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Cover page of the Journal of Health Sciences


 
 Table of Contents  
REVIEW ARTICLE
Year : 2022  |  Volume : 15  |  Issue : 3  |  Page : 211-213

Incorporating One Health competencies into the medical curriculum: Need of the hour


1 Deputy Director – Academics, Sri Balaji Vidyapeeth – Deemed to be University, Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

Date of Submission15-May-2022
Date of Acceptance04-Jul-2022
Date of Web Publication17-Sep-2022

Correspondence Address:
Dr. Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_406_22

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  Abstract 


The manner in which a doctor approach patient care significantly depends on the way in which they were trained during their undergraduation period. The purpose of the current review is to explore the necessity to incorporate One Health competencies in the medical curriculum and devise a framework for the same. An extensive search of all materials related to the topic was carried out on the PubMed search engine and a total of 14 articles were selected based on their suitability with the current review objectives. Keywords used in the search include One Health and medical education in the title alone only. The analysis of the major outbreaks of infectious diseases in the last couple of decades has shown an association with environmental changes. The presence of all these factors has compelled the international welfare agencies and public health authorities to adopt a One Health approach in medical curriculum to integrate humans, animals, and the ecosystem for the containment of these infectious diseases. To ensure that the current crop of medical students who will be joining the health workforce on completion of their training should be trained in different aspects of one health during their undergraduation period. In conclusion, the training of medical students on the One Health approach is an essential aspect of medical training considering the trends of outbreaks of infectious disease outbreaks. It is high time to acknowledge the need and prepare medical students to work as effective members of the interprofessional team and accordingly incorporate One Health competencies into the medical curriculum.

Keywords: Infectious diseases, medical education, One Health


How to cite this article:
Shrivastava SR, Shrivastava PS. Incorporating One Health competencies into the medical curriculum: Need of the hour. Indian J Health Sci Biomed Res 2022;15:211-3

How to cite this URL:
Shrivastava SR, Shrivastava PS. Incorporating One Health competencies into the medical curriculum: Need of the hour. Indian J Health Sci Biomed Res [serial online] 2022 [cited 2022 Sep 25];15:211-3. Available from: https://www.ijournalhs.org/text.asp?2022/15/3/211/356282




  Introduction Top


The manner in which a doctor approach patient care significantly depends on the way in which they were trained during their undergraduation period.[1] It is quite obvious and practical that as medical educators, we should adopt a flexible and need-driven approach to medical curriculum delivery, especially considering that there has been a remarkable change in the trends and patterns of the diseases that have been reported worldwide.[1] The need for curricular reforms is further strengthened owing to globalization, population mobility, escalation in agricultural activities, population growth, climate change, etc., which tend to cast a major threat not only to the environment, but also to health standards at individual, family, and community level.[2] The purpose of the current review is to explore the necessity to incorporate the One Health competencies in the medical curriculum and devise a framework for the same.


  Methods Top


An extensive search of all materials related to the topic was carried out on the PubMed search engine. Relevant research articles focusing on the One Health approach in medical education published in the period 2005–2021 were included in the review. A total of 17 studies similar to the current study objectives were identified initially, of which three were excluded due to the unavailability of the complete version of the articles. Overall, 14 articles were selected based on their suitability with the current review objectives and analyzed. Keywords used in the search include One Health and medical education in the title alone only (namely, One Health [ti] AND medical education [ti]; One Health [ti] AND medical curriculum [ti]; veterinary [ti] AND medical [ti]; One Health [ti]). The articles published in only the English language were included in the review [Figure 1]. The collected information is presented under the following subheadings, namely infectious diseases and One Health, necessity to effectively contain future outbreaks and pandemics, medical education and One Health, One Health competencies in the medical curriculum, and medical curriculum targeting One Health.
Figure 1: Flowchart for selection of research articles

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  Infectious Diseases and One Health Top


The analysis of the major outbreaks of infectious diseases in the last couple of decades has shown an association with environmental changes.[2] At the same time, most of the infectious disease outbreaks reported among humans are found to be zoonotic (diseases that are transmitted between humans and animals in either direction) origin, and these numbers continue to increase.[2],[3] The common such outbreaks or pandemics of zoonotic origin include severe acute respiratory syndrome, avian influenza, H1N1 influenza pandemic, Middle East Respiratory Syndrome, Ebola virus disease, etc.[2],[4] Even the ongoing coronavirus disease-2019 pandemic has been traced back to being originated from bats and then undergoing mutations with the help of an intermediate host and then only being transmitted to humans.[4]

Further, environmental alterations have also been linked with different forms of malnutrition and deterioration in the quality of air, water, and soil.[4] At the same time, we cannot ignore the emergence of antimicrobial resistance which has been linked to the indiscriminate and irrational use of antibiotics among animals, and the same has been subsequently reported among humans.[5] The presence of all these factors has compelled the international welfare agencies and public health authorities to adopt a One Health approach, which looks at the interplay of all these factors and thereby develops a comprehensive and systematic approach to integrating humans, animals, and the ecosystem for the containment of these infectious diseases.[4],[5],[6]


  Necessity to Effectively Contain Future Outbreaks and Pandemics Top


The findings of a study reported that the practicing health-care professionals had minimal awareness of the role of environmental factors in the causation of medical problems and the strategies that can be adopted for the prevention and management of infectious diseases.[3] However, realizing the rising frequency of outbreaks of infectious diseases of zoonotic origin makes it crucial for medical education to train and prepare future doctors to effectively respond to novel infectious diseases in the future.[1],[2],[4] There is an immense need to eliminate the existing compartmentalization between different streams (namely, human medicine, environmental health, veterinary, public health, social science, etc.), and work in collaboration.[7],[8] In other words, we have to adopt a transdisciplinary One Health approach to ensure the rapid containment of the infection, and this will essentially require the active involvement of physicians.[6],[7],[8]


  Medical Education and One Health Top


It will not be wrong to state that in comparison to the veterinary schools which have integrated One Health in their curriculum, not much has been done in medical schools.[7],[8] To ensure that the current crop of medical students who will be joining the health workforce on completion of their training should be trained in different aspects of One Health during their undergraduation period.[6],[8] The imparted training is expected to make them active and contributing members of the interdisciplinary team, and will also enhance their potential in responding to other public health concerns (such as antimicrobial resistance and climate change).[2],[5],[7] In an attempt to expedite the developments, the formulation of the One Health curriculum and committees has been advocated.[9],[10]


  One Health Competencies in the Medical Curriculum Top


On justifying the need to train medical students in different aspects of One Health and to become active members of the interdisciplinary team, the next priority is to design an appropriate curriculum.[11] However, considering the limited duration of the training period, it is always wise to design One Health competencies that can be integrated into the existing curriculum without stretching the duration of the course further.[8] The competencies in the cognitive domain can cover zoonotic diseases, vector-borne diseases, human–animal relationships, the role of animals in the causation of human infections, ecosystem and health, food chain and its significance in maintenance of health or diseases, environment attributes and health, common grounds wherein human medicine and veterinary medicine can work together, etc.[6],[12],[13]

With reference to the psychomotor domain, the core competencies in the curriculum should include training medical students to elicit an appropriate history of human, animal, and environmental interactions.[12] In addition, the students should be trained to diagnose and treat zoonotic diseases promptly and in a cost-effective manner.[13] Considering that prevention is better than cure, medical students should be exposed to understand the potential factors in the environment that needs to be either modified or eliminated to prevent the recurrence or the progression of the disease.[6],[12] Further, medical students are expected to work in an interdisciplinary team, and thus they should be trained to improve their communication and teamwork skills.[12],[13]


  Medical Curriculum Targeting One Health Top


Once the One Health competencies are identified, the next step will be to integrate into the curriculum and use the same for the training of medical students.[1],[6] It is essential to do curriculum mapping and clearly specify which of the competencies will be covered when, using which teaching-learning method, the required logistics, and how and when the taught competencies will be assessed.[11] This entire process of curriculum mapping will make things clear and avoid overlapping during different stages of training of medical students.[11] The sessions pertaining to One Health can be either covered during the foundation course (first professional year) or integrated teaching sessions involving microbiology, community medicine, medicine, and other specialties. In addition, an elective course can also be designed to cover different aspects of the exchange of medical and veterinary students or teachers can also be planned to strengthen and streamline the entire process.[14]


  Conclusion Top


The training of medical students on the One Health approach is an essential aspect of medical training considering the trends of outbreaks of infectious disease outbreaks. It is high time to acknowledge the need and prepare medical students to work as effective members of the interprofessional team and accordingly incorporate One Health competencies into the medical curriculum.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chapman HJ, Gupta S. Incorporating the one health framework in medical education. Med Teach 2019;41:1086.  Back to cited text no. 1
    
2.
Allen HA. Characterizing zoonotic disease detection in the United States: Who detects zoonotic disease outbreaks & how fast are they detected? J Infect Public Health 2015;8:194-201.  Back to cited text no. 2
    
3.
Hamilton WJ, Ryder DJ, Cooper HP Jr., Williams DM, Weinberg AD. Environmental health: A survey of Texas primary care physicians. Tex Med 2005;101:62-70.  Back to cited text no. 3
    
4.
Dykstra MP, Baitchman EJ. A call for one health in medical education: How the COVID-19 pandemic underscores the need to integrate human, animal, and environmental health. Acad Med 2021;96:951-3.  Back to cited text no. 4
    
5.
Paulson JA, Zaoutis TE, Council on Environmental Health, Committee on Infectious Diseases. Nontherapeutic use of antimicrobial agents in animal agriculture: Implications for pediatrics. Pediatrics 2015;136:e1670-7.  Back to cited text no. 5
    
6.
Frankson R, Hueston W, Christian K, Olson D, Lee M, Valeri L, et al. One health core competency domains. Front Public Health 2016;4:192.  Back to cited text no. 6
    
7.
Eyre P. Combined veterinary-human medical education: A complete one health degree? J Vet Med Educ 2015;42:283.  Back to cited text no. 7
    
8.
Abdus Samad M. Current status and challenges for globalisation of veterinary medical education for the 'One Health' programme. Rev Sci Tech 2017;36:741-65.  Back to cited text no. 8
    
9.
Haxton E, Lindberg A, Troell K, Redican KJ. One Health education meets science. Infect Ecol Epidemiol 2015;5:30264.  Back to cited text no. 9
    
10.
Gonzalo JD, Wolpaw DR, Lehman E, Chuang CH. Patient-centered interprofessional collaborative care: Factors associated with bedside interprofessional rounds. J Gen Intern Med 2014;29:1040-7.  Back to cited text no. 10
    
11.
Mor SM, Robbins AH, Jarvin L, Kaufman GE, Lindenmayer JM. Curriculum asset mapping for one health education. J Vet Med Educ 2013;40:363-9.  Back to cited text no. 11
    
12.
Rabinowitz PM, Natterson-Horowitz BJ, Kahn LH, Kock R, Pappaioanou M. Incorporating one health into medical education. BMC Med Educ 2017;17:45.  Back to cited text no. 12
    
13.
Cribb A, Buntain B. Innovation in veterinary medical education: The concept of 'One World, One Health' in the curriculum of the faculty of veterinary medicine at the university of Calgary. Rev Sci Tech 2009;28:753-62.  Back to cited text no. 13
    
14.
Evrony GD. A piece of my mind. A Wild Rotation. JAMA 2016;316:713-4.  Back to cited text no. 14
    


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