The View from Canada: A New Collaboration between U.S. Preventive Medicine Residents and Canadian Community Medicine Residents
by Lawrence Loh, External Officer, NSSCM Resident Council and Co-Chief Resident of Community Medicine, University of Toronto
Community Medicine is the equivalent specialty in Canada to Preventive Medicine in the United States. In Canada, there are thirteen Community Medicine residency programs country-wide, training one hundred and thirty one residents. Training is five years in length. At a minimum, residents complete at least one year of clinical training, twelve to eighteen months of graduate training, and one year of practicum rotations in community medicine.
Unlike the U.S., clinical training is incorporated into Community Medicine programs in Canada; as such, most residents complete the two years of clinical training required for family medicine certification, and become dual certified in both family and community medicine. Together with graduate work leading to a Masters in Public Health, graduates enjoy flexibility to pursue both clinical and public health practice opportunities.
There are around five hundred Community Medicine physician specialists in Canada. They are represented by the National Specialty Society for Community Medicine (NSSCM), who advocates on their behalf. One notable issue taken up this past summer was a specialty name change; members of the NSSCM voted overwhelmingly to change the name of the specialty to Public Health and Preventive Medicine. Reasons for the change included the elimination of ambiguity with community-based internal medicine physicians, and to ensure the name reflects the specialty's purpose. The change would become official once reviewed by the national specialty accreditation body, the Royal College of Physicians and Surgeons of Canada.
A new collaboration has formed between the Resident Physician Section of the ACPM and the Resident Council of the NSSCM in Canada. In our interconnected world, the hope is that communication between members of the two organizations will afford opportunities for knowledge exchange, collaboration, and joint advocacy.
One of the first tangible aspects of collaboration is this column in the ACPM resident section newsletter, which will provide insights into public health and preventive medicine from a Canadian perspective. The ACPM is reciprocating by providing insight articles in the NSSCM's own publication. Future collaborations will be discussed at each society's respective national meetings, with some Canadian residents making plans to attend the Preventive Medicine 2011 conference in February. The NSSCM also hosts a conference in June, which will be held in Montreal; watch this space for further announcements.
For more information on Community Medicine and on the NSSCM, please visit:
Healthy People 2020 LaunchedBy Charlie Preston
On December 2, 2010, the Obama Administration unveiled the latest version of its national blueprint for prevention, Healthy People 2020. Begun in 1979, Healthy People sets national public health objectives and monitors progress towards achieving them. It is divided into topic areas like diabetes and environmental health. Within each topic area, it is further divided into objectives like reducing the rate of diabetic amputations by 10%. Each objective must have a data source so that progress towards it can be tracked.
Healthy People 2020 is improved over 2010. It reaffirms the two overarching goals from Healthy People 2010 (to live long healthy lives and to achieve the best possible health and health care for all) and adds two more: promoting health across life stages; and creating social and physical environments that promote good health. Further, it includes new topic areas like preparedness and dementia. It is also the product of the most extensive stakeholder feedback process in its history-- in addition to input from a federal advisory group of experts and a federal interagency working group, there were more than 8,000 comments considered in its drafting.
Healthy People has seen a number of successes over the last decade. Overall, it made progress towards or met 70% of its objectives. The death rate from coronary heart disease dropped well below the target of 162 deaths per 100,000 population - to 135 per 100,000 in 2007. Immunization rates among children 19-35 months old improved significantly, from 73% a decade ago to 81% in 2006, with great progress made in shrinking racial and ethnic disparities.
Yet some Healthy People objectives continue to be a challenge. The rate of cigarette smoking among adults 18 years of age or older remains well above the 2010 target of 12%-- it was at 21% in 2008. And over the last 20 years, obesity rates increased significantly, which has helped drive the cases of diabetes to 59 per 1000 population in 2008, far above the target of 25 cases per 1000. For more information, go to: http://www.healthypeople.gov/2020/default.aspx.
Lung Cancer Screening with Spiral CT May Reduce Mortality
by Jordana Rothschild
On November 4, the National Cancer Institute released preliminary results from National Lung Screening Trial (NLST) indicating a 20.3% reduction in lung cancer among smokers who underwent low dose helical CT screening. Although there has been great enthusiasm in the past over low dose CT as a lung cancer screening tool, no study to date has successfully demonstrated a decrease in mortality as a result of screening. Survival studies have been complicated due to the well-known biases of lead-time, length, and overdiagnosis. The NLST aims to overcome these difficulties with its large, randomized study whose primary endpoint is lung cancer mortality.
The trial, which began enrollment in 2002, randomized over 53,000 people with a smoking history of at least 30 pack-years to undergo baseline and 2 annual screenings either with low dose CT or with chest radiography. Participants were then followed for an additional 5 years, and deaths from lung cancer as well as other causes were recorded. As of October 2010, a total of 354 deaths from lung cancer had occurred among participants in the CT arm of the study, whereas 442 lung cancer deaths had occurred among those in the chest X-ray group. This 20.3% difference in mortality prompted the investigators to end the study and publish the preliminary data.
Further analysis has yet to be completed, and a full publication of the study, including many secondary endpoints, is expected in the next few months.
For more information, visit:
Extended ACGME Guideline Analysis
by Samuel Peik
As reported last month, the Accreditation Council for Graduate Medical Education (ACGME) has released its final Program Requirements for Graduate Medical Education in Preventive Medicine.This month we will provide a more in-depth review of the requirements, highlighting some of the most important parts and changes that residents should be aware of.The requirements will take effect July 1, 2011.
Education & Certification
- Funds for least one national professional meeting
- Regularly scheduled didactic sessions
- MPH or equivalent degree, including core PM coursework
- Additional advanced graduate level coursework in specific additional areas (determined by specialty i.e. PH/GPM, OM, AM)
- 50% of residents must take the ABPM exam
- 75% of a program's graduates over last five years must pass exam on first try
Patient Care & Rotations
- 12 months of clinical training during internship (11 must be direct patient care)
- 24 months minimum of PM-specific training after internship
- Progressive responsibility for direct patient care and health management
- Direct patient care requirements
- PH/GPM: 2 months each year
- OM: 4 months each year
- AM: 4 months each year
- Additional PH/GPM requirements
- Minimum of 2 months total at a governmental public health agency
- Clinical experiences incorporating USPSTF recommendations
- Resident Learning Portfolio to demonstrate competencies
All other common program requirements for all specialties also apply.The impact and interpretation of all of these requirements are sure to be discussed in much further detail.Of note, it will be important to see what the definition of "direct patient care" exactly entails, and how much needs to be done to constitute a month.
To view the full requirements visit the ACGME website at http://www.acgme.org/acWebsite/RRC_380/380_prIndex.asp.
ACPM Sections Produce AMSA Webinar
by Samuel Peik
On November 5th, a webinar featuring ACPM Past President Mike Parkinson was broadcast as part of AMSA's National Primary Care Week.This webinar helped to put Preventive Medicine into the scope of the broader practice of medicine and healthcare reform and Dr. Parkinson had some great advice and information to share.This webinar was a joint venture of the MSS, RPS, and YPS, and marks a successful collaboration across sections and with other organizations.While the focus of the presentation was getting medical students interested in the specialty, all residents can gain something from participating in this.The webinar is available for download athttp://www.acpm.org/MSS-webinars.htm.
RPS President Wins Annual Resident Award
by Charlie Preston
This past week, Samuel Peik, president of the Resident Physician Section, won the 2011 ACPM Don Gemson Resident Award-- the highest honor the ACPM bestows on a preventive medicine resident. Given to "acknowledge accomplishments as a resident and contributions to ACPM", Dr. Peik is credited by many within ACPM for revitalizing the RPS through new advocacy and outreach efforts, a monthly newsletter, and cross-border collaboration with Canadian preventive medicine residents. The award will be presented at the ACPM Awards/New Fellows Banquet on Saturday, February 19, 2011.
Prevention Spotlightby Samuel Peik
This section provides a brief overview of current clinical preventive recommendations, including the United States Preventive Services Task Force (USPSTF) as well as other pertinent national organizations.This month's topic is on aspirin use for primary prevention.
To prevent colorectal cancer (released March 2007)
To prevent cardiovascular disease (released March 2009)
- A (strongly recommend) for men age 45-79 for MI\
- A (strongly recommend) for women age 55-70 for stroke
- I (insufficient evidence) for 80+ years
- D (recommend against) for women <55 and men <45
*Low doses is as effective as high dose for prevention
*Benefits must always outweigh risk of gastrointestinal bleeding
American Diabetes Association (ADA), American Heart Association (AHA), American College of Cardiology Foundation (ACCF) Joint Recommendation
- Aspirin recommended for diabetics at increased CV risk
- Men >50 and women >60 with at least one additional risk factor
- Released May 2010
- Separate recommendations exist for secondary prevention
For more on the USPSTF recommendations, visit their website at http://www.uspreventiveservicestaskforce.org/.