Advancing the Art and Science of Community Engagement:

Transforming Medical Schools

Syed M. Ahmed, MD, MPH, DrPHSenior Associate Dean for Community EngagementProfessor, Family and Community Medicine Director, Community Engagement Key Function of Clinical and Translational Science Institute of Southeastern WisconsinMedical College of WisconsinEmail: sahmed@mcw.edu

Wisconsin Campus CompactCivic Engagement Institute

March 26, 2015

The Need for Experience in Learning

“…the most valuable ‘product’ of education are the ability to use knowledge and skill to solve unscripted problems to explore the frontiers of knowledge and understanding, and to experience life in deeper way.”

(Lingenfelter, 2012)

We must Restore Balance to the Community Academic Partnership

4

Community Academic

Ahmed, SM, Medical College of Wisconsin, 2010

What is in a Name? Community Engagement in Research (CEnR) Community Engagement in Research/ Community Engaged Research (CEnR) Community Based Participatory Research (CBPR) Community Academic Partnership (CAP) Community Based Research (CBR) (Canada) Community Based Participatory Action Research (CBPAR) Dialogue Research Involved Research (UK) Community Engaged Scholarship Action Research (AR) Participatory Action Research (PAR) Empowerment Research Community Service Service Learning

Rationale for CEnRCommunity Perspective Community Demand Can not be just “subject” Demand for elimination health disparities Potent

alternative to “outside expert” driven research Active participation of the target population Incorporation of local knowledge which overcome

“community distrust” of academic research Provides resources (e.g. funds, training, job opportunities

for communities (Israel et al, 1998) Interest in the contextual factor (e.g. social, economical,

cultural, environmental, etc.)Ahmed, SM, Medical College of Wisconsin, 2010

Rationale for CEnRAcademic Perspective Failure of “Traditional” research approaches:

98% of Americans receive their health care outside of academic medical centers

The challenge of “Translational Research” Enhance the relevance and use of the research data by all

partners Funder Demand Need to see impact IOM report 2003, Who Will Keep Public Healthy? Educating

public health professionals for the 21st century. IOM report 2013, The CTSA Program at NIH: Opportunities

for Advancing Clinical and Translational Research.7Ahmed, SM, Medical College of Wisconsin, 2010

Community Academic

PRINCIPLES OF COMMUNITY ENGAGEMENT

Ahmed, SM, Medical College of Wisconsin, 2010Based on: 5. Ahmed SM & Palermo AS. 2010. Community Engagement in Research: Frameworks for Education and Peer Review. American Journal of Public Health. Vol. 100, No 8: 1380-1387.

Defined Communi

ty & Program

Scope

Equitable Power and Responsib

ility

Strong Communit

y-Academic Partnershi

p

Effective Dissemination Plan

Capacity Building

Challenges: National Slow evolution of CEnR Resistance to new concepts Questions of legitimacy as a research

paradigm Questions of lack of data on effectiveness

of CEnR Lack of leadership Lack of funding

9Ahmed, SM, Medical College of Wisconsin, 2010

Challenges: Institutional “Novel” idea Lack of leadership Lack of faculty with CEnR expertise Lack of infrastructure support Faculty development issues IRB issues Missing “boat” vs. Jumping on “bandwagon”

10Ahmed, SM, Medical College of Wisconsin, 2010

Missions statement supporting community engagement in US and Canadian Medical Schools (N=142)

Number (%)

Mission

• Engagement language clearly delineated and representing at least 20% of statement

12 (8.6)

• Engagement language clearly delineated and representing less than 20% statement

10 (7.1)

Goldstein AO & Sobel Bearman R. Community Engagement in US and Canadian Medical Schools. Advances in Medical Education and Practice. 2011:2; 43-49.

Promotion and Tenure Guidelines relating to community service and community engagement in US and Canadian medical schools (N=142)

Community Service and Engagement

Number (%)

• Used as primary or major criteria in promotion or tenure 10 (8.5)

• An area of excellence or one of a set of standards included in promotion and tenure

30 (25.6)

• Taken into consideration in promotion and tenure but is not a primary criteria or one of a set of standards

29 (24.8)

• Not mentioned in consideration of promotion and tenure 48 (41.0)

Goldstein AO & Sobel Bearman R. Community Engagement in US and Canadian Medical Schools. Advances in Medical Education and Practice. 2011:2; 43-49.

Recognition for community engagement at US Canadian medical schools

Four medical schools received Carnegie Classification for Community Engagement**

Number (%)

Recipient of an AAMC medical school award for outstanding community service*

12 (9.6)

*Goldstein AO & Sobel Bearman R. Community Engagement in US and Canadian Medical Schools. Advances in Medical Education and Practice. 2011:2; 43-49.**Carnegie Community Engagement Classification, Classified Campuses. http://nerche.org/index.php?option=com_content&view=article&id=341&Itemid=92

Challenges: Individual Lack of education/training Lack of role model Skepticism Promotion & tenure issues Lack of support: departmental &

institutional Considerable investment of time and energy

to build and sustain relationship14Ahmed, SM, Medical College of Wisconsin, 2010

Challenges: Community Definition of “Community” Communities are not mono-liths Lack of trust of academia Not Same missions / goals / priorities Lack of understanding of CEnR Lack of understanding of roles / responsibilities Lack of skills in developing partnerships with academics Funding issues Who owns data? Who disseminates? Considerable investment of time and energy to build and sustain

relationship Location of “power” in the partnership

15Ahmed, SM, Medical College of Wisconsin, 2010

COMMUNITY ENGAGEMENT AT MCW

Community Engagement

Mission (Senior

Associate Dean for

Community Engagement)

Advancing a Healthier Wisconsin

Healthier Wisconsin Partnership Program

Departmental Programs

Inter-Departmental: Injury Research Center

Institute of Health and Society:Violence Prevention InitiativeHealth Equity and Urban Clinical Care Partnerships

Psychiatry:

Center for AIDSIntervention Research

Pediatrics: Center for the Advancement for Underserved ChildrenCenter for Clinical Effectiveness ResearchProject Uji

ma

Educational Programs

Courses & Groups: Global Health OrganizationMCW

Council on AIDSSaturday Clinic

Events: CEnR Conferences/ Webinars/Workshops

Clinical and Translational Science Institute

Community Engagement Key Function:Science CafésCTSI SMART TeamsCEnR Course

Healthier Wisconsi

n Leadersh

ip Institute

MCW Library

Services

Family & Community Medicine:

Center for Healthy Communities & ResearchResidency Programs with

Waukesha, St. Joe’s Hospital, and Columbia St.

Mary’s

Medical Legal

Partnership for

Children

Personal Responsibil

ity Ed Program

MKE Adolescent

Health Program

Reach Out & Read-

MKEHmong Health

Education

Inter-Institution

al Programs

Survey Background

MCW Faculty Community Engagement Survey is the first survey of its kind by MCW to gather campus- wide data on CE activities

Issued July-August 2014 Five survey questions:

CEnR & CBPR Projects, Publications, Coursework, Awards, and Outreach activities

Community Engaged Faculty Data

10

100

200

300

400

500

600

101

54

143

75

483

Total Number of CE Activities Reported

CBPR Projects Publications Courses Awards Outreach

% of Respondents

%of all Faculty

42.99%

17.80%

42.77%

18.93%

62.50%

10.64%

50.00%

2.41%

0.00%

0.00%

% of MCW Faculty at Reporting Community Engagement ActivitiesFaculty- Emeritus Faculty - Term Faculty - Part-Time Faculty - Full-Time

Faculty - Total

Community Engaged Faculty Data

Of the 658 MCW faculty members who submitted survey responses, 42.86% reported community-engagement activities over the past 12 months. These community engaged faculty represented 17.80% of all MCW Faculty who were included in the survey distribution, both reporting and non-reporting.

SNA of HWPP Funding Years 2009-2013MCW C-A Partnerships

SNA of HWPP Funding Years 2005-2008MCW C-A Partnerships

Research on Past and Current Community-Academic Partnerships

Social Networking AnalysisPreliminary Visualization of Funding Cycles: Projects and Partners

Community Partners• Dryhootch• Marquette University• Mental Health America• UW-Milwaukee• Edgewood College• Waukesha Technical College• VA (Linked in this project

through jointly appointed faculty at MCW)

UW-Milwaukee is a partner in 3 other projects

Marquette is a partner in 4 other projects

DryHootch iPeer: A Social & Technology Support Program for Veteran Mental HealthImprove access to trained peer mentor support for younger veterans at risk for mental

health problems on college campuses using a combination of face-to-face and smartphone interventions.

Translational Partnership Projects

Community Engagement Landscape

Qualitative Content Analysis of 109 final reports from community-academic partnerships written for the Healthier Wisconsin Partnership Program.

Used method described by Altheide (1): Familiarization with the context of the information source.

Familiarization with 6-10 relevant examples and select a unit of analysis

List several items or categories to guide data

Test the protocol by applying it to several documents

Revise the protocol following the testing of additional cases

Attributes of Successful Community-Academic Partnerships

Attribute Definition

Community Involvement

Involvement of the community in projects outside of the partnerships including references to using surveys as a means of engagement.

Collaboration Explicit or implied references to work or accomplishments completed in collaboration.

Communication All items related to communication including written, verbal and the physical translation of documents.

Relationship-Building

Aspects of the partnership that relate to trust and respect.

Attributes of Successful Community-Academic Partnerships – cont’d

Attribute Definition

Best Practices Partnerships describing the use of peer-reviewed material including the use of evidence-based tools.

Clarity Aspects of project that need clarification or insight gained as a result of something that occurred during the process of the project.

Strategic Planning

Partnerships developing a plan or objectives gained from information gathered during the process of the project. Strategic planning may include the use of an “advisory committee.”

Potential Challenges of Community-Academic Partnerships

Potential Challenge

Definition

Sustainability Continuing at least a portion of the project after the grant has concluded.

AdministrationAdministrative aspects of the partnership including aspects of human resources, budgeting, and finance.

Adjustment to Plan

Making adjustments from the original partnership plan or proposal. “Adjustment of the Plan” differs from an adjustment due to a strategic plan process.

Time All aspects related to time.

Science Café SeriesScience and a Healthier You, Spring 2013

Scientific and Health Literacy Areas

Mean Post-Scores

(N= 141) s.d.

Mean Retrospective

Pre-Scores (N=141) s.d.

Difference (95% CI)

I am confident in my…

Ability to talk about [today’s Science Café topic] with a health care provider 6.2* 0.9 5.5 1.5 .70

Ability to tell what information is trustworthy or not on [this Science Café’s topic] 6.1* 1.1 5.4 1.5 .65

Ability to find other sources of information on [this Science Café’s topic] 6.2* 1.1 5.7 1.4 .52

Ability to speak to a scientist or a health researcher 6.2* 1.1 5.6 1.5 .60

General understanding of the methods used by scientists 6.0* 1.1 5.5 1.5 .50

Table 3. Mean and Standard Deviations for Scientific and Health Literacy Areas. The following table outlines the means, standard deviations and difference values between pre-Café ratings and retrospective pre-ratings for each of the self-reported measures of scientific and health literacy*Paired samples t-test: statistically significant at p< .001, one-tailed Scale of 1=low to 7=high

• Increase in self-rated confidence in scientific and health literacy on the topic post Science café • No difference between repeat and new attendees• Continue to use scale to evaluate impact of Science Café on attendees self-reported confidence in scientific and

health literacy

Conclusion

Community Engagement is as much as an art as it is a science.

“When facing a difficult task, act as if it is impossible to fall. When going after Moby Dick, bring along the tartar sauce.”—Anon

Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has.-- Margaret Mead