Over the conceptual horizon of public health : a living theory of teaching undergraduate medical students

Abstract

The health needs of society extend beyond the treatment of the individual and the ill. These needs are at the core of public health which addresses health at a population-level. Regulations dictate that public health must be included in the South African medical curriculum, but healthy populations hold little interest for medical students. As a result public health remains over the conceptual horizon of medical students. At the University of Pretoria the responsibility for the inclusion of public health is the responsibility of the School of Health Systems and Public Health. Participation in the medical curriculum is a minor but important part of my educational practice. But two of my professional values – care and agency – have been denied in that practice. The central purpose of the research was to construct the meaning of my educational practice with the aim of progressive realisation of my values. The study explored how public health is conceptualised as a subject in the medical curriculum at the University of Pretoria, the intended educational achievements of public health in the curriculum and the optimal strategies for its inclusion. An action research living theory design made use of a concurrent embedded mixed-methods approach. Data was gathered primarily from external experts, the academic staff of the School of Medicine and the SHSPH, key academic documents and the medical students. A constructivist grounded theory approach was employed to construct meaning from the findings. The findings revealed the effect of the historical decision to split public health and medicine and the resulting increasing distance between the disciplines. Resting on this fractured foundation is the understanding of what public health is. The understanding of public health suggests a multiple concurrent understanding that is constructed by diverse and seemingly conflicting perspectives while the discipline remains identifiable as public health. The curricular intentions of including public health in the medical curriculum at the University of Pretoria are characterised by a varied topography that includes externally and internally imposed educational tensions, constraints and intractable contradictions. Curricular intentions revolve around ontological aspirations. The medical students’ perspectives of their educational experience in public health are surprisingly similar to those of students in other countries. The current and imagined strategies to include public health formed the basis for the scepticism of educational orthodoxy and suggested the exploration of the dual uncontested spaces – social media and the elective experience in the medical curriculum. The findings from my innovative practice in using the elective experience challenge the notion that public health is over the conceptual horizon of medical students. A theme that runs through the narrative suggests, instead, that other conceptual horizons obscure meaningful engagement with medical students around public health. This research is a rich account of my complex context and my connected practice and through action research I claim to live my values of care and agency. My living theory of practice as a form of meaning making could help others to look over their own conceptual horizons in search of wholeness.