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Prevention

Rationale

One of the most important responsibilities of primary care physicians is to promote health and prevent disease in a cost-effective manner. Appropriate care by internists includes not only recognition and treatment of disease but also the routine incorporation of the principles of preventive health care into clinical practice. All physicians should be familiar with the principles of preventive health care to ensure their patients receive appropriate preventive services.

Prerequisite

Introductory course on fundamental principles of epidemiology and public health.

Specific Learning Objectives

  1. Knowledge: Each student should be able to describe:
    1. primary, secondary, and tertiary prevention.
    2. criteria for determining whether or not a screening test should be incorporated into the periodic health assessment of adults.
    3. general types of preventive health care issues that should be addressed on a routine basis in adult patients (i.e., cancer screening; prevention of infectious diseases, coronary artery disease, osteoporosis, and injuries; and identification of substance abuse).
    4. vaccines that have been recommended for routine use in at least some adults (i.e., influenza, pneumococcal, measles, mumps, rubella, tetanus-diphtheria, hepatitis).
    5. indications for endocarditis prophylaxis.
    6. methods for counseling patients about risk-factor modification.
    7. influence of age and clinical status on approach to prevention.
    8. general categories of high-risk patients in whom routine preventative health care must be modified or enhanced (e.g., family history, travel to an underdeveloped area, etc.).
    9. the major areas of controversy in screening.
  2. Skills: Each student should be able to:
    1. 1. locate recently published recommendations regarding measures that should be incorporated into the periodic health assessment of adults.
    2. identify patients at high risk for developing coronary artery disease and cancer by screening for major risk factors.
    3. obtain a sexual history and counsel patients about safe-sex practices.
    4. obtain and interpret a Pap smear report.
    5. counsel a patient on smoking cessation.
    6. perform a breast exam.
    7. perform a digital rectal exam.
    8. place and interpret a tuberculin skin test (PPD).
  3. Attitudes: Each student should:
    1. address preventive health care issues as a routine part of their assessment of patients.
    2. encourage patients to share responsibility for disease prevention.