Medical education in the twentieth century was largely influenced by the Flexner Report, with significant proportions of instruction dedicated to the molecular underpinnings of the pathologic pathways and minimal mention of the socio-ecological determinants of health. When examining the predominant diseases of the twenty first century landscape, widening health disparities, and significant changes in the United States healthcare system, it is imperative to view wellness and sickness in a broader public health context rather than a singular focus of the biomedical model. While undergraduate opportunities to study public health are on the rise in the United States, there is a parallel urgency for medical curricula to recognize the importance of the complex interrelated socio-ecological root causes of health, well-being, and illness. In order to reduce the risk of non-communicable diseases and increase health equity, it is necessary for medical education to integrate core public health knowledge and competencies. Contemporary health challenges require a public health approach, in addition to clinical skills, for physicians to provide equitable care. The COVID-19 pandemic further underscores the necessity to mitigate the effects of socio-ecological determinants of health. Seven key recommendations are presented from a training to practice timeline emphasizing the important linkages between medical education, socio-ecological influences on health, and public health. As the health challenges in society and communities shift, so too must training of future physicians. There is a need and an opportunity for medicine and public health to address the shared health challenges of our global society.

Collaboration can be challenging; nevertheless, the emerging successes of large, multi-partner, multi-national cooperatives and research networks in the biomedical sector have sustained the appetite of academics and industry partners for developing and fostering new research consortia. This model has percolated down to national funding agencies across the globe, leading to funding for projects that aim to realise the true potential of genomic medicine in the 21st century and to reap the rewards of ‘big data’. In this Perspectives article, the experiences of the RA-MAP consortium, a group of more than 140 individuals affiliated with 21 academic and industry organizations that are focused on making genomic medicine in rheumatoid arthritis a reality are described. The challenges of multi-partner collaboration in the UK are highlighted and wide-ranging solutions are offered that might benefit large research consortia around the world.

Rheumatoid arthritis (RA) is a chronic inflammatory disorder with poorly defined aetiology characterised by synovial inflammation with variable disease severity and drug responsiveness. To investigate the peripheral blood immune cell landscape of early, drug naive RA, we performed comprehensive clinical and molecular profiling of 267 RA patients and 52 healthy vaccine recipients for up to 18 months to establish a high quality sample biobank including plasma, serum, peripheral blood cells, urine, genomic DNA, RNA from whole blood, lymphocyte and monocyte subsets. We have performed extensive multi-omic immune phenotyping, including genomic, metabolomic, proteomic, transcriptomic and autoantibody profiling. We anticipate that these detailed clinical and molecular data will serve as a fundamental resource offering insights into immune-mediated disease pathogenesis, progression and therapeutic response, ultimately contributing to the development and application of targeted therapies for RA.

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