This document summarizes the Community Health Assessment (CHA) project curriculum implemented by the University of Minnesota Rural Physicians Associate Program (RPAP). The CHA project, required since 2004, aims to improve the health of a specific population through community engagement. Students complete CHA proposals, implementation, and evaluations during their 9-month rural clinical placements. While most students find the projects valuable, some challenges exist around project continuity, expectations, and impact. The discussion explores experiences engaging students in authentic community partnerships and themes around CHA curriculum.

1. Community Health Assessment Project
Curriculum in a Rural LIC
Kathleen
D.
Brooks
MD,
MBA,
MPA
Nancy
Baker,
MD
University
of
Minnesota
Rural
Physicians
Associate
Program

2. Faculty Presenter Disclosure Slide
• Faculty:
Kathleen
Brooks
• RelaAonship
with
Commercial
Interests:
None

3. hFp://www.flickr.com/photos/jimbrekke
hFp://www.flickr.com/photos/jpellgen/

4. Presentation Outline
• Review
of
the
Univ.
of
MN
RPAP
program’s
Community
Health
Assessment
(CHA)
curriculum
• Summarize
2011-­‐2012/2012-­‐2013/2013-­‐2014
CHA
projects
• Student
feedback
on
the
value
of
CHA
projects
• Themes
&
conundrums
generated
by
the
CHA
requirement
• A;endee
experience
with
collaboraAons/curricula
that
facilitate
medical
student
engagement
with
the
community.

5. RPAP Description
• 43
yo
rural
distributed
model
longitudinal
integrated
clerkship
(LIC)
• 30-­‐40
3rd
year
med
students
spend
9
mo
in
a
rural
seYng,
typically
one
student
per
community
• Designed
to
nurture
interest
in
rural
medicine
&
primary
care
• Students
complete
requirements
for
core
clerkships
• On-­‐line
curriculum
organized
w/web-­‐based
resources
• CHA
project
required
since
2004

8. Rationale for Community Health
Assessment Curriculum
• Comprehensive,
care
in
the
context
of
family
and
community
• NuYng’s
COPC
“roadmap”
• Rhyne’s
emphasis
on
partnership
• Bonafede
at
Dartmouth,
&
McIntosh
at
the
Univ.
of
Rochester,
incorporated
CHA
into
1
month
FM
clerkships
• The
social
mission
of
Academic
Medical
Centers
• The
Ame
is
right
to
bridge
clinic
and
community
to
improve
health
NuYng
‘90;
Rhyne
‘98;
Bonafede
‘09;
McIntosh
’08
Gourvitch
‘14

9. RPAP CHA Curriculum
• States
goal
is
to
improve
the
health
of
a
specific
populaAon
• Provides
links
to
CHA
references
&
the
COPC
process
• Describes
health
status
indicators
• Lists
resources
w/current
data
on
health
dispariAes
• Promotes
teamwork
• Emphasizes
access
to
care,
prevenAon,
lifestyle
modificaAon
• Focuses
on
measurable
outcomes
• Grading
based
on
presentaAon
of
data,
stakeholder
involvement,
implementaAon,
evaluaAon
&
lessons
learned

10. RPAP CHA Project Timeline
• September:
RPAP
orientaAon
• October:
Students
define
populaAon
and
idenAfy
an
issue
• November-­‐December:
RPAP
faculty
discuss
CHA
project
ideas
during
CS
1
visits;
promote
partnership(s)
• January:
CHA
project
proposals
due
• February-­‐May:
CHA
project
implementaAon
and
evaluaAon
• May:
CHA
project
summary
due
• June:
CHA
project
poster
session

12. 2011-2104 RPAP Community Health
Assessment Project Categories
Lifestyle
Teen
Health
Health
Care
Access
PrevenAon
End-­‐of-­‐Life
Chronic
Disease
Maternity
Mental
Health
17
9
9
8
5 5
33
13

13. “My
preceptor
Suzy
Human
with
me
demonstraNng
making
a
low
fat
Caesar
salad
at
the
InformaNon
Session”
USDA
Food
Desert
Map
LI
=
Low
Income
LA
=
Low
Access
to
Food
Taken
from
USDA
Economic
Research
Service
InteracAve
Atlas
Healthy
Cooking
for
Healthy
CommuniAes

14. Adolescent
Sexual
Health

15. Culturally
Competent
Care
for
the
Amish

16. “Overall Value in Completing CHA on My
60
50
40
30
20
10
0
Very
Helpful
Helpful
Adequate
Not
Helpful
2011/2012
2012/2013
2013/2014
Learning”

17. CHA Project Student Feedback
• “I
do
feel
I
provided
a
good
service
in
the
HS
with
my
CHA.”
• “I
loved
it
even
though
I
didn’t
expect
to.”
• “The
real
value
in
this
project
isn’t
just
in
changing
the
community;
it
lies
in
learning
how
to
effect
change
in
a
system.”
• “I
was
able
to
become
invested
in
the
community
through
my
CHA
project
and
know
I
was
a
large
part
of
geYng
‘Project
Can-­‐Do’
off
the
ground.”
• “Time
spent
on
the
CHA
project
takes
away
from
your
other
rotaNons
and
adds
stress.”
• “I
think
the
CHA
should
be
an
elecAve…
or
allow
the
students
to
perform
QI
iniNaNves
within
the
clinic
or
hospital.”

18. CHA Project Evaluation Conundrums
• CHA
project
outcomes
vs.
learning
outcomes
• Learning
from
failure
• ExpectaNons
when
2
students
work
together
• Is
there
greater
depth,
or
breadth?
• Project
locaNon
issues
• Clinic
(CQI
acAvity)
vs.
community
based
• Projects
which
reflect
too
much
vs.
too
li;le
effort
• What
amount
is
“just
right?”
• 15%
of
their
overall
RPAP
grade

19. CHA Project Programmatic Conundrums
• Succession
challenges
• Community
vs.
student
expectaAons
for
conAnuaAon
• Research
issues/need
for
IRB
approval
• Funding
• AddiAonal
opportuniAes
for
presentaAon
and
publicaAon
• Community
percepNon
of
the
value
• Need
for
sensiAvity
regarding
being
“used”
for
educaAon
• Does
this
work
improve
the
health
of
the
community?

20. Unanswered CHA Project Questions
• How
does
a
CHA
project
impact
the
learner
long-­‐
term?
• Does
a
+
(or
-­‐)
CHA
project
experience
affect
student’s
specialty
selecAon,
or
future
engagement
in
community
&
public
health
iniAaAves?
• Do
the
preceptors,
communiAes
&
health
systems
with
whom
we
collaborate
perceive
the
students’
work
on
CHA
projects
to
be
of
value?

21. Conclusion
• CompleAon
of
a
CHA
project
by
3rd
year
medical
students
on
a
9
mo.
LIC
facilitates
community
engagement
&
collaboraAon
• Students
glean
saAsfacAon
from
partnering
with
community
stakeholders
• CHA
curricula
within
the
context
of
longitudinal
clinical
clerkships
prepares
medical
students
to
provide
opAmal
care
to
paAents
in
the
context
of
family
and
community.

22. Discussion
• What
has
been
your
experience
engaging
medical
students
in
authenAc,
self-­‐directed
community
partnerships?
• What
addiAonal
themes
and/or
conundrums
have
you
seen
emerge?
• Any
other
comments
or
quesAons?

23. Bibliography
1. NuYng,
Paul
A.
Community-­‐oriented
primary
care:
from
principle
to
pracAce.
Albuquerque
:
University
of
New
Mexico
Press,
1990.
2. Rhyne,
Robert.
Community-­‐oriented
primary
care
:
health
care
for
the
21st
century.
Washington,
DC
:
American
Public
Health
AssociaAon,
1998.
3. Bonafede
K,
Reed
VA,
Pipas
CF.
Self-­‐directed
community
health
assessment
projects
in
a
required
family
medicine
clerkship:
an
effecAve
way
to
teach
community-­‐oriented
primary
care.
Fam
Med.
v.
41(10):
2009.
4. McIntosh
S
et.
al.
Training
medical
students
in
community
health:
a
novel
required
fourth-­‐
year
clerkship
at
the
University
of
Rochester.
Acad
Med.
v.
83(4):
2008.
5. Halaas
GW
et.
al.
Recruitment
and
retenAon
of
rural
physicians:
outcomes
from
the
rural
physician
associate
program
in
Minnesota.
J
Rural
Health.
v.
24(4).
2008.
6. Gourevitch,
Marc
N.
“PopulaAon
Health
and
the
Academic
Medical
Center:
the
Time
is
Right.”
Acad
Med.
v.
89(4):
2014
7. Hunt
JB
et
all.
“Understanding
the
Goals
of
Service
Learning
and
Community-­‐Based
Medical
EducaAon:
A
SystemaAc
Review.”
Acad
Med
v.
86(2).
2011..