Clinical Epidemiology and Population Health (CEPH) is a core component of the Harvard Medical School Pathways Curriculum. The clinical Epidemiology and Population Health Curriculum is led by DPM faculty members Laura Garabedian, PhD, MPH, Jason Block, MD, MPH, and Emily Oken, MD, MPH. Many other DPM faculty currently teach CEPH and have taught over the years in current and prior course offerings.
This four-year longitudinal curriculum includes several components:
Pre-Principal Clinical Experience:
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. Essentials, which is a required month-long course taken in the first year of medical/dental school, fosters the skills and perspectives that medical and dental students need to:
- Critically evaluate evidence and use it appropriately in their clinical decisions and population health management;
- 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 it;
- Understand the health policy context in which they will practice; and,
- become grounded in the ethical principles that underline clinical care, research, and professionalism generally, with the facility to recognize and analyze ethical issues in practice.
The CEPH component of Essentials combines teaching of core skills of clinical epidemiology (biostatistics, study design, and critical reasoning) as they apply to the care of individuals and populations with an introduction to key public and population health topics. An overarching goal is to provide students with an appreciation of the health and well-being of individual patients and those of populations as a continuum; and to understand that improving health may involve interventions by clinicians, public health authorities, and other sectors with impact on health. In studying clinical epidemiology, we focus on interpreting and applying evidence about the occurrence and natural history of disease and on comparing the relative benefits and risks of different methods of prevention and treatment. Studying statistical principles helps us to understand how uncertainty affects our interpretation of data and clinical decisions. These skills are essential as consumers of the medical literature for patient care and for creating effective public health policies. We also seek to help students gain specific skills to foster critical thinking. These include probabilistic thinking, assessing the evidence for casual connections on the basis of available data, effective use of (always imperfect) screening and diagnostic information, and understanding cognitive biases that affect reasoning.
Additional CEPH sessions are integrated within other courses throughout the first year. Sessions co-taught with clinical experts are focused on the application of evidence to inform physical examination and diagnosis. Other sessions, co-developed and taught with medical librarians, guide students in how to find, appraise and apply evidence in practice.
Post-Principal Clinical Experience:
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. This course, which again includes Clinical Epidemiology and Population Health as well as Ethics, Health Policy, and Social Medicine content, helps students refine their skills and perspectives to:
- 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;
- Identify the complex interplay of social and structural forces that affect health and health care to improve clinical care and advance health equity;
- 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;
- Discuss and appraise the ethical principles that underline care, research, and professionalism, and apply these principles to ethical issues in practice.
Weekly cross-disciplinary themes focus on:
- Making Things Better Within Health Care Institutions
- When Things Go Wrong
- Mental Health and the Opioid Epidemic
- Making Things Better at the Scale of Population Health.
The course also includes a novel collaboration with Harvard Business School (HBS). HBS faculty lead discussions of HBS cases to teach principles of value-based health care. The CEPH component of the Essentials II 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 to critically appraise population health research studies. Covered population health topics include: preventing nosocomial infections in health care institutions disease surveillance using electronic health record and health insurance claims data, and the impact of climate change on health and health care.
All of the Clinical Epidemiology and Population Health sessions incorporate components of case-based collaborative learning, a new pedagogical approach designed and adopted by HMS faculty to teach medical and dental students to think critically, apply basic concepts and work in teams.