. 2006;40:430–436
3. Tyler IV, Hau M, Buxton JA, et al. Canadian medical students’ perceptions of public health education in the undergraduate medical curriculum. Acad Med. 2009;84:1307–1312
4. Hau MM, Tyler IV, Buxton JA, et al. Assessing Canadian medical students’ familiarity with and interest in pursuing a career in community medicine. Can J Public Health. 2009;100:194–198
5. Maeshiro R, Johnson I, Koo D, et al. Medical education for a healthier population: Reflections on the Flexner Report from a public health perspective. Acad Med. 2010;85:211–219
6. Levy BS, Wegman DH. Commentary: Public health and preventive medicine: Proposing a transformed context for medical education and medical care. Acad Med. 2012;87:837–839
7. Buffington J, Bellamy PR, Dannenberg AL. An elective rotation in applied epidemiology with the Centers for Disease Control and Prevention (CDC), 1975–1997. Am J Prev Med. 1999;16:335–340
8. Nguyen-Van-Tam JS, Logan RF, Logan SA, Mindell JS. What happens to medical students who complete an honours year in public health and epidemiology? Med Educ. 2001;35:134–136
9. Schapiro R, Stickford-Becker AE, Foertsch JA, Remington PL, Seibert CS. Integrative cases for preclinical medical students: Connecting clinical, basic science, and public health approaches. Am J Prev Med. 2011;41(4 suppl 3):S187–S192
12. Johnson I, Donovan D, Parboosingh J. Steps to improve the teaching of public health to undergraduate medical students in Canada. Acad Med. 2008;83:414–418
13. Association of Faculties of Medicine of Canada. . Medical Education: Public Health. http://http://www.afmc.ca
/social-public-health-e.php. Accessed March 20, 2013
14. Kerr JR, Seaton MB, Zimcik H, McCabe J, Feldman K. The impact of interest: How do family medicine interest groups influence medical students? Can Fam Physician. 2008;54:78–79
15. Harris DL, Coleman M, Mallea M. Impact of participation in a family practice track program on student career decisions. J Med Educ. 1982;57:609–614
16. Cadesky E. One year later. Starting a family medicine student interest group. Can Fam Physician. 2005;51:918–921
17. McKee ND, McKague MA, Ramsden VR, Poole RE. Cultivating interest in family medicine: Family medicine interest group reaches undergraduate medical students. Can Fam Physician. 2007;53:661–665
18. Wilkinson JE, Hoffman M, Pierce E, Wiecha J. FaMeS: An innovative pipeline program to foster student interest in family medicine. Fam Med. 2010;42:28–34
19. Dorrance KA, Denton GD, Proemba J, et al. An internal medicine interest group research program can improve scholarly productivity of medical students and foster mentoring relationships with internists. Teach Learn Med. 2008;20:163–167
20. Melissa Shahin. Project associate, Association of Faculties of Medicine of Canada. Personal communication with M. Hau, November 2, 2011.
© 2013 by the Association of American Medical Colleges
21. Canadian Institutes of Health Research; Natural Sciences and Engineering Research Council of Canada; Social Sciences and Humanities Research Council of Canada. . Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. http://http://www.pre.ethics.gc.ca
/pdf/eng/tcps2/TCPS_2_FINAL_Web.pdf. Accessed March 20, 2013