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    Academic Medicine Academic Medicine Document Transcript

    • Community-Based EducationUsing Service-Learning to Teach CommunityHealth: The Morehouse School of MedicineCommunity Health CourseAyanna V. Buckner, MD, MPH, Yassa D. Ndjakani, MD, MPH, Bahati Banks, MBA,and Daniel S. Blumenthal, MD, MPHAbstractMedical education is evolving to include Health Course (CHC) that entails The authors describe the course andmore community-based training conducting a community health needs offer data from the course’s past 11opportunities. Most frequently, third- assessment and developing, years. Data include the types ofand fourth-year medical students have implementing, and evaluating a collaborating community sites, theaccess to these opportunities. However, community health promotion community health issues addressed, andintroducing community-based learning to intervention. In teams, students conduct the interventions implemented andmedical students earlier in their training health needs assessments in the fall, and evaluated. The MSM CHC has providedmay provide a more formative experience in the spring they develop interventions students with an opportunity to obtainthat guides their perspectives as they in response to the problems they hands-on experience in collaboratingenter clinical clerkships. Few known identified through the needs with diverse communities to addresscourses of this type exist for first-year assessments. At the end of each community health. Students gain insightmedical students. semester, students present their findings, into how health promotion interventions outcomes, and policy recommendations and community partnerships can improveSince 1998, the Morehouse School of at a session attended by other students, health disparities. The MSM CHC is aMedicine (MSM) has required first-year course faculty, and community model that other medical schools acrossstudents to take a yearlong Community stakeholders. the country can use to train students.Medical school curricula are incorporate community concerns into engaging in risky behaviors.9 The changesconstantly evolving to prepare young health care delivery. In recent years, in the provider occur through thephysicians-in-training to be able to medical educators have placed more combination of service tasks and structuredprovide high-quality health care within attention on equipping medical students opportunities that link the service task todynamic medical systems that often and residents with the tools to self-reflection, self-discovery, and thestruggle to balance care for poor and incorporate the community in their acquisition and comprehension of values,underserved communities with economic delivery of primary health care.1–5 skills, and knowledge content.solvency. In this context, teaching However, medical curricula are still notmedical students community medicine fully adequate for preparing students to Recognizing the significance of service-means teaching them to employ public meet the demands that they will face in learning in medical education, the Liaisonhealth approaches while caring for serving poor, underserved communities. Committee on Medical Education (LCME)individuals. Students do not learn revised its accreditation standards in Julythrough traditional curricula to 2008 to include a new standard on service- One approach to teaching future clinicians learning, stating that medical schools the skills they need to serve communities is should not only make available sufficient “service-learning.”6,7 Service-learning is aDr. Buckner is assistant professor, Department of opportunities for medical students to teaching and learning strategy thatCommunity Health and Preventive Medicine, participate in service-learning activities butMorehouse School of Medicine, Atlanta, Georgia. integrates meaningful community service also encourage and support student with instruction and reflection to enrichDr. Ndjakani is assistant professor, Department of participation.10 The LCME suggests thatCommunity Health and Preventive Medicine, the learning experience, teach civic medical schools provide information aboutMorehouse School of Medicine, Atlanta, Georgia. responsibility, and strengthen available service-learning opportunities,Ms. Banks is a staff member, Office of Institutional communities. Service-learning combines develop service-learning opportunities inAdvancement & Marketing and Communications, service objectives and learning objectives partnership with relevant communities,Morehouse School of Medicine, Atlanta, Georgia. with the intent that the activity will change offer students credit for participating inDr. Blumenthal is professor, Department of both the recipient and the provider of the service-oriented activities and courses, andCommunity Health and Preventive Medicine, service. Research has shown that students hold presentations or public forums toMorehouse School of Medicine, Atlanta, Georgia. engaged in service-learning showed an highlight and recognize service-learningCorrespondence should be addressed to Dr. increase in the degree to which they feltBuckner, Morehouse School of Medicine, 720 activities.Westview Drive, SW, NCPC Suite 335-C, Atlanta, GA aware of community needs, believed they30310-1495; telephone: (404) 752-1517; fax: (404) could make a difference, and were Learning the tools of community health752-1160; e-mail: abuckner@msm.edu. committed to service in the future,8 and needs assessment and health promotionAcad Med. 2010;85:1645–1651. communities involved in service-learning and having an opportunity to exercisedoi: 10.1097/ACM.0b013e3181f08348 have shown decreased numbers of people these skills can prepare students toAcademic Medicine, Vol. 85, No. 10 / October 2010 1645
    • Community-Based Educationdeliver care to communities as well as populations in Georgia and across the and evaluating a health promotionindividual patients.2 Community health nation and to address primary health care intervention. Spring lectures also addressneeds assessments are used to identify the needs through programs in education, the relationship between public health andstrengths and needs of the community, to research, and service. MSM requires the public policy.establish community health priorities, Community Health Course (CHC) for alland to facilitate collaborative action first-year medical students. Originally Groups of 10 to 14 students and twoplanning directed at improving taught as a series of individual, discrete faculty facilitators are assigned tocommunity health status and quality of classroom lectures, it became a community sites at the start of eachlife.11 Some examples of community community-based service-learning course academic year. Classes occur athealth needs assessment tools include in 1998.16 The course engages first-year community sites that the facultyfocus groups and surveys. Health medical students, faculty members, and facilitators of each small group havepromotion is the process of enabling community-based organizations in selected either through their own priorpeople to increase their control over and service-learning and community service. experiences or through referrals fromimprove their own health.12 We believe other faculty members or communitythat educating physicians early in their contacts. Faculty select sites on the basistraining and giving them an opportunity The CHC at MSM of each site’s involvement with andto practice their skills in a service The CHC is a two-semester course that commitment to low-income andenvironment may be one factor leading provides students with the opportunity to underserved populations, the site’sto the greater incorporation of public analyze the health, health problems, geographic location (located inhealth in health care delivery. Whereas and the delivery of health services in metropolitan Atlanta), the sitestudents learn primary care medicine in underserved communities. The course’s administration’s willingness to facilitatemedical school, exposure to community topics of study comprise community health involving its staff and the community itsettings is often sparse in the first two analysis, health-related behavior, and serves in the health needs assessment andyears of medical education, which are community health promotion. intervention, the availability of alargely focused on the basic sciences. We Instructional methods include hands-on community liaison who can serve as afeel that early exposure to or familiarity community activities in a small-group primary contact for the course facultywith community medicine may inspire setting, group discussions, reading and and students, and the availability of on-more physicians to specialize in primary writing assignments, and introductory site weekly meeting space for the coursecare or community medicine or to lectures. Students receive classroom faculty and students. Each site’sintegrate community-based medicine instruction in two 3-hour sessions at the community liaison agrees to work withprinciples into their chosen specialty. beginning of each semester. As a the faculty facilitators and students for foundation for the health promotion the entire year. These community liaisonsSome medical trainees have the activities in the course, the two fall lectures may be, for example, a school principalopportunity to participate in community focus on viewing the community as a or guidance counselor or the director orexperiences in their clinical clerkships, in patient (“Clinical Community Health”) program manager of a communityelectives during the third and fourth and review theory on how the physician organization. The faculty facilitators areyears of medical school, or through will diagnose and treat the patient, that is, health professionals with experience inresidency programs.13–15 However, few the community. This CHC conceptual community health. At least one facilitatorcourses of this type exist for preclinical framework is the converse of the well- in each group has an MD degree, and themedical students, and studies that known “community-oriented primary other has a PhD or a master’s degree indocument the immersion of medical care” model, which uses public health public health or a related discipline.students in the community during the concepts to guide the actions offirst two years of their training are lacking clinicians.17,18 In the CHC clinical concepts Small-group instruction emphasizesin the literature. The purpose of this guide the actions of students engaged in the access and barriers to health services,article is to describe a novel course that practice of public health. That is, students team collaboration, project evaluation,both uses the service-learning construct gather subjective and objective data, community service, health promotion,to expose preclinical medical students to compile a problem list, and formulate and and disease prevention. Each week,the community setting and allows carry out a therapeutic plan, all in the students meet for a three-hour sessionstudents to analyze the health problems manner of a clinician treating a patient.16 at their assigned community sites toof the community and to design and To prepare students to adapt evidence- complete course objectives. The courseimplement an intervention to address based health promotion activities for their meetings are factored into the students’identified community problems. communities, fall lecture topics also include curriculum schedule and do not interfere performing searches of the medical with the time that students spend in theirMorehouse School of Medicine (MSM) literature and instruction on critiquing other required courses. Students arewas founded to train students for careers articles. For the remainder of the fall responsible for arranging and organizingas primary care physicians who will semester, students use a team-based their weekly course activities (coursepractice in medically underserved areas approach for the community assessments activities described below), while facultyamong populations of minorities and/or and the required presentations (Table 1). In leaders serve as group facilitators, guidingpopulations with low socioeconomic the spring semester, students receive groups toward completion of weeklystatus. MSM’s curriculum reflects the instruction on writing program objectives, tasks. In addition to completing theinstitution’s commitment both to on constructing and understanding logic actual assessment activities in the fallsupport the underserved urban and rural models, and on designing, implementing, semester and implementing the1646 Academic Medicine, Vol. 85, No. 10 / October 2010
    • Community-Based Education measurable, achievable, relevant, andTable 1 time bound. As with the needsTimeline of the Community Health Course at the Morehouse School of Medicine assessments, creativity is paramount in designing interventions at sites that haveTiming Activity or activities—Students… been long-standing community partners.Fall semester......................................................................................................................................................................................................... Because students must design aWeeks 1–3 ѧ attend lectures community intervention based on their.........................................................................................................................................................................................................Weeks 4–5 ѧ begin meeting at community site and conduct key informant needs assessment, they may not merely interviews continue the work of previous students..........................................................................................................................................................................................................Weeks 6–8 ѧ conduct focus group interviews and plan surveys If the needs assessment dictates an.........................................................................................................................................................................................................Week 7 ѧ submit their journal critiques expansion on previous students’ work,......................................................................................................................................................................................................... the faculty facilitators challenge theWeeks 8–9 ѧ conduct their surveys and start their community engagement activities students to be creative in designing an.........................................................................................................................................................................................................Weeks 10–11 ѧ conduct their data analyses and share the results of their needs intervention that is unique yet effective in assessment with community liaisons and leaders meeting the community’s needs. Students.........................................................................................................................................................................................................Weeks 12–13 ѧ prepare their presentations and papers also design an evaluation of their......................................................................................................................................................................................................... intervention. In most instances, theyWeek 13 ѧ submit their papers......................................................................................................................................................................................................... use brief pretest and posttest surveys toWeek 14 ѧ give their presentations to course faculty, community stakeholders, assess knowledge change, but faculty and other students encourage students to also collectSpring semester satisfaction and/or process data..........................................................................................................................................................................................................Week 1 ѧ attend lectures Chart 1 provides a sample student.........................................................................................................................................................................................................Weeks 2–12 ѧ plan and revise their interventions needs assessment and intervention.........................................................................................................................................................................................................Weeks 2–13 ѧ conduct community engagement activities from the MSM CHC..........................................................................................................................................................................................................Weeks 6–13 ѧ conduct their community interventions.........................................................................................................................................................................................................Weeks 14–16 ѧ conduct their data analyses and prepare their final papers and Student Assessment presentations.........................................................................................................................................................................................................Week 16 ѧ submit their final papers and give their presentations to course Faculty facilitators assess student learning faculty, community stakeholders, and other students and service through multiple-choice examinations, fall and spring semesterintervention activities in the spring them the opportunity to make subjective group papers, fall and spring semestersemester, the students spend weekly and objective evaluations that include presentations, class participation, andcourse time planning these activities. descriptions of the community and any completion of a reflection journal. AllDuring the weeks of planning, dedicated evidence of trends, stability, or changes students in the group receive the samecourse time also allows the students to that may contribute to the health of the grade for the group papers andinteract with community representatives population. Other fall semester activities presentations, but students receiveand provide community service. In the include student-conducted key informant individual grades for class participation,CHC, we refer to these interactions with interviews, (i.e., interviews with integral journal entries, and their performance onthe community and/or community community stakeholders) and, usually examinations. Students complete threerepresentatives as “community following these, focus groups and reflection journal entries each semester;engagement activities.” As a group, the community surveys. Although all in each journal entry, they answerstudents determine the focus of their students in the course must complete predetermined questions (e.g., “Describecommunity engagement activities; the the same components of the needs your experience at your community site,”focus is largely site dependent. For assessment, faculty facilitators encourage “What were your initial perceptions?”,example, groups assigned to schools or them to be creative in their approach to “What are some of the generalafter-school programs frequently doing so. Sometimes students collect stereotypes or misconceptions you’veparticipate in tutoring. In keeping with other information—for instance, had?”, and “Has your experience at yourthe principles of service-learning,6 the anthropometric (i.e., height and weight) site supported or refuted thesestudents reflect on their experiences data on elementary school children. stereotypes?”). Faculty facilitators readthrough scheduled journal entries and the reflection journals of the students ingroup discussions. Students continue working in their small their group. Although the students do groups at community sites during the not receive subjective comments on theirTable 1 provides a timeline of course spring semester, planning, implementing, responses, they do receive a gradeactivities. During the fall semester, faculty and evaluating a health promotion (complete or incomplete) for answeringfacilitators guide students through intervention that addresses one or more the questions. The multiple-choicethe community needs assessment of the community health issues identified examinations take place once permethodology by engaging the students in during the fall semester. The students semester and are based on thea variety of assessment activities. The begin by revisiting the needs assessment introductory lectures that studentsassessment begins with a “windshield to determine components for their spring receive at the start of each semester.survey”—that is, the students conduct a intervention. They write objectives for Lecturers submit three to four questionsvisual assessment while they drive the intervention, using the SMART per lecture. The two faculty facilitatorsthrough the community. The drive allows model: Their objectives must be specific, assigned to each group decide theirAcademic Medicine, Vol. 85, No. 10 / October 2010 1647
    • Community-Based Education first-year medical students that included Chart 1 a focus on biostatistics, epidemiology, Sample Student Needs Assessment and Intervention From the Morehouse and health disparities. It included lectures School of Medicine Community Health Course given by MSM faculty and faculty from the Centers for Disease Control and Needs assessment Prevention. In 1991, MSM received a Community site: grant from the W.K. Kellogg Foundation Local church to expand this course. The grant proposal Windshield survey*: was written based on the Area Health Conducted in a 10-mile radius of the church Education Centers (AHEC) program Key informant for key informant interviews: model, which included partnerships • Priest between medical schools and • Health ministry leaders communities. AHEC’s mission is to enhance access to quality health care, • Teen group advisors particularly primary and preventive care, • Deacon by improving the supply and distribution of health care professionals through • Lay members (e.g., president of the church parish council, president of the men’s community/academic educational group, member of the committee that developed the church’s strategic vision, partnerships.19 The U.S. Congress member of the senior citizen’s group) developed the AHEC program to recruit, train, and retain a health professions Focus group: Two conducted: One group with adults and one group with teens workforce committed to underserved Survey: populations.20 With the support of the Distributed to all parishioners at morning church service and midday church service W.K. Kellogg Foundation grant, the course designers created the original Intervention iteration in conjunction with faculty and Wellness initiative: students from local nursing schools, a Entitled “A New Year, A New You” theological center, and a school of social • Nutrition and exercise intervention: Part 1—focused on healthy cooking and work. Although its interdisciplinary exercise demonstrations (conducted at Week 7) nature was a strength, the course • Teen conference focused on coping with stress and healthy communication experienced several challenges, including (conducted at Week 9) the difficulties of identifying community faculty who could design educational • Nutrition and exercise intervention: Part 2—focused on the spiritual basis of lectures of graduate school quality, healthy eating, a healthy promotion scavenger hunt, and a healthy food potluck coordinating multiple presentations (conducted at Week 10) while avoiding redundant material, and identifying community presenters who understood the course’s relevance to* A windshield survey is an activity during which students drive through the community whose needs they plan to medical school education. In 1998, assess in order to observe and do an initial observation-only-based assessment. the course coordinator and faculty redesigned the course using the service- students’ participation grades through • a summary of the leading health-related learning construct and emphasizing the consensus. Participation grades are based community concerns including the training of only medical students. The on weekly attendance, contribution to consequences of these public health redesigned course received funding weekly discussions and course activities, concerns and the local resources from the Corporation for National and and interaction with colleagues and available to the community Community Service. Group leaders are community partners. All 10 to 14 primarily faculty from the Department of students in a group contribute to the Community Health and Preventive The spring semester papers and group papers, but they are divided into Medicine. Over the years, the course presentations offer descriptions and smaller subgroups of two or three faculty has expanded to include one evaluations of the student-conducted students for the presentations. The faculty member from the MSM interventions. Each semester, the students papers are limited to 3,000 to 3,750 Department of Pediatrics who has give their presentations (of 20 minutes, words, excluding tables, figures, and extensive community-based experience followed by a 5- to 10-minute question- appendices. All of the fall papers and and several staff members from public and-answer period) to an audience presentations include a description of the health organizations such as the Centers composed of other students, course faculty, community needs assessment and detail for Disease Control and Prevention. and community stakeholders. • community demographics and assets, A Review of the Community • morbidity and mortality data, Development of the Program Projects • socioeconomic factors that impact As in most U.S. medical schools, MSM In the first 11 years of the CHC (1999 – health, and had a required lecture-based course for 2010), over 500 students conducted 56 1648 Academic Medicine, Vol. 85, No. 10 / October 2010
    • Community-Based Educationcommunity interventions—all in community partners to improve their both integral parts of the CHC—alsometropolitan Atlanta, Georgia. The health. address the Healthy People Curriculumstudents established partnerships with the Task Force’s Community Aspects ofAtlanta Housing Authority, the Boys and A CHC can also expose medical students Practice component,22 which is designedGirls Club of Metro Atlanta, Atlanta to the common health issues (e.g., poor to reflect both clinical prevention andPublic Schools (grades K–12), Headstart, nutrition/obesity, substance abuse, and a population health.and other smaller grassroots organizations lack of sexual health education/resources)(e.g., churches and neighborhood experienced by adults, adolescents, and Service-learning opportunities forgroups). The two leading health children in various communities. Many medical students are becoming moreproblems the students identified through of the problems the students diagnose common; as mentioned, the LCME nowtheir health needs assessments were the each semester also mirror the leading mandates that they be made available forprevalence of violence and substance health indicators associated with Healthy students who wish to experience them.abuse (usually identified as comorbid by People 2010.1,21 These indicators reflect MSM’s CHC differs from most of thesethe community and thus considered a the major health concerns in the United in that it is required of all first-yearsingle problem in this analysis [12 States at the beginning of the 21st students (rather than offered as anassessments]) and the lack of community century. These concerns are important elective) and thus introduces all students,development (including unemployment, public health issues, and their significance including those who would not havedeteriorating housing, and lack of as relevant health disparities is reflected pursued it otherwise, to a communitysecurity [12 assessments]). Other leading by the fact that the students ascertained health experience. Further, wherehealth problems identified in the health the necessity for interventions for similar required courses or clerkships do exist,needs assessments included low literacy problems each year. either they focus on “communityrates (10 assessments), obesity and diagnosis” alone24 (or conversely, theynutrition (8 assessments), chronic Several organizations, including the require a community project without thediseases such as asthma (8 assessments) Association of American Medical needs assessment component25) or they areand hypertension (3 assessments), and Colleges (AAMC), the Healthy People classroom-based courses that are closelyadolescent sexual health (3 assessments). Curriculum Task Force convened by the tied to epidemiology and traditionalInterventions included educational Association for Prevention Teaching and population health experiences.26 We are notprograms, health fairs, and policy Research (formerly the Association of aware of any other required course in a U.S.initiatives. Some examples of Teachers of Preventive Medicine), and or Canadian medical school that providesinterventions include dental, physical the Association of Academic Health the full spectrum of communityfitness, and parent education workshops, Centers, have delineated standards for assessment, intervention, and evaluationtutoring sessions to address the low integrating population health into the for first-year medical students.literacy levels, and sexual health training of health professions students.22,23education workshops for teenagers. No The AAMC has asserted that physicians Over the span of the CHC, thedata are available regarding the effect of must collaborate with other health partnerships with the community havethe CHC on student perceptions during professionals and individuals enabled us to mobilize more than 500clinical preceptorships or after graduation; representing a wide variety of community medical students to address the healthhowever, anecdotal experience and agencies to use systematic approaches disparities of underserved youth andinformal feedback suggest that students for promoting, maintaining, and adults by providing responsive healthrefer to their CHC experience if/when they improving the health of individuals and promotion intervention projectschoose primary care residencies and that populations.23 Through participating in throughout metropolitan Atlanta.many graduates integrate community the CHC, MSM students collaborate both Each year, the community sites haveservice into their practice. with peers and with community members responded very favorably to the students. and work with a team. We feel that Community sites typically return each through the course they learn skills that year to participate in the program, evenThe Significance of Preclinical ease their transition into clinical rotations though none of the sites, communityCommunity Health Training as upper-level medical students and members, or administrators receiveThis description of the CHC and review residents, and we hope they will gain compensation or honoraria forof the first 11 years of CHC data suggest proficiencies that may help them participating. Existing organizations (i.e.,that a medical school course focused on function better as physicians as the parent auxiliaries and parent–teachercommunity health and service-learning medical model moves toward organizations at schools) at thecan expose students to community needs multidisciplinary approaches to patient community sites have soughtassessments and health promotion management. By performing needs opportunities to collaborate with theinterventions in a variety of community assessments and designing interventions students, frequently scheduling theirsettings. When incorporated into the for underserved communities, students activities to coincide with the student-medical school curriculum, a CHC can in the CHC address the AAMC’s planned interventions. The communityprovide an opportunity for medical objective that medical students sites receive, at no cost, the results of thestudents to obtain hands-on community understand the economic, social, and community needs assessments, and theyengagement experiences. These courses cultural factors that contribute to the benefit from an intervention designed bycan provide medical students with the conditions that impact health.23 The students in response to that assessment,knowledge and skills to assess the health assessments of community needs and but they receive no financial benefitsof the community and to collaborate with strengths as well as the interventions— other than the nominal budget ($500 –Academic Medicine, Vol. 85, No. 10 / October 2010 1649
    • Community-Based Education$600) that each group uses to support the consideration. Although effective and 5 Carney JK, Hackett R. Community–academicassessments and interventions. easily implemented educational programs partnerships: A “community-first” model to teach public health. Education for Health. such as this course may contribute to 2008;21(1). Available at: http://www.educationWe feel that MSM students and faculty improving the education of future forhealth.net/publishedarticles/article_print_serve as role models to the youth and physicians, further study is needed to 166.pdf. Accessed June 10, 2010.young adults in the community; for assess student and community 6 Seifer SD. Service-learning: Community–example, for more than four years, perceptions of the course as well as its campus partnerships for health professions education. Acad Med. 1998;73:273–277.students in the CHC have implemented a long-term effectiveness. Additional 7 Mohan CP, Mohan A. HealthSTAT: Aseries of life skills, substance abuse, and research is also needed to investigate the student approach to building skills needed tosexual health education workshops for impact that the CHC has on community serve poor communities. J Health Care Pooryouth who live in public housing. health status, the continuity or Underserved. 2007;18:523–531.Following the end of the course, some of sustainability of student interventions, 8 Melchior A. Summary Report: National Evaluation of Learn and Serve America.the medical students have continued the specialties chosen by CHC medical Waltham, Mass: Brandeis University, Centertheir relationships with the youth whom students, the types of communities in for Human Resources; 1999. Available at:they mentored. We also hope that which they choose eventually to practice, http://www.learnandserve.gov/pdf/lsa_community partners feel more and the degree to which they use the evaluation.pdf. Accessed July 6, 2010.empowered to make health decisions and knowledge and skills gained from their 9 Kirby D. Emerging Answers: Research Findings on Programs to Reduce Teento become advocates for their own health. CHC experiences. Pregnancy. Washington, DC: NationalEvaluations from student interventions Acknowledgments: The authors wish to thank Dr. Campaign to Prevent Teen Pregnancy; 2001.reveal short-tem behavior changes such Meryl McNeal and the staff of the Center for 10 Liaison Committee on Medical Education.as increased physical activity and making Community Health and Service-Learning at the LCME Accreditation Standards. IS-14-A. Available at: http://www.lcme.org/functionslist.healthier food choices. We hope that Morehouse School of Medicine. The authors also htm. Accessed June 10, 2010.these behaviors continue in the long wish to thank Dr. George Rust and the staff in the 11 Manitoba Health. Community Health Needsterm. Through the course, MSM has Faculty Development Program at the Morehouse Assessment Guidelines. Available at: http:// School of Medicine.strengthened its partnerships with www.chssn.org/En/pdf/networking/Atlanta community organizations and Funding/Support: The Morehouse School of community%20health%20assessment.pdf. Medicine Community Health Course has been Accessed July 2, 2010.remains poised to respond to the 12 World Health Organization. Ottawa Charter funded in part by the W.K. Kellogg Foundationdeveloping needs of the community. and the Corporation for National and for Health Promotion. First International Community Service. Conference on Health Promotion. Ottawa, 21 November 1986 –WHO/HPR/HEP/95.1.CHC Funding and Support Other disclosures: Dr. Blumenthal serves on the Available at: http://www.who.int/hpr/NPH/ board of directors of the Southeastern Primary docs/ottawa_charter_hp.pdf. Accessed July 2,The course is faculty-intensive; at least Care Consortium/Atlanta Area Health Education 2010.eight faculty members devote a half-day Center, which provided some financial support 13 Andrus NC, Bennett NM. Developing annearly every week to it. Institutional (i.e., for the course. He receives no compensation for interdisciplinary, community-basedMSM) support has been important, and serving on this board. education program for health professions students: The Rochester experience. Acadgrant funding from the Corporation for Ethical approval: The Community Health Course Med. 2006;81:326 –331.National and Community Service and the was not evaluated in this manuscript, so IRB 14 Mareck DG, Uden DL, Larson TA, ShepardU.S. Health Resources and Services approval was not obtained. MF, Reinert RJ. Rural interprofessionalAdministration (HRSA) has provided Previous presentations: The authors (A.B., Y.N., service-learning: The Minnesota experience.additional support. HRSA funds the and D.B.) gave a poster presentation with Acad Med. 2004;79:672–676. information about the Morehouse School of 15 McIntosh S, Block RC, Kapsak G, PearsonAHEC program; the MSM AHEC TA. Training medical students in communityprogram is 1 of 54 nationally. The Atlanta Medicine Community Health Course on health: A novel required fourth-year clerkship February 22, 2007, at the American College ofAHEC program has helped implement at the University of Rochester. Acad Med. Preventive Medicine “Preventive Medicine 2007”the course through support of 2008;83:357–364. meeting in Miami, Florida.community sites and by offering student 16 Blumenthal DS, Jones A, McNeal M. Evaluating a community-basedtravel (mileage) reimbursement. multiprofessional course in community References health. Educ Health (Abingdon). 2001;14: 1 Magill MK, Quinn R, Babitz M, Saffel-Shrier 251–255.Opportunities for Enhancement S, Shomaker S. Integrating public health into 17 Kark SL. 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However, the current medicine/public health initiative: The roles of Accessed June 10, 2010.economic climate makes this difficult. As preventive medicine and community- 19 National AHEC Organization. AHECmentioned, grant funding has supported responsive care. Acad Med. 1999;74:473–483. Mission. Available at: http://www.nationalahec.the course since its inception, but 4 Paterniti DA, Pan RJ, Smith LF, Horan NM, org/About/AHECMission.asp. Accessed June West DL. From physician-centered to 30, 2010.funding opportunities are becoming community-oriented perspectives on health 20 National AHEC Organization. About Us.scarcer, and greater institutional financial care: Assessing the efficacy of community- Available at: http://www.nationalahec.org/commitment has become a necessary based training. Acad Med. 2006;81:347–353. About/AboutUs.asp. Accessed June 30, 2010.1650 Academic Medicine, Vol. 85, No. 10 / October 2010
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