Preventive Medicine & Public Health – MCCQE1 High-Yield Notes

Preventive Medicine and Public Health is a major MCCQE1 component covering Canadian screening guidelines, biostatistics, epidemiology, and population health principles.

🔑 Key Topics for MCCQE1

Levels of prevention: primary (prevent disease), secondary (screening), tertiary (reduce disability)
Canadian screening guidelines: cervical (Pap 25-69), breast (mammogram 50-74), colorectal (50-74)
Screening criteria (Wilson & Jungner): important problem, acceptable test, effective treatment
Sensitivity vs Specificity: SnNout (high sensitivity rules OUT), SpPin (high specificity rules IN)
PPV and NPV: affected by disease prevalence in the population
Incidence vs Prevalence: incidence = new cases, prevalence = all existing cases
Study designs: RCT > cohort > case-control > cross-sectional > case report
Bias types: selection bias, information bias, confounding
Number Needed to Treat (NNT) = 1/ARR; Number Needed to Harm (NNH)
Relative Risk vs Odds Ratio: RR in cohort studies, OR in case-control studies
Immunization in Canada: routine schedule, live vs killed vaccines, contraindications
Occupational health: workplace hazards, WHMIS, return-to-work principles
Socioeconomic determinants of health: income, education, housing, social support
Canadian healthcare system: publicly funded, provincial jurisdiction, Canada Health Act
Food and water safety: reportable diseases, outbreak investigation steps

⚠️ High-Yield Clinical Pearls

Sensitivity: Best for screening – high sensitivity, accept false positives (don't miss disease)
Specificity: Best for confirmation – high specificity (don't label healthy as sick)
PPV increases with higher disease prevalence in the population
RCT: Gold standard for establishing causation – randomization removes confounding
Confounding: Third variable associated with both exposure and outcome
Colorectal screening: FIT test every 2 years OR colonoscopy every 10 years age 50-74

📊 Quick Reference Table

Screening	Age Group	Interval
Cervical cancer (Pap)	25–69 years	Every 3 years
Breast cancer (mammogram)	50–74 years	Every 2-3 years
Colorectal cancer (FIT)	50–74 years	Every 2 years
AAA (ultrasound)	Men 65–75, ever smoker	One-time screen
Osteoporosis (DEXA)	Women ≥65, men ≥70	As indicated

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