A New Model of Community Engaged Interdisciplinary Medical Education

ABSTRACT

TITLE:A New Model of Community Engaged Medical & Interdisciplinary Education

BACKGROUND:

Coinciding with the 100th anniversary of the Flexner Report and sweeping health care reform legislation, the Florida International University (FIU) Herbert Wertheim College of Medicine (HWCOM) is the first medical school to open in a major metropolitan area in 25 years. This occurs at a time of an increased understanding of how the social determinants of health and illness are at the root of unprecedented health inequities

OBJECTIVE:

To transform medical education to meet the needs of patients, medically underserved communities, and society based on the ACGME general competencies and an additional competency, social accountability.

METHODS:

The curriculum includes an enhanced emphasis on primary care, behavioral and social sciences, and public health; incorporating early community and clinical experiences integrated longitudinally over the four years. The signature community component, NeighborhoodHELPTM (Health Education Learning Program), is integrated with a four year family medicine clerkship. Medical, nursing, social work, and other students form inter-professional teams assigned longitudinally to neighborhoods and households in medically underserved communities. NeighborhoodHELPTM has adopted a community-based participatory approach that stresses mutual learning, capacity building and trust.

RESULTS:

The college of medicine has developed multiple partnerships including coursework integrating medical, nursing, and social work students. Twenty five affiliation agreements have been executed with local community based organizations who are referring households. Baseline community data has been collected for the outcome evaluation. Recruitment of households is underway.

CONCLUSIONS:

To fulfill the implicit social contract of medicine, the NeighborhoodHELPTM curriculum is designed to integrate students into medically underserved communities. It incorporates elements of participatory research, asset based community development, community oriented primary care, and service learning. The goal is to educate students to form inter-professional, inter-cultural, collaborative partnerships to improve the health of patients, households and communities.

NEXT STEPS:

Household visits begin in September.

BACKGROUND

•South Florida’s First Public Medical School

•Miami is one of the poorest big cities in the country

•NeighbhorhoodHELPTM is the school’s signature program

•Primary care is the vehicle for integration of curriculum across 4 years

•10:1 ratio of students to full-time NeighborhoodHELP primary care teaching faculty

David Brown, MD; Pedro “Joe” Greer, MD; Luther Brewster, PhD; Iveris Martinez, PhD; Juan Acuna, MD, MPH; Alina Perez-Stable, MSW; Virginia Harvin, RN; Joe Leigh Simpson, MD; and John Rock, MD, MPH Florida International University Herbert Wertheim College of Medicine

OBJECTIVE

To educate students to form inter-professional, inter-cultural, collaborative partnerships to

improve the health of patients, households and communities. The curriculum is

intended to transform medical education to meet the needs of patients, medically

underserved communities, and society based on the ACGME general competencies and

an additional competency, social accountability. To fulfill the implicit social contract

of medicine, the curriculum is designed to integrate students into medically

underserved communities and to develop social accountability in students and social

capital in communities.

METHODS

What is NeighborhoodHELPTM?

Health Education Learning Program

Educating future physicians and providing service to our communities through community engagement

Experiential learning opportunities that expose students to the social, psychological, and economic conditions that influence health outcomes.

Community Experiences

Community Advisory Team

Community Classrooms

Service-Learning Projects

Household Visits

Health Professions Pipeline Activities

Household Visits (Begin September 2010)

Medical students along with students from nursing, social work, law education, and other professions, are assigned to a community and a household. Medical students make monthly visits to the same household, continued longitudinally throughout their training. Students engage with household members and community organizations in health promotion service learning activities supervised by family medicine faculty (ten students per full-time faculty member).

Four Distinct Global Tasks:

1. Build a rapport with communities & households

2. Assess health, educational, social service and advocacy needs and available resources

3. Develop and help implement an action plan with the including methods for measuring success

4. Comprehensive intervention & outcome reporting

METHODS

Community Engagement Model

CONCLUSIONS

NeighborhoodHELPTM is designed to integrate students longitudinally into medically underserved communities. It incorporates elements of participatory research, asset based community development, community oriented primary care, and service learning. The goal is to educate students to form partnerships to improve the health of patients, households and communities. A door-to-door community survey will serve as a benchmark for program evaluation. Outcomes to be evaluated include costs, neighborhood indicators, as well as household assessments of health literacy, health behaviors, health care access and utilization, and other health outcomes. Student outcomes will be evaluated by a variety of tools to assess knowledge and skills and attitudes relating to cultural competency, social accountability, and inter-professional team work.

RESULTS

For additional information please contact:

David BrownDepartment of Humanities, Health & SocietyFlorida International University Herbert Wertheim College of Medicine drbrown@fiu.edu

Community Engagement

Community Organizations

Affiliation agreements with 25 organizations

Engagement activities include meeting, presentations, health fairs

Household Recruitment

Households referred by community partners

121 of targeted enrollment of 168 households completed

Academic Partner Development

Development of Household Protocols

Inter-Professional Supervision

Health Professions Core with Multiple Inter-Professional Partners

Curriculum, Medical Records Policies, HIPAA, Evaluation

Joint Curriculum Development

Inter-professional Workshop Held with Seven Disciplines

Shared Classroom Curriculum (Medicine, Nursing, & Social Work)

Benchmark Survey Preliminary Results (Data still being entered)

Multi-method Evaluation

Benchmark Survey

Process Evaluation

Household Outcomes

Student Learning Outcomes

Economic Analysis

Population Based Benchmark Survey

Household Problems

% of Households

Hypertension 80

Diabetes 41

Asthma 28

Obesity 27

Anxiety or Depression

25

Heart Disease 20

Cancer 10

Main Source of Insurance

%

Employer 44

Medicare 25

Medicaid 21

None 10

Other 11