|Session 1: Community-Based Health Professional Education (HPE) in Resource-Poor Settings|
|Presenter||Webcast Session Abstract Title|
|B.1||Marietjie de Villiers||Evaluating CBE—The Ukwanda Rural Clinical School: A Longitudinal Evaluative Study|
|B.2||Andreea Szilagyi||The Mental Health Facilitator Program|
|B.3||Zohray Moolani Talib||African Medical Schools Invest in Community-Based Education to Increase the Quality, Quantity, and Rural Retention of Their Graduates|
|Session 2: Interprofessional Education (IPE) Related to Community-Based HPE|
|Presenter||Webcast Session Abstract Title|
|B.4||Linda Casser||The Pacific University Interprofessional Diabetes Clinic: A Community-Based Health Care Initiative Involving a Member Institution of the Association of Schools and Colleges of Optometry (ASCO)|
|B.5||Jan De Maeseneer||Undergraduate Community-Based Health Professional Education: An Interprofessional COPC Experience in Deprived Neighborhoods at Ghent University|
|B.6||Robb Russell||Tales from Two Cities: Community-Based Integrative Health Care Education in Toronto and Los Angeles|
|B.7||Holly Wise||Caregivers Are Heroes|
|Session 3: Community-Based HPE of Students in Medicine and Nursing|
|Presenter||Webcast Session Abstract Title|
|B.8||Rick Kellerman||Expansion of the University of Kansas School of Medicine–Wichita: A Community-Based Medical School|
|B.9||Mary Paterson||Community-Based Nursing Education|
|B.10||Frederic Schwartz||Training Medical Students and Residents at Community Health Centers: Context, Continuity, Commitment, and Community-Oriented Primary Care|
Susan C. van Schalkwyk, Ph.D.,
Juanita Bezuidenhout, M.B.Ch.B., M.Med., Ph.D.,
Julia Blitz, M.B.Ch.B., M.Fam.Med.,
Hoffie H. Conradie, M.B.Ch.B., D.C.H., M.Prax.Med., FCFP(SA),
Therese Fish, M.B.Ch.B., M.B.A.,
Norma J. Kok, M.P.H.,
Ben van Heerden, M.B.Ch.B., M.Sc., M.Med.,
Marietjie R. de Villiers, Ph.D., M.B.Ch.B., M.Fam.Med., FCFP
Implementing medical education innovations places a responsibility on the relevant institutions to critically consider the efficacy and relevance of these innovations. The implementation of the Ukwanda Rural Clinical School (RCS) in 2011—the first of its kind in Southern Africa—established such an imperative for the Faculty of Medicine and Health Sciences at Stellenbosch University, South Africa. This presentation outlines the methods and some results of a 5-year longitudinal study that is investigating the impact of the Ukwanda RCS by drawing on the perceptions of those who are within its sphere of influence (students, clinicians, health care practitioners, patients, and the community).
Funded by the Stellenbosch University Rural Medical Education Partnership Initiative (SURMEPI), the study will ultimately conduct in-depth and focus group interviews with close to 350 respondents. Statistical analyses, including comparisons between RCS students and those completing their final year at the tertiary hospital, of each successive cohort from 2011 to 2015 will be completed. Now in the fourth year of data collection, the project has progressed from an initial baseline study to where it is currently seeking to identify the factors that can explain some of the experiences that have been described to date.
The study is situated predominantly in an interpretive paradigm and draws on several different data sets providing mostly qualitative data but also some quantitative results. Given the extent of the study, the design is complex, functioning at both a horizontal level—within a specific year across a range of stakeholders—and at a vertical level (the ongoing cohort analyses). Important overarching themes from the baseline study included a different learning experience, an enabling clinical environment, the role of the specialists (clinicians), and the influence of community immersion.
The second phase of analysis provides an opportunity to start tracking experiences over time. The newly generated qualitative data sets (2012), which included interviews with RCS students in that year, with the 2011
RCS cohort (as interns) and their intern supervisors at different hospitals, as well as further interviews with clinicians involved on the rural platform, were subjected to thematic content analyses. At the same time, data from 2011 were revisited. The emerging themes from this expanded data set were then considered in light of Kirkpatrick’s levels for appraising educational interventions, thus developing a hierarchy from the participants’ views. This analysis demonstrated how the students’ initial uncertainties about attending the RCS had shifted. The results indicated a progression through the levels of Kirkpatrick’s model. Attitudes, skills, and knowledge were modified during the RCS year (Level 2a and 2b), followed by a change in behavior (Level 3) and ultimately, in professional practice (Level 4a). Quantitative analysis of students’ assessment marks showed that the RCS cohort performed on par with their counterparts, and better in some instances.
The experience of an educational intervention in a rural space appeared to be enriching, not only for students but also for clinicians and other health care practitioners. The rural platform provides opportunity for the lived experiences of the students to contribute to their embodied knowledge through being constantly immersed in the practice of their profession. Our findings highlight the importance of location, context, and identity development in this process, offering critical insights for medical education going forward.
J. Scott Hinkle, Ph.D., NCC, CCMHC, ACS, HS-BCP, BCC,
Wendi K. Schweiger, Ph.D., NCC, LPC,
Andreea Szilagyi, Ph.D., NCC, GCDF
National Board for Certified Counselors
The World Health Organization estimates that 450 million people worldwide are underserved in the area of mental health care. The citizens of many countries have little to no access to mental health services, and there are many areas of the United States where people have difficulties accessing services. The Mental Health Facilitator (MHF) program trains mental health first responders to work toward meeting these service gaps. This program is based on a 30-hour curriculum integrating internationally accepted and multidisciplinary mental health concepts and skills. It is designed to be contextualized to fit diverse local mental health needs and is currently translated into 10 languages. The curriculum trains laypersons, paraprofessionals, and professionals from outside of mental health in areas such as fundamental helping skills, identification of mental health needs, referral, and advocacy. The MHF program is not intended to develop a new
mental health profession. Its aim is to provide trainees with skills they can use to support those in need of mental health care.
Initially conceptualized in consultation with the Department of Mental Health and Substance Abuse of the World Health Organization, the MHF program was created and is administrated by NBCC International (NBCC-I), a division of the National Board for Certified Counselors. It is currently being expanded to include two more versions of the initial curriculum. NBCC-I is conducting a pilot program using the MHF-Educator’s Edition (MHF-EE) with a county school system. This curriculum version is being developed to train teachers, administrators, and staff of K–12 schools in fundamental mental health knowledge and skills specifically geared toward the needs of schoolchildren. For individuals who cannot commit the time to the 30-hour curriculum but are still committed to community mental health education, the 8-hour MHF-ASAP! is being developed and covers the basic components of the original 30-hour version of the curriculum.
NBCC-I is currently analyzing qualitative data collected in collaboration with MHF program partners in Malawi and Mexico toward a mixed methods study that will be submitted for journal publication. In addition, NBCC-I is working in collaboration with a U.S. counseling professor who has received a grant to train teachers in a local school system using the MHF-EE curriculum. This grant will include outcome research on the effectiveness of this curriculum.
Zohray Moolani Talib, M.D.,1 Rhona Kezabu Baingana, M.Sc.,2
Atiene Solomon Sagay, M.D., FWACS, FRCOG,3
Susan Camille Van Schalkwyk, Ph.D.,4
Sinit Mehtsun, M.Sc.,1
Elsie Kiguli-Malwadde, M.B.Ch.B., M.Med., M.Sc.HPE.5
1 The George Washington University
2 Makerere University College of Health Sciences
3 University of Jos
4 Stellenbosch University
5 African Centre for Global Health and Social Transformation, Kampala
Background The Medical Education Partnership Initiative (MEPI) is a $US130 million program funded by the U.S. government supporting 13
African medical schools to increase the quantity, quality, and retention of physicians in underserved areas. All of the schools involved in the initiative have invested in strengthening community-based education (CBE) to achieve these goals.
Methods We used data from site visits of the funded schools, from a survey of all schools in the MEPI network, and from focal persons from the three MEPI programs highlighted.
Findings There are 13 primary awardees of the MEPI grant with some schools partnering with other in-country schools, creating a network of 24 schools. All are engaged in CBE. There is considerable diversity in the goals and characteristics of CBE activities among these schools. Although the majority of schools provide a total of less than 6 months of training in the community, a few schools offer longer experiences. The competencies addressed during community rotations are similar. Almost all of the schools teach public health skills, clinical skills, and research skills; two-thirds also offer management training during community rotations. CBE rotations are held at both rural and urban sites. The supervision of students during CBE rotations is largely through faculty from the medical school, but in some cases, clinicians working at the clinical sites provide oversight. Three programs exemplify how different models of CBE are being leveraged to achieve health workforce goals. In Nigeria, the tertiary hospitals have become crowded with students from many different training programs, limiting opportunities for students to practice clinical skills. The expansion of CBE is therefore to accommodate growing student numbers by using community hospitals for core rotations in internal medicine, surgery, and pediatrics. In Uganda, the goal of CBE is to train students to provide community-based care and to increase the number of physicians who practice in rural areas. To achieve these goals, Ugandan medical schools are strengthening their curriculum (particularly in the areas of research and management training) and have developed criteria for community sites to ensure the quality of these rotations. At Stellenbosch University in South Africa, the goal is to increase the number of students who choose to work in rural areas. Students are offered an elective year-long comprehensive rural immersion experience. Extensive evaluations are under way to examine the impact of these efforts to leverage CBE to improve the health workforce and health services.
Conclusion The MEPI program has stimulated an evolution in CBE among African medical schools. Schools are leveraging CBE in different ways to achieve the goals of improving the quality, quantity, and retention of physicians.
Carole Timpone, O.D.
Pacific University College of Optometry
Jennifer Smythe, O.D., M.S.
Association of Schools and Colleges of Optometry
Linda Casser, O.D.
Pennsylvania College of Optometry at Salus University
Association of Schools and Colleges of Optometry
Background/Introduction A doctor of optometry (O.D. or optometrist) is an independent primary health care professional who is trained, educated, and credentialed to examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures and who identifies related systemic conditions affecting the eye and visual system. An optometrist has completed preprofessional undergraduate education and 4 years of professional education at a school or college of optometry, leading to the Doctor of Optometry degree.
Established in 1941, the Association of Schools and Colleges of Optometry (ASCO) is the academic leadership organization committed to promoting, advancing, and achieving excellence in optometric education. ASCO has achieved this objective by representing the interests of institutions of optometric education, enhancing the efforts of these institutions as they prepare highly qualified graduates for entrance into the profession of optometry, and serving the public’s eye and vision needs. ASCO proudly represents all 21 accredited schools and colleges of optometry in the 50 states and Puerto Rico, including the Pacific University College of Optometry (PUCO) in Forest Grove and Hillsboro, Oregon.
To address the needs of the growing predominantly Latino population that has diabetes and to prepare students for community-based collaborative health care delivery models, the College of Optometry and the College of Health Professions at Pacific University have developed and implemented an innovative model for interprofessional education and collaborative patient care.
Methods The Pacific University Interprofessional Diabetes Clinic (IDC) employs a teaching- and patient-centered model that provides optometry,
dental health, physical and occupational therapy, mental health, physician assistant, and pharmacy services. Patients are evaluated by faculty and student teams from up to three disciplines at one visit in order to improve access and to promote collaborative, coordinated care. Care concludes with a team case management conference led by student presentations and facilitated by an integrated electronic health record.
The bicultural patient care coordinator provides patient navigation, coordinating services, follow-up care, and, along with other community trainers, patient education in diabetes and chronic care using Stanford University’s Chronic Disease Self-Management Program, Tomando Control de su Salud. Patients access the IDC through community health centers, outreach efforts, and other university-based clinical facilities.
Results Group patient data and demographics presented from the past 2 years demonstrate the need for interprofessional care and intervention (see Table B-1).
In a series of the first 50 consecutive patients, 42 percent exhibited diabetic retinopathy, more than 10 percent presented with glaucoma, and 100 percent had periodontal disease. A third of patients required physical or occupational therapy or would benefit from behavioral health intervention to mitigate barriers to self-management.
Patient satisfaction data collected after the first year indicated that 97 percent of participants would refer others to the IDC (n = 37). Students (n = 41) rated the experience favorably (4.5, scale 1–5), highlighting the knowledge and respect for all the participating professions that they acquired (4.6), the collaborative learning environment (4.2), and a more comprehensive knowledge of diabetic patient needs (4.5).
Discussion The IDC has provided the opportunity for students to gain firsthand team-based, collaborative, multifaceted practice experience that
TABLE B-1 Group Patient Data and Demographics
|Age (years)||49||24–75||Median age 50 years|
|BMI (kg/m2)||34||21.5–68||68 percent > 29|
|HbA1c (percent)||8.2||5.2–14||77 percent > 6.9; 45 percent > 8.0|
|BP (mmHg) systolic||131||95–191||53 percent > 129|
|BP (mmHg) diastolic||80||52–107||41 percent > 81; 17 percent > 89|
NOTE: BMI = body mass index; BP (mmHg) = blood pressure (millimeters of mercury); HbA1c = glycated hemoglobin.
focuses on the whole patient. Diabetes, as a complex multisystem chronic disease, is a natural starting point for interprofessional care and clinical teaching. Integral to the success of this patient-centered model, the patient care coordinator, employing a culturally competent approach, assists in the effective coordination of care and patient self-management education.
Advantages of this community-based model include a more comprehensive patient history when gathered within the different contexts of each profession, aiding in the development of a more comprehensive evaluation and treatment plan; enhanced opportunities for both patients and providers to identify and address key barriers to successful self-management; and delivery of consistent, coordinated patient education. Challenges to this model beyond language and cultural barriers included creating an integrated electronic health record and addressing limited mutual understanding of each profession’s roles and practices.
Conclusion The Pacific University IDC is a viable community-based model for providing patients and students the benefits and experience of comprehensive and coordinated collaborative patient care. Future goals include expanding services to diagnose and manage other chronic conditions and developing more robust evaluation measures of student education and patient care outcomes (Timpone, 2012; Timpone and Smythe, 2013).
Lynn Ryssaert, M.A., Jan De Maeseneer, M.D., Ph.D.
Ghent University (Belgium)
Background In the undergraduate medical curriculum, students are, from the first year, learning the background of social inequities in health. They study social determinants and look at the importance of health systems and health policy in achieving health equity. In the third year, they work during 1 week in deprived areas in the city of Ghent, making a “community diagnosis” in the framework of community-oriented primary care (COPC).
Learning objectives The specific learning objectives of this 1 week are to develop a practical understanding of inequities in health; gain insight into the meaning of health and illness and their practical consequences in the
primary care context; appreciate the impact the community has on individual health; gain understanding of the range of professionals and services involved in health care; and learn how to make a community diagnosis by collecting and integrating individual stories as well as epidemiological data. In addition, the students have to acquire different skills, such as conducting semistructured patient and careprovider interviews; cooperating with students from different disciplines (apart from medical students, social pedagogic students, sociology students, nursing students, social worker students, management students are involved); taking up the advocacy role; formulating strategies for improvement at community level; and presenting the results to a public audience of health care workers and policy makers.
Organization The first day the students are introduced to the background of the community that they will work in. Then they visit a family living in poverty and three care providers who are working with this family. They do that in interprofessional groups of four students. On Tuesday afternoon they bring together all the information and try to find out what the commonalities are. Information from the family and provider interviews is complemented with statistical data on morbidity, demographic features, and criminality. The students then check their first community diagnosis with agencies involved in neighborhood development, in order to assess if the diagnosis is appropriate. Then they brainstorm to think about a possible intervention and how to monitor it. On Friday afternoon they present their results and debate the results with local stakeholders. In addition, they produce a poster that can be used later on by the community when taking up action. Finally they write a letter to an agency in order to improve the situation of the family they visited.
The 2014 COPC week During March 24–28, 2014, 233 students participated, working in 8 neighborhoods. They visited 64 patients and families and contacted 192 care providers.
Evaluation and report In the week following the COPC week, an electronic survey assessed attitudes of participating students, using a Likert scale: 55.2 percent of the students (totally) agreed with the statement, “As a care provider, it is your duty to continuously improve the care system”; 78.3 percent (totally) agree with, “In order to eradicate social inequities in health, we should tackle the upstream causes at the level of education, income, and work”; 78.3 percent (totally) disagreed with the statement, “People living in poverty are to a large extent themselves responsible for their situation.” Working with other disciplines has broadened the scope of the students. The statement “To work with students from other disciplines was an enriching experience” received (totally) disagreement from only
19.1 percent of the students. Of the total, 87.8 percent disagreed with the statement, “It is better for a family physician to only focus on curing diseases.” The experience did not lead to pessimism; only 12.7 percent (totally) agreed with, “I do not see solutions to all the problems of the people living in this neighborhood.” Finally, only 11.3 percent (totally) disagreed with the statement, “Health care is politics.”
Robb Russell, D.C.
Southern California University of Health Sciences
Nicholas De Groot, N.D.
Canadian College of Naturopathic Medicine
Myles Spar, M.D., M.P.H.
Venice Family Clinic
Academic Consortium for Complementary and Alternative Health Care
Introduction Integrative teaching and learning programs affiliated with mainstream health care delivery can help close gaps between differently trained or licensed practitioners and dissolve interprofessional barriers. At the same time they can improve patient choice and community health. A prior Academic Consortium for Complementary and Alternative Health Care (ACCAHC)-involved survey of all accredited institutions in the United States and Canada from the chiropractic, naturopathic, acupuncture, and Oriental medicine, massage therapy, and direct-entry midwifery schools found that 34 percent had formal classroom experience with medical doctors, 39 percent had formal clinical experience involving care from medical doctors, and approximately 30 percent had clinical education provided through city or county-sponsored clinics. ACCAHC-affiliated academic institutions have traditionally been almost entirely in outpatient environments, often separate from the mainstream delivery system. Recent efforts to offer integrative, community-based education have focused on collaborating within institutions such as hospitals, health systems, and conventional primary care delivery. Two such programs are illustrated.
Purpose Two innovative, interprofessional programs, one in Toronto, the other in Los Angeles, are summarized. Although different in their settings
and the professions represented, each program actively involves integrative and mainstream health care practitioners in educational clinics whose overall purpose is offering patient-centered, community-based health.
Discussion In January 2013, in the Greater Toronto area suburb of Brampton, the Canadian College of Naturopathic Medicine (CCNM) opened the Brampton Naturopathic Teaching Clinic (BNTC) within an outpatient clinic of a conventional medical hospital, Brampton Civic Hospital (BCH). BNTC, however, operates during the hospital clinic’s off-hours. With BNTC and BCH staff not physically working side by side, true interprofessional clinical integration has occurred only through effort and initiatives of administrators and faculty. For more than 7 years in the Los Angeles suburb of Santa Monica, the Venice Family Clinic has operated the Simms-Mann Health and Wellness Center, which houses an integrative chronic pain program for underserved and largely Spanish-speaking patients. Interns and their licensed supervisors are from two acupuncture colleges, Los Angeles College of Chiropractic (a college of Southern California University of Health Sciences), University of California, Los Angeles (the medical residents, physical therapy, and social work and mental health interns and practitioners), and trainees in massage, yoga therapy, and Feldenkrais. Integrative health and medicine practitioners interact with each other in the Western medical model during clinic shifts and case presentations.
Conclusion Health care practitioners exposed to these integrative clinics become familiar with the skill sets and toolkits of multiple professions. The communication fostered in these community-based programs helps reconcile the difference between the perceived needs of a patient—based on each practitioner’s specific training (practitioner-centered care)—with the patient’s actual needs, drawing from a variety of clinically effective approaches for truly patient-centered care.
In Toronto, after a little more than 1 year, interprofessional collaboration has begun to grow. A grant proposal for integrative care of diabetes is being pursued. Referrals and coordination of care between naturopathic and medical practitioners is budding. Further, BCH now appears to see the value of BNTC in building a bridge to the local community, which has a sizable population of South Asian and Caribbean inhabitants who value natural health care. In Los Angeles, the chronic pain clinic is well established and is successful, having a waiting list for all modalities of care. The structure and function of the Venice Family Clinic’s integrative features serve to educate staff physicians on uses of integrative approaches in the care of chronic pain as well as exposing integrative practitioners to conventional health care.
Holly H. Wise, P.T., Ph.D., Paul F. Jacques, D.HSc., PA-C,
Nancy E. Carson, Ph.D., OTR/L,
Maralynne D. Mitcham, Ph.D., OTR/L, FAOTA
Medical University of South Carolina
Although academic educational programs espouse the tenets of compassion and caring in their mission statements and curricular design, educational methodologies that promote the development of compassionate and caring attitudes are not well delineated. The purpose of this presentation is to highlight innovative interprofessional (IP) educational strategies designed to imbue compassion and caring within health professions curricula. Key components of a model educational program in compassion and caring that has potential for universal and global application in educational curricula will be described. Preliminary baseline and comparative data using qualitative assessment and quantitative measures related to empathy, purpose in life, and altruism will be presented.
Caregivers are Heroes is an IP community-based learning activity designed to enhance caring and compassionate attitudes toward caregivers in first-year occupational therapy, physical therapy, and physician assistant students. For the past 5 years, more than 180 students per year engage in learning about the trials and tribulations of caregivers. A caregiver is an individual who provides unpaid care and support for a family member, friend, or partner with a disability who needs assistance with activities of daily living. Research has shown that caregivers may experience poor health associated with caregiving due to financial costs, discrimination at work, social isolation, stress, and physical injury.
The students are assigned to IP teams and are prepared for an in-home caregiver interview through a series of four interactive large group sessions followed up by individual team meetings. At the conclusion of the semester, the IP student teams creatively share their experiences through music, art, poetry, drama, etc., to present the humane perspective of the caregiver.
Funding Source: Arthur Vining Davis Foundation
Rick Kellerman, M.D.
University of Kansas School of Medicine–Wichita
The mission of the University of Kansas School of Medicine–Wichita (KUSM–Wichita) is to educate students, residents, and physicians through patient care, service, research, and scholarly activities to improve the health of Kansans in partnership with Kansas communities.
In response to a shortage of physicians in Kansas, KUSM–Wichita opened in 1971 to provide hands-on clinical training to 3rd- and 4th-year medical students. In 2011, KUSM–Wichita expanded to a full, 4-year campus, welcoming its inaugural class of 1st-year medical students.
Prior to 2011, all 200 University of Kansas medical students did their first 2 years of training on the Kansas City campus, a traditional academic medical center. Fifty to 60 third-year and 50–60 fourth-year students would complete their final 2 years of medical school on the Wichita campus. With the expansion of the first 2 years in Wichita, 28 students complete all 4 years of medical school in Wichita. They are joined for the third and fourth year by students who transfer from the Kansas City campus. The full 4-year class complement on the Wichita campus is currently 28 first-year medical students, 28 second-year medical students, 60 third-year medical students, and 60 fourth-year medical students.
The curriculum on the Kansas City and Wichita campuses is identical. Most lectures originate on the Kansas City campus and are podcast to Wichita. An experienced basic scientist oversees coordination of the year 1 and year 2 curriculum on the Wichita campus. His work is supplemented by bioscientists from local universities who teach in small group sessions. Cadaver dissection is performed on the campus of Newman University in Wichita, a 4-year college with a strong premedical program.
Full-time clinical faculty members teach history taking, the physical examination, developing of a differential diagnosis, and other aspects of the clinical process. Experienced clinicians facilitate problem-based learning courses that are linked to organ-based curricular modules. Special emphasis is given to the development of communication and interpersonal skills through the use of standardized patients. Each medical student during the first 2 years is paired with a community physician for shadowing experiences.
The extant third and fourth year of the curriculum has remained intact. More than 1,000 community physicians in Wichita and rural Kansas volunteer to teach medical students and resident physicians. Inpatient care
is provided in the state’s two largest hospitals, Via Christi Hospitals and Wesley Medical Center.
Each year, 20 percent to 40 percent of KUSM–Wichita graduating medical students enter family medicine residency programs. KUSM–Wichita ranks sixth nationally in the production of graduates who practice primary care 5 years after the completion of medical school, many in rural and frontier communities (Chen et al., 2013). The KUSM ranks fifth in the nation for fulfilling a social mission of graduates who practice primary care in underserved areas and are underrepresented minorities (Mullan et al., 2010).
Mary A. Paterson, Ph.D., R.N., Joan Stanley, Ph.D., R.N., CRNP
American Association of Colleges of Nursing
The American Association of Colleges of Nursing (AACN) supports curriculum development and innovation in undergraduate and graduate nursing programs through faculty-development workshops, curriculum resource material, toolkits, and guidelines. Community-based education has been one of our focus areas since 1999, when a faculty development workshop, supported by the Helene Fuld Health Trust, was held on this topic.
We define community-based nursing education as a pedagogy that enables students to learn to provide nursing care for people no matter where they encounter them. The content taught includes health promotion and disease prevention as well as the nursing care of people of all ages as they encounter the need for medical or health care interventions (Matteson, 2000). Early models of community-based nursing education include partnerships between schools of nursing and various community agencies to provide health education, screening, and immunizations. Recent community-based nursing education models have evolved to continuous student involvement over more than one semester in a community. Over time students form strong community partnerships to develop service learning projects and community support activities. The AACN with the support of the Centers for Disease Control and Prevention is currently inviting proposals for several small impact evaluation projects in established academic/practice partnerships in community health. Impact evaluations may focus on student impact, faculty impact, patient impact, community impact, or any combination of these foci. These projects will develop pilot approaches to support larger impact evaluations in community-based nursing education.
Creating the doctors that the country needs to serve
the underserved and help close the care gap.
Frederic N. Schwartz, D.O., FACOFP
A.T. Still University (ATSU)
According to Federal Uniform Data Set Reports assessed by the National Association of Community Health Centers (NACHC), the U.S. Federally Qualified Health Centers serve 20.2 million people annually. This number has grown 96.1 percent since 2001 and may double in the next half-decade given the progress of the Affordable Care Act. There is little debate that there is a growing shortage of providers in primary care disciplines (medicine, family medicine, pediatrics, and OB/GYN) and general surgery, geriatrics, and psychiatry (collectively, NACHC-needed specialties). This provider gap threatens the effectiveness of the national safety net system. The nation’s approximately 1,200 community health center organizations provided more than 80 million patient visits in 2013. The patients served were poorer, sicker, and at higher risk than average for the United States. They were offered comprehensive, team-based, interdisciplinary, and prevention-oriented care.
And yet, the School of Osteopathic Medicine in Arizona (SOMA) at A.T. Still University (ATSU) is the only U.S. medical school to locate all of its medical students at community health centers (CHCs) for 3 of their 4 years of training. The difference between training “at” a CHC for a few weeks and “in” a CHC and its care partner institutions is significant. Because SOMA second-year students (OMS II-Osteopathic Medical Student II) receive their second year of basic science training while working 1 day per week under supervision at the CHC primary care clinics, they are able to place the clinical presentations discussed in class into the context of real care of the underserved.
Video telecommunication technology is employed to maintain the linkage between students and the Mesa Arizona campus. Educational offerings are both live and asynchronous. Students work in teams and interact with classmates around the country. SOMA CHC campuses span the distance from Hawaii to Brooklyn and South Carolina.
Second-, third-, and fourth-year medical students and family medicine (FM) residents (at the six sites where SOMA has both medical students and FM residents) participate in monthly interdisciplinary grand rounds designed to further the values and philosophy of community-oriented primary
care. All students must study epidemiology, biostatistics, and preventive medicine. Almost 10 percent of the student body will receive an M.P.H. from the ATSU School of Health Management upon graduation.
SOMA has pioneered the use of technology-enhanced active learning including games and simulations that promote engagement and active (interactive) learning.
All eligible students who applied for residency to date, beginning with the first graduating class in 2011, were accepted in the first year of application (nationally, 1,097 students did not match). Primary care and NACHC-needed specialties were chosen at a 3-year rate of more than 80 percent. Early evidence of employment agreements at CHCs is encouraging.
SOMA faculty understand that our role is to train interprofessionally competent, mission-motivated, teamwork-oriented “complexivists” who derive satisfaction from the community-focused, continuity-driven preventive and restorative care they can help to provide in meeting the Institution for Healthcare Improvement’s Triple Aim of enhanced experience, improved community health, and reduced cost of care. We believe our model is worthy of emulation and are willing to work with interested institutions and organizations to share what we have learned.
Chen, C., S. Petterson, R. L. Phillips, F. Mullan, A. O. Bazemore, and S. D. Donnell. 2013. Toward graduate medical education (GME) accountability: Measuring the outcomes of GME institutions. Academic Medicine 88(9):1267-1280.
Matteson, P. 2000. Community-based nursing education. New York: Springer Publishing Company.
Mullan, F., C. Chen, S. Petterson, G. Kolsky, and M. Spagnola. 2010. The social mission of medical education: Ranking the schools. Annals of Internal Medicine 152(12):804-811.
Timpone, C. A. 2012. Implementation of a coordinated care clinical education and practice model to promote health: The interprofessional diabetes clinic. Health and Interprofessional Practice 1(3):1-12.
Timpone, C. A., and J. Smythe. 2013. Innovations in the management of diabetes in a Latino population: Pacific University interprofessional diabetes clinic. Poster presentation at the American Academy of Optometry Annual Meeting. Seattle, WA, October 23-26.
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