TEDx: The Schism Between Medicine and Public Health (~18 minutes)
Choose one question from each of the categories below (5 total questions) and answer them within the course’s Slack channel.
- Why is public health so important to take into account when dealing with the field of medicine?
- What is the main difference between clinical medicine and public health that Remington highlights?
- Why does he describe these fields as being “in a schism”? What examples from the talk illustrate this divide?
- Why does Remington argue that focusing only on individual patients limits our ability to improve health at a population level?
- Can you think of a health issue in your community that requires public health strategies more than just clinical treatment? Explain.
- What are “upstream” factors in health, and how are these different from downstream interventions?
- How might health professionals better balance treating individuals and preventing illnesses in communities?
- Did anything in the talk challenge your assumptions about how health care should work? If so, what?
- What aspects of your own health (or your family’s health) could have been influenced more by upstream public health efforts?
- If you were designing a project to bridge the gap between medicine and public health, what would it focus on? Why?
- What role could you personally play – as a student or future professional – in helping to integrate clinical care and population health?
Themes reflecting the schism
Curriculum overload
Medical curricula are so full that public health content is often siloed or squeezed out.
Lack of educator preparedness
Faculty often feel underqualified to teach public health topics.
Fragmented approaches
Inclusion of SDoH and public health is inconsistent, rarely longitudinal, and often poorly evaluated.
Biomedical model dominance
The legacy of Flexner leads to institutional inertia favoring clinical sciences over public health.
A consistent pattern emerges
Medical schools struggle to integrate public health coherently, often defaulting to superficial, short-term interventions rather than embedding it deeply throughout the curriculum. Progress demands long-term structural reform, not just isolated add-ons.
Moving forward: Suggested reforms
Longitudinal and integrated design
Public health cannot be a one-off lecture. It must be part of the language students speak every day in training.
Public health topics are often treated as “add-ons” or electives, with minimal integration into the core structure of medical education.
- Embed public health principles across existing basic and clinical sciences, not siloed in pre-clinical lectures.
- Link every organ system or clinical block to its population health implications, such as environmental risks for asthma in pulmonology.
- Use case-based learning to highlight upstream causes of illness (e.g., tying hypertension management to food deserts or housing policy).
The University of New Mexico School of Medicine developed a longitudinal curriculum linking SDoH and clinical reasoning throughout all four years, not just pre-clinical phases.
Experiential and community learning
You cannot understand the health of a community from a lecture hall.
Students may memorize SDoH but struggle to apply them meaningfully in patient care or advocacy.
- Require longitudinal service-learning projects with public health agencies, clinics, or advocacy organizations. Involving students in real-world settings for greater impact.
- Incorporate home visits, community assessments, and patient navigation into clerkships.
- Promote interprofessional collaboration with nursing, public health, and social work students/professionals.
The Community Health Immersion Program at Emory University places students in underserved neighborhoods for longitudinal community-based learning tied to health equity metrics.
Faculty development investment
Even the most well-designed curriculum will fail if educators don’t feel confident teaching it.
Many medical school faculty lack training or comfort in teaching public health, especially clinicians who were trained in traditionally biomedical curricula.
- Provide faculty development workshops on SDoH, population health, and public policy.
- Create toolkits with case studies, active learning strategies, and public health data.
- Identify and support public health champions among clinical faculty who can model integration in practice.
The “Teach-In” series at UCSF equips clinical preceptors with strategies to discuss SDoH during ward rounds and case conferences.
Policy and infrastructure support
Reforms in public health education require ecosystem changes beyond just one curriculum.
Many reforms stall because of a lack of institutional and policy support, including funding, time in the curriculum, and clear mandates from accreditation bodies.
- Accreditation organizations (like the LCME or ACGME) should strengthen requirements for public health integration.
- Fund joint MD-MPH pathways or population health tracks with tuition support and protected time.
- Collaborate with public health departments and community-based organizations to co-create and co-lead educational experiences.
After Covid-19, the AAMC and Association of Schools and Programs of Public Health (ASPPH) launched joint initiatives urging medical schools to adopt shared competencies in population health, urging medical educators to design curricula that transcend traditional silos.
- The Evolving Role of Public Health in Medical Education (Frontiers in Public Health, 2020).
- Medical educators’ perspectives on the barriers and enablers of teaching public health in the undergraduate medical schools: a systematic review (PubMed, 2022).
- Effectiveness of alternative approaches to integrating SDoH into medical education: A scoping review (BMC Medical Education, 2023).
- Integrating public and population health into medical education curricula: opportunities and challenges for reform (Academic Medicine, 2023).
- Integrating the social determinants of health into graduate medical education training: A scoping review (BMC Medical Education, 2024).