Regaining the preventive medicine edge: training for 2000 and beyond

We review the state of preventive medicine in the context of four factors that have eroded the influence and effectiveness of the specialty: (1) historical; (2) cultural; (3) political-economic; and (4) changing epidemiological and demographic factors. We address the implications for public and medical peer recognition of preventive medicine, for funding of residency programs, and for recruitment of medical students. We outline five objectives for preventive medicine training as steps to improve the response of the specialty to the above factors and to regain its edge. Also, we propose two specific innovative training programs to partially meet these objectives: a cross-cultural public health exchange and a preventive medicine fellowship in policy and public administration. We discuss the pertinence of these programs in terms of reversing preventive medicine's growing obsolescence.