Curriculum and Evaluation Results of a Third-Year Medical Student Longitudinal Pathway on Underserved Care
Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas 77098, USA. Teaching and Learning in Medicine
(Impact Factor: 0.66).
04/2010; 22(2):123-30. DOI: 10.1080/10401331003656611
There is a need to train compassionate and competent physicians to care for the growing underserved population in this country.
The authors developed the third-year Longitudinal Ambulatory Care Experience (LACE) Underserved Care pathway at Baylor College of Medicine in 2003 to help interested students prepare to be clinicians who care for the underserved. The pathway curriculum included seminar/journal clubs on relevant underserved care topics, clinical time with an underserved care preceptor, visits to community organizations, an assignment to help an uninsured patient obtain health care funding, and a group project. The authors report on the student evaluations of the first 4 years of the pathway, 2003 to 2007. The Institutional Review Board of Baylor College of Medicine granted this educational study exempt status.
Students highly rated each pathway component in enhancing their knowledge, skills and attitudes. For 2005 to 2007, students rated most knowledge, skills, and attitudes items more highly at the conclusion of the pathway compared to the beginning (p <.05).
The pathway has been successful in enhancing knowledge, skills, and attitudes in underserved care for its participants. Further study is needed to evaluate long-term outcomes of participants in this pathway, including practice setting, knowledge, skills, attitudes, quality of care, and ability to help patients navigate through the health care system and overcome barriers.
Available from: Heather Carnahan
- "Primary care (Helm et al. 2001; Peters et al. 2001; Pipas et al. 2004; Peleg et al. 2005; Wass 2008; Zink et al. 2008; CACE 2010) Support for the roles of general practitioners in education (Wass 2008; Sturman et al. 2011) Longitudinal and continuing experiences (Peters et al. 2001; Drees et al. 2007; Linssen et al. 2007; Westra et al. 2008; Wamsley et al. 2009; Huang & Malinow 2010; Pfeiffer et al. 2010) Rural community experiences (Sen Gupta & Spencer 2001; Birks et al. 2004; AFMC 2006, 2010b; Zink et al. 2008; Couper & Worley 2010) Primary care and community care experiences (Dent et al. 2001; Sen Gupta & Spencer 2001; Collinson et al. 2002; Quirk et al. 2002; Langlois & Thach 2003; AFMC 2006; Gensichen 2006; Drees et al. 2007; Pearce et al. 2007; Thistlethwaite et al. 2007; McKinlay et al. 2009; CACE 2010), e.g., home visits (Medina-Walpole et al. 2005; Peleg et al. 2005; Silk & Weber 2008; McKinlay et al. 2009; O'Connor 2010), community visits and community-oriented primary care (Rodriguez & Fornari 2006; Art et al. 2008; Huang & Malinow 2010), primary care clerkship (Peters et al. 2001; Pipas et al. 2004) Advance Inter-and Intra- Professional Practice Inter-disciplinary (Crooks et al. 2001; Helm et al. 2001; Sen Gupta & Spencer 2001) and inter-professional (Dent et al. 2001; Huang et al. 2004; Peleg et al. 2005; Rodriguez & Fornari 2006; Pearce et al. 2007; CACE 2010; O'Connor 2010) teaching and learning, e.g., with practice nurses (Smith et al. 2009), social workers (Huang et al. 2004; Art et al. 2008), nutritionists (Rodriguez & Fornari 2006) Teamwork and cooperation on interdisciplinary or inter-professional healthcare teams (Cooper et al. 2001; Helm et al. 2001; Collinson et al. 2002; Pipas et al. 2004; Art et al. 2008; Zink et al. 2008; Leong 2009; CACE 2010) Connecting primary and secondary care (CACE 2010) "
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ABSTRACT: Background: Since a disproportionate amount of medical education still occurs in hospitals, there are concerns that medical school graduates are not fully prepared to deliver efficient and effective care in ambulatory settings to increasingly complex patients. Aims: To understand the current extent of scholarship in this area. Method: A scoping review was conducted by searching electronic databases and grey literature sources for articles published between 2001 and 2011 that identified key challenges and models of practice for undergraduate teaching of ambulatory care. Relevant articles were charted and assigned key descriptors, which were mapped onto Canadian recommendations for the future of undergraduate medical education. Results: Most of the relevant articles originated in the United States, Australia, or the United Kingdom. Recommendations related to faculty development, learning contexts and addressing community needs had numerous areas of scholarly activity while scholarly activity was lacking for recommendations related to inter-professional practice, the use of technology, preventive medicine, and medical leadership. Conclusions: Systems should be established to support education and research collaboration between medical schools to develop best practices and build capacity for change. This method of scoping the field can be applied using best practices and recommendations in other countries.
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The number of U.S. medical school graduates who choose to practice in health professional shortage areas (HPSAs) has not kept pace with the needs of society. The University of Wisconsin School of Medicine and Public Health has created a new program that prepares medical students to reduce health disparities for urban medically underserved populations in Milwaukee. The authors describe the Training in Urban Medicine and Public Health (TRIUMPH) program and provide early, short-term outcomes.
TRIUMPH integrates urban clinical training, community and public health curricula, longitudinal community and public health projects, mentoring, and peer support for select third- and fourth-year medical students. The authors tracked and held focus groups with program participants to assess their knowledge, skills, satisfaction, confidence, and residency matches. The authors surveyed community partners to assess their satisfaction with students and the program.
From 2009 to 2012, 53 students enrolled in the program, and 45 have conducted projects with community organizations. Participants increased their knowledge, skills, confidence, and commitment to work with urban medically underserved populations. Compared with local peers, TRIUMPH graduates were more likely to select primary care specialties and residency programs serving urban underserved populations. Community leaders have reported high levels of satisfaction and benefits; their interest in hosting students exceeds program capacity.
Early, short-term outcomes confirm that TRIUMPH is achieving its desired goals: attracting and preparing medical students to work with urban underserved communities. The program serves as a model to prepare physicians to meet the needs of urban HPSAs.
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ABSTRACT: In 2006, the University of Washington School of Medicine (UWSOM) launched the Underserved Pathway (UP), an extracurricular longitudinal experience supporting student interest in caring for underserved populations. This study examined the association between UP participation and residency choice.
The study population was 663 UWSOM graduates who matched to a residency from 2008 to 2011; 69 were UP participants. Outcomes included matching to primary care residencies (family medicine, internal medicine, pediatrics, or medicine-pediatrics). The authors calculated graduate rates and odds of UP participants versus nonparticipants matching to primary care residencies overall and to residencies in individual primary care specialties. This analysis included all graduates and 513 graduates who had dual interest in primary care and underserved care at matriculation. Of 336 graduates matching to primary care, the authors calculated rates of entering the individual specialties with respect to UP participation.
UP participants matched at significantly higher rates than nonparticipants to primary care (72.5% versus 48.1%, adjusted odds ratio [OR] 2.2) and family medicine residencies (33.3% versus 15.0%, adjusted OR 2.9). Of graduates with dual matriculation interest in primary care and underserved care, 73.4% of participants versus 53.5% of nonparticipants matched to primary care (adjusted OR 1.9), and 31.2% of participants versus 18.0% of nonparticipants matched to family medicine (adjusted OR 2.1). Of primary care matched graduates, 46.0% of participants versus 31.1% of nonparticipants entered family medicine.
Supporting student interest in underserved careers is associated with higher rates of graduates entering primary care residencies, specifically family medicine.
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