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01-12-2018 | Innovation and Improvement: Innovations in Medical Education

Two Novel Urban Health Primary Care Residency Tracks That Focus On Community-Level Structural Vulnerabilities

Authors: Benjamin J. Oldfield, MD, Bennett W. Clark, MD, Monica C. Mix, MD, Katherine C. Shaw, MD, Janet R. Serwint, MD, Sanjay V. Desai, MD, Rachel M. Kruzan, MD, Rosalyn W. Stewart, MD MS, Sebastian Ruhs, MD PhD, Leonard S. Feldman, MD

Published in: Journal of General Internal Medicine | Issue 12/2018

Abstract

Background

Although residency programs are well situated for developing a physician workforce with knowledge, skills, and attitudes that incorporate the strengths and reflect the priorities of community organizations, few curricula explicitly do so.

Aim

To develop urban health primary care tracks for internal medicine and combined internal medicine-pediatrics residents.

Setting

Academic hospital, community health center, and community-based organizations.

Participants

Internal medicine and combined internal medicine-pediatrics residents.

Program Description

The program integrates community-based experiences with a focus on stakeholder engagement into its curriculum. A significant portion of the training (28 weeks out of 3 years for internal medicine and 34 weeks out of 4 years for medicine-pediatrics) occurs outside the hospital and continuity clinic to support residents’ understanding of structural vulnerabilities.

Program Evaluation

Sixteen internal medicine and 14 medicine-pediatrics residents have graduated from our programs. Fifty-six percent of internal medicine graduates and 79% of medicine-pediatrics graduates are seeking primary care careers, and eight overall (27%) have been placed in community organizations. Seven (23%) hold leadership positions.

Discussion

We implemented two novel residency tracks that successfully placed graduates in community-based primary care settings. Integrating primary care training with experiences in community organizations can create primary care leaders and may foster collective efficacy among medical centers and community organizations.

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Institute of Medicine. Primary care and public health: exploring integration to improve population health. Washington, DC: National Academies Press; 2012.

Institute of Medicine. Who will keep the public healthy? Educating public health professionals for the 21st century. Washington, DC: National Academies Press; 2003.

Cooke M, Irby DM, Sullivan W, Ludmerer KM. American medical education 100 years after the Flexner report. N Engl J Med. 2006;355(13):1339–44. doi:https://doi.org/10.1056/NEJMra055445 CrossRefPubMed

Cassel C, Wilkes M. Location, location, location: where we teach primary care makes all the difference. J Gen Intern Med. 2017;32(4):411–5. doi:https://doi.org/10.1007/s11606-016-3966-x CrossRefPubMedPubMedCentral

Holmes SM. Structural vulnerability and hierarchies of ethnicity and citizenship on the farm. Med Anthropol. 2011;30(4):425–49. doi:https://doi.org/10.1080/01459740.2011.576728 CrossRefPubMed

Bourgois P, Holmes SM, Sue K, Quesada J. Structural vulnerability: operationalizing the concept to address health disparities in clinical care. Acad Med. 2016. doi:https://doi.org/10.1097/ACM.0000000000001294 CrossRef

Bourgois P, Hart LK. Commentary on Genberg et al. (2011): the structural vulnerability imposed by hypersegregated US inner-city neighborhoods—a theoretical and practical challenge for substance abuse research. Addiction. 2011;106(11):1975–7. doi:https://doi.org/10.1111/j.1360-0443.2011.03615.x CrossRef

Genberg BL, Gange SJ, Go VF, Celentano DD, Kirk GD, Latkin CA, et al. The effect of neighborhood deprivation and residential relocation on long-term injection cessation among injection drug users (IDUs) in Baltimore, Maryland. Addiction. 2011;106(11):1966–74. doi:https://doi.org/10.1111/j.1360-0443.2011.03501.x CrossRefPubMedPubMedCentral

Alicea-Alvarez N, Reeves K, Lucas MS, Huang D, Ortiz M, Burroughs T, et al. Impacting health disparities in urban communities: preparing future healthcare providers for "neighborhood-engaged care" through a community engagement course intervention. J Urban Health. 2016;93(4):732–43. doi:https://doi.org/10.1007/s11524-016-0057-6 CrossRefPubMedPubMedCentral

10.

Goroll AH. Recruiting quarterbacks: strategies for revitalizing training in primary care internal medicine. Acad Med. 2016;91(2):168–70. doi:https://doi.org/10.1097/ACM.0000000000000891 CrossRefPubMed

11.

Meurer LN, Young SA, Meurer JR, Johnson SL, Gilbert IA, Diehr S, et al. The urban and community health pathway: preparing socially responsive physicians through community-engaged learning. Am J Prev Med. 2011;41(4 Suppl 3):S228–36. doi:https://doi.org/10.1016/j.amepre.2011.06.005 CrossRefPubMed

12.

Rios N, Stewart R. Personal and professional growth through community service. Medical Teacher. 2013;35(2):172.CrossRef

13.

Cousineau MR, Flores H, Cheng S, Gates JD, Douglas JH, Clute GB, et al. Transforming a family medicine center and residency program into a federally qualified health center. Acad Med. 2013;88(5):657–62. doi:https://doi.org/10.1097/ACM.0b013e31828ace4e CrossRefPubMed

14.

Fancher TL, Keenan C, Meltvedt C, Stocker T, Harris T, Morfin J, et al. An academic-community partnership to improve care for the underserved. Acad Med. 2011;86(2):252–8. doi:https://doi.org/10.1097/ACM.0b013e31820469ba CrossRefPubMed

15.

Michael YL, Gregg J, Amann T, Solotaroff R, Sve C, Bowen JL. Evaluation of a community-based, service-oriented social medicine residency curriculum. Prog Community Health Partnersh. 2011;5(4):433–42.PubMed

16.

Fessler DA, Huang GC, Potter J, Baker JJ, Libman H. Development and implementation of a novel HIV primary care track for internal medicine residents. J Gen Intern Med. 2017;32(3):350–4. doi:https://doi.org/10.1007/s11606-016-3878-9 CrossRefPubMed

17.

Bade E, Baumgardner D, Brill J. The central city site: an urban underserved family medicine training track. Fam Med. 2009;41(1):34–8.PubMed

18.

Strelnick AH, Swiderski D, Fornari A, Gorski V, Korin E, Ozuah P, et al. The residency program in social medicine of Montefiore Medical Center: 37 years of mission-driven, interdisciplinary training in primary care, population health, and social medicine. Acad Med. 2008;83(4):378–89. doi:https://doi.org/10.1097/ACM.0b013e31816684a4 CrossRefPubMed

19.

Zakaria S, Johnson EN, Hayashi JL, Christmas C. Graduate Medical Education in the Freddie Gray Era. N Engl J Med. 2015;373(21):1998–2000. doi:https://doi.org/10.1056/NEJMp1509216 CrossRefPubMed

20.

Stewart R, Feldman L, Bitzel D, Gibbons MC, McGuire M. Urban health and primary care at Johns Hopkins: urban primary care medical home resident training programs. J Health Care Poor Underserved. 2012;23(3 Suppl):103–13. doi:https://doi.org/10.1353/hpu.2012.0123 CrossRefPubMed

21.

Stewart R, Feldman L, Weisfeldt M. Addressing the primary care deficit: building primary care leaders for tomorrow. J Grad Med Educ. 2010;2(2):294–6. doi:https://doi.org/10.4300/JGME-D-09-00088.1 CrossRefPubMedPubMedCentral

22.

Lale A, Moloney R, Alexander GC. Academic medical centers and underserved communities: modern complexities of an enduring relationship. J Natl Med Assoc. 2010;102(7):605–13.CrossRef

23.

Norris KC, Brusuelas R, Jones L, Miranda J, Duru OK, Mangione CM. Partnering with community-based organizations: an academic institution's evolving perspective. Ethn Dis. 2007;17(1 Suppl 1):S27–32.PubMed

24.

Skloot R. The immortal life of Henrietta Lacks. New York: Crown Publishers; 2010.

25.

Bandura A. Self-efficacy: the exercise of control. New York: W.H. Freeman; 1997.

26.

Bandura A. Social cognitive theory: an agentic perspective. Annu Rev Psychol. 2001;52:1–26. doi:https://doi.org/10.1146/annurev.psych.52.1.1 CrossRefPubMed

27.

Fox CE, Morford TG, Fine A, Gibbons MC. The Johns Hopkins Urban Health Institute: a collaborative response to urban health issues. Acad Med. 2004;79(12):1169–74.CrossRef

28.

Tyus NC, Gibbons MC, Robinson KA, Twose C, Guyer B. In the shadow of academic medical centers: a systematic review of urban health research in Baltimore City. J Community Health. 2010;35(4):433–52. doi:https://doi.org/10.1007/s10900-010-9258-1 CrossRefPubMed

29.

Neighborhood Health Profile Reports [database on the Internet] 2011. Available from: http://health.baltimorecity.gov/neighborhoods/neighborhood-health-profile-reports. Accessed November 11, 2017.

30.

The Johns Hopkins Hospital Community Health Needs Assessment, Fiscal Year 2013 [database on the Internet] 2013. Available from: http://web.jhu.edu/administration/gca/CHNA%20and%20CBR%20Docs/CHNA%20FY13.pdf. Accessed November 11, 2017.

31.

Gibbons MC, Illangasekare SL, Smith E, Kub J. A Community Health Initiative: Evaluation and Early Lessons Learned. Prog Community Health Partnersh. 2016;10(1):89–101. doi:https://doi.org/10.1353/cpr.2016.0011 CrossRefPubMed

32.

The Johns Hopkins Urban Health Institute Self Study and External Evaluation [database on the Internet]. Two Gems Consulting. 2010. Available from: http://urbanhealth.jhu.edu/media/reports/self_study.pdf. Accessed November 11, 2017.

33.

Oldfield BJ. Invisible colleagues. N Engl J Med. 2015;373(9):792–3. doi:https://doi.org/10.1056/NEJMp1506873 CrossRefPubMed

34.

Glantz LH. Nontherapeutic research with children: Grimes v Kennedy Krieger Institute. Am J Public Health. 2002;92(7):1070–3.CrossRef

35.

Gomez MB. Race, class, power, and organizing in East Baltimore: rebuilding abandoned communities in America. Lanham, MD.: Lexington Books; 2013.

36.

Thomas PA, McGuire M, Hellmann DB. A blueprint for building an AMC-HMO teaching affiliation. Acad Med. 1996;71(6):577–9.CrossRef

37.

Bronfenbrenner U. The ecology of human development: experiments by nature and design. Cambridge, MA: Harvard University Press; 1979.

38.

McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q. 1988;15(4):351–77.CrossRef

39.

Poland BD, Green LW, Rootman I. Settings for health promotion: linking theory and practice. Thousand Oaks, CA: Sage Publications; 2000.

40.

Stokols D. Establishing and maintaining healthy environments. Toward a social ecology of health promotion. Am Psychol. 1992;47(1):6–22.CrossRef

41.

McLeroy KR, Norton BL, Kegler MC, Burdine JN, Sumaya CV. Community-based interventions. Am J Public Health. 2003;93(4):529–33.CrossRef

42.

Santilli A, Carroll-Scott A, Ickovics JR. Applying community organizing principles to assess health needs in New Haven, Connecticut. Am J Public Health. 2016;106(5):841–7. doi:https://doi.org/10.2105/AJPH.2016.303050 CrossRefPubMedPubMedCentral

43.

Stokols D. Translating social ecological theory into guidelines for community health promotion. Am J Health Promot. 1996;10(4):282–98.CrossRef

44.

Schwartz RP, Gryczynski J, O'Grady KE, Sharfstein JM, Warren G, Olsen Y, et al. Opioid agonist treatments and heroin overdose deaths in Baltimore, Maryland, 1995-2009. Am J Public Health. 2013;103(5):917–22. doi:https://doi.org/10.2105/AJPH.2012.301049 CrossRefPubMedPubMedCentral

45.

Israel BA, Eng E, Schulz AJ, Parker EA. Methods for community-based participatory research for health. San Francisco: Jossey-Bass; 2012.

46.

Pietila A. Not in my neighborhood: how bigotry shaped a great American city. Chicago: Ivan R. Dee; 2010.

47.

Baum HS. Brown in Baltimore: school desegregation and the limits of liberalism. Ithaca: Cornell University Press; 2010.

48.

Watkins D, Talbot D. The Beast side: Living and Dying while Black in America. New York: Hot Books; 2015.

49.

Stanley M, O'Brien B, Julian K, Jain S, Cornett P, Hollander H, et al. Is training in a primary care internal medicine residency associated with a career in primary care medicine? J Gen Intern Med. 2015;30(9):1333–8. doi:https://doi.org/10.1007/s11606-015-3356-9 CrossRefPubMedPubMedCentral

50.

Lipkin M, Zabar SR, Kalet AL, Laponis R, Kachur E, Anderson M, et al. Two decades of title VII support of a primary care residency: process and outcomes. Acad Med. 2008;83(11):1064–70. doi:https://doi.org/10.1097/ACM.0b013e31818928ab CrossRefPubMed

Title: Two Novel Urban Health Primary Care Residency Tracks That Focus On Community-Level Structural Vulnerabilities
Authors: Benjamin J. Oldfield, MD
Bennett W. Clark, MD
Monica C. Mix, MD
Katherine C. Shaw, MD
Janet R. Serwint, MD
Sanjay V. Desai, MD
Rachel M. Kruzan, MD
Rosalyn W. Stewart, MD MS
Sebastian Ruhs, MD PhD
Leonard S. Feldman, MD
Publication date: 01-12-2018
Publisher: Springer US
Published in: Journal of General Internal Medicine / Issue 12/2018
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-017-4272-y

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Two Novel Urban Health Primary Care Residency Tracks That Focus On Community-Level Structural Vulnerabilities

Abstract

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Aim

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Program Description

Program Evaluation

Discussion

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Program Evaluation

Discussion

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