• Ian L Johnson, Fran E Scott, Niall P Byrne, Katherine A MacRury, and Jay Rosenfield.
• Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. ian.johnson@oahpp.ca
• Am J Prev Med. 2011 Oct 1; 41 (4 Suppl 3): S176-80.

BackgroundIn 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.PurposeTo demonstrate the value of an integrated, longitudinal approach to the efficiency of delivering a public health curriculum.DesignTime-series comparing the curricular change over two periods of time.Setting/ParticipantsUndergraduate medical students from 1993 to 2009.InterventionUsing a spiral curriculum, the educational materials are integrated across all 4 years, based on the concept of medical decision making in a community context.Main Outcome MeasuresThis 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.ResultsThe 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.ConclusionsFor the same amount of curricular time, an integrated spiral curriculum for teaching public health appears to be more effective than traditional approaches.Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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