What is the value of a Master’s in Public Health during medical school? How do we balance our need for physicians with physicians’ training needs?
Creators: name: Smiley, Sarah
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2014

description: Objective: The purpose of this study is to understand the reasons medical students chose to take a leave-of-absence (LoA) during medical school to pursue a Master's in Public Health (MPH) and its perceived value. Our overarching purpose in investigating this topic is to be able to shed light on whether delaying medical school graduation to pursue other areas of study is creating physicians that feel more capable upon graduation to deliver quality health care to populations or whether it is simply keeping valuable members of society out of the workforce for an extra year. Methods: A longitudinal, web-based panel survey administered through Qualtrics was distributed to UNC-CH medical students, including LoA students. The survey included both quantitative and qualitative questions. Results were analyzed according to class and LoA status using Fisher's exact, chi-squared, and one-way ANOVA tests of association. Results: Students who have already earned or are planning to pursue an MPH indicated a variety of motivating factors and interests. All of them cited an interest in health disparities, health policy, and health care systems to be driving factors in their decision to pursue a MPH. MD-MPH students also were more likely than were their peers to indicate a community health center or local health department as potential places of future employment (Relative Risk (RR) =2, p=0.017; RR=3.75, p=0.041). They were also less likely to choose medium-sized private practice (RR=0.5, p=0.033). Students planning to earn or who have completed a MPH in medical school also indicated that they intend to spend a greater amount, an average of 5%, of their professional time in the future on policy-making or advocacy than their peers (p=0.0137). All students who took a LoA said they were glad they had done so and that they had developed more critical thinking skills, perspective on physicians' roles, interpersonal communication skills, and analytical skills than initially expected. Significance: Physicians are increasingly becoming responsible for leading health care delivery teams towards the "Triple Aim: improving the individual experience of care; improving the health of populations; and reducing the per capita costs of care for populations" (Berwick, Nolan, & Whittington, 2008). With the introduction of new care delivery and payment models, physicians are required to work more fluidly within multidisciplinary teams, use electronic health records for care coordination and performance measures, and interpret available evidence to make clinically and economically sound decisions in order to best serve patients and payers (Burrow, 2011; Pershing & Fuchs, 2013; Sava, Armitage, & Kaufman, 2013). While the role of physicians is changing, both the predicted physician shortage and rising price of education are also driving many to re-evaluate how physicians are trained and look for waste that can be cut (Emanuel & Fuchs, 2012). Estimates of physician shortages predict an additional 45-42 thousand primary care physicians needed by 2020-2025 and an additional 46,000 specialists needed by 2020 (Kirch, Henderson, & Dill, 2012; Petterson, Liaw, Phillips, et al, 2012). This imminent rise in demand for health care professionals demands that medical schools examine the value of the training that their students are receiving to ensure high-value experiences that will produce the best workforce for the future. The perceived value students surveyed in this study reported about their experiences and knowledge gains from their MPH studies suggest there is a potentially important role for incorporation of certain content from public health study into undergraduate medical curriculums.