A decade's experience at Tufts with a four-year combined curriculum in medicine and public health.

The absence of a good working relationship between medicine and public health is a cardinal feature of the health care system in the United States. Nowhere has the "uneasy alliance" between proponents of care for the individual versus those who advocate greater attention to the health needs of the population been more apparent than within medical schools. This article chronicles ten years of experience at the Tufts University School of Medicine where, for a limited number of students, the Combined MD-MPH (Master of Public Health) Program has been created and sustained and continues to produce professionals trained and credentialed in both public health and medicine. The four-year program has graduated over 75 students and provides a medical-school-based model that combines education in medicine with a comprehensive, prevention-oriented, population-based approach to health. The Program is described, and experience-based suggestions are offered for medical schools interested in developing training opportunities that address both the care of the individual patient and the care of populations. The Tufts experience shows that a four-year program that combines rigorous education in medicine and public health does not require drastic changes in medical school admission policy or major revisions in curricula. The introduction of combined MD-MPH programs can better serve the changing needs of medical practitioners and their patients while also fostering the health of the public.