The coronavirus pandemic has thrust public health (PH) into the spotlight, with regular reports on epidemiological modelling, studies and disease outbreak control. The general public became more aware of PH practices and the role of PH professionals in the fight against the pandemic.¹ The renewed interest has placed responsibility on PH academics to provide students with the necessary knowledge and skills to be effective clinicians who can play a meaningful role in the fight against the coronavirus disease 2019 (COVID-19) pandemic and future pandemics.²

Studies have shown that medical students understand and appreciate the value of PH in the undergraduate curriculum of medical schools.^3,4,5 However, the students identified several factors that influenced their negative attitudes and perceptions of PH: poor educational experiences in PH training, a lack of positive role models, particularly exposure to PH medicine specialists, an overemphasis on statistics and epidemiology and negative attitudes towards PH topics.^2,5

Students’ performance, satisfaction and success in medical school are related to their perceptions of the educational environment in which they learn.⁶ Experiential learning and innovative teaching approaches, such as community-based projects and group discussions, can improve the educational experience in the PH curriculum.^2,4

Research on students’ knowledge, attitudes and perceptions about their PH training might provide insight and help provide evidence to inform and guide curriculum renewal. However, these curriculum changes should include students’ voices, and there is a need to evaluate students’ perceptions and views regarding their preferred learning environment before implementing changes to the curriculum.^2,6

This study aimed to determine the knowledge of fifth-year medical students in PH after completing a PH training course, explore their attitudes and perceptions towards PH training and make recommendations for improvements.

Eighty-five (85) students out of a total of 248 responded to the online questionnaire, representing a response rate of 34%. The mean age of the participants was 24 years, ranging from 22 to 38 years. There were 61 (71.8%) female respondents and 24 (28.2%) male respondents. The focus group participants comprised three female students and two male students, aged from 22 to 25 years.

Table 1 shows the students’ attitudes towards the PH training. Most survey respondents (71 out of 85 (83.5%)) strongly agreed that the medical and PH fields collaborate to benefit patient care. Seventy participants (82%) agreed that doctors are an important part of the PH system, and 69 (81%) agreed that doctors play an important role in patient education. Only 41 (48%) survey participants strongly agreed that doctors should be required to learn PH.²

Table 2 shows the respondents’ views on important topics that should be included in the PH curriculum. All survey respondents agreed or strongly agreed that maternal and child health, epidemiology, communicable diseases and health promotion are important PH topics that should be covered in the PH curriculum.²

Table 3 displays respondents’ perspectives on teaching methods that should be included in the PH training. Hands-on projects in PH and tutorials should be used to teach PH, according to 42 (49.4%) and 31 (36.5%) survey respondents, respectively. Twenty-five (29.4%) respondents agreed that the department should use online and blended learning in the PH training, whereas 23 (27.1%) agreed that the department should use formal face-to-face lectures. Fifty-four (51.8%) survey participants were unsure whether flipped classroom techniques should be used to teach PH.²

The qualitative data further informed the survey findings. Using the thematic analysis approach, the researchers identified three emerging themes, namely the ‘scope of public health practice’, ‘the teaching and learning experience’ and ‘attitudes towards their public health training’.

The following particularly expressive and representative quotes by the participants are listed as exemplary. The quotes illustrate the different perceptions regarding the training. Among the eight prospective previous class representatives, five consented to participate in the study.

The results of this study shed light on the perceptions and attitudes of medical students towards their PH training. The findings reveal that most of the respondents appreciate the importance of PH in their medical training. However, the timing of exposure to PH and the teaching methods used in delivering the training content were areas of concern for the students.

The late introduction of PH training in the medical curriculum was a concern for most students. They believed that early exposure to PH concepts would allow for better integration with other medical courses and provide a comprehensive understanding of its relevance in clinical practice.¹² However, this finding is in contrast with the findings by Zweigenthal and colleagues, who reported that postgraduate students’ appreciation of PH was often shaped by later clinical experiences, not early undergraduate exposure.¹³ On the other hand, the advent of the COVID-19 pandemic may have led to the students appreciating the role of PH in clinical practice early on and thus shaped their favourable views towards PH,¹ even though PH critical content remains poorly integrated or introduced late into the curriculum.¹⁴

Early introduction of PH aligns with the competencies outlined by the Health Professions Council of South Africa (HPCSA), which are derived from the Canadian Medical Education Directives for Specialists (CanMEDS) framework.¹⁵ These include the roles of medical expert, health advocate and scholar, each of which requires foundational knowledge in PH to address population-level health needs. Furthermore, early integration should be longitudinal across all the years of medical training lest students view PH as less legitimate than ‘hard’ clinical courses and thus fail to prioritise it when dealing with competing academic pressures.

The teaching methods used in delivering the PH content were another area of concern for the students. The students expressed the need for more engaging and interactive teaching strategies. Specifically, the FGD participants advocated the use of pedagogical strategies such as group learning and integrated case studies. These findings align with the literature that suggests the use of active learning strategies to enhance student engagement and understanding of PH concepts.^16,17

Despite these concerns, most students agreed that PH is an integral part of clinical medicine that should be included in undergraduate medical training. This finding was consistent with the opinions of several PH authors^18,19 and the findings of studies conducted elsewhere.^3,20 This positive perception of PH is encouraging and supports ongoing efforts to strengthen PH training in medical education.²¹

Moreover, the current findings point to a need for the integration of research skills training within the undergraduate PH curriculum. Students expressed concern about being ill-prepared for post-graduation research. Prior work by Adefolalu and colleagues similarly found that students lack sufficient exposure and support to pursue research during medical school.²² Structured research exposure, embedded in PH teaching, could help address this concern.

The findings of this study support the widely held perception among medical students that PH is an easy and less demanding subject when compared to other clinical courses.^4,5 This perception may result in students allocating less time and effort to PH in favour of subjects they view as more challenging. However, strategies such as integrating PH throughout the curriculum and adopting assessment practices such as authentic assessments (tasks that mimic real-life problems)²³ competency-based assessments and formative assessments with feedback can enhance student learning and promote better student engagement with the course content.^24,25

This study provides potentially valuable insights into the perceptions and attitudes of medical students towards their PH training. The findings highlight the need for early but integrated exposure to PH across the curriculum, interactive and experiential teaching strategies and the inclusion of structured research training.