Clinical Epidemiology and Population Health Curriculum

Clinical Epidemiology and Population Health (CEPH) is one of four core topic areas within the January Essentials of the Profession course, known to students as "Essentials", which also incorporates ethics, social medicine, and health policy content. Our aims are to teach students the specific skills of clinical epidemiology to interpret and apply medical evidence to disease prevention and care for individual patients and populations.

This month-long course fosters the skills and perspectives that students need to:

1. Apply multiple perspectives to understand the social, economic, and political forces that affect both the burden of disease for individuals and populations and the ability of the health system to ameliorate them.
2. Become grounded in the ethical principles that underlie clinical care, research, and professionalism generally with the facility to recognize and analyze ethical issues in practice.
3. Critically evaluate evidence and use it appropriately in clinical decisions and population health management.
4. Understand the health policy context in which they will practice.

The CEPH component focuses on the core skills for interpreting evidence for the treatment of individual patients and an introduction to considering health and health care at the population level. An overarching goal of the longitudinal CEPH curriculum is to make clear that the problems of individual patients and those of populations form a continuum, requiring both coordinated treatment of individuals and population-wide interventions.

We compare the relative benefits and risks of different methods of prevention, diagnosis, and treatment. Studying statistical principles helps students understand how uncertainty affects their interpretation of data and clinical decisions. In addition, we seek to help students gain specific skills that will foster critical thinking including: probabilistic thinking, assessing the evidence for causal connections on the basis of available data, and effective use of (always imperfect) diagnostic test information. These skills are essential for using medical literature to inform patient care and for creating effective population health interventions.

CEPH Essentials I Topics (and associated key concepts documents):

• Study Design and Causality – Critically Appraising What We Think We Know
• Frequency and Association: Calculating Measures of Population Health Impact
• Descriptive Statistics
• Sampling Distribution
• Interpreting Statistics in Clinical Research
• When There are More Than 2 Variables: Bias, Confounding, Effect Modification
• Randomized Controlled Trials and Power
• Multivariable Modeling
• Diagnostic Testing and Screening

For more details, see the full CEPH Essentials I Syllabus

All Pathways students are required to also take the month-long Essentials of the Profession II course in either March or October of their third or fourth year of medical school. CEPH is one of five core topic areas within the “Essentials II” course, which also incorporates content on ethics, social medicine, health policy, and healthcare delivery and leadership. This post-clerkship course builds on experiences in Essentials I and the Principle Clinical Experience (i.e., clerkship) to refine students’ critical thinking skills to:

1. Interpret and critique data from various sources to explore and improve population health problems and employ clinical epidemiology concepts to critically appraise population health research studies.
2. Identify the complex interplay of social and structural forces that affect health and health care to improve clinical care and advance health equity.
3. Assess the health policy context in which our health care system operates and how it informs and impacts clinical practice, while discovering opportunities for innovation and reform.
4. Discuss and appraise the ethical principles that underlie clinical care, research, and professionalism, and apply these principles to ethical issues in practice.
5. Understand, apply, and critique the key tenets of value-based health care and their application to health care organization, delivery, and assessment.

The CEPH component of this course focuses on identifying population health problems using real-world data from various sources and developing evidence-based strategies to improve population health. For the CEPH sessions, students attend interactive lectures on timely population health topics, given by local and national experts, and meet in student-led journal clubs to apply clinical epidemiology concepts from Essentials I to critically appraise population health research studies. Students are also exposed to advanced clinical epidemiological concepts, such as machine learning and quasi-experimental designs. The curriculum focuses on using data to describe inequities in health and finding evidence-based strategies to improve these inequities, in the context of important population health topics such as substance use, police violence, climate change, and COVID-19.