1. An Innovative Longitudinal Community Health Assessment Curriculum for 3 rd Year Medical Students Nancy J. Baker MD Kathleen D. Brooks MD, MBA, MPA University of Minnesota Rural Physicians Associate Program

2. Learner Objectives Define the components of a community health assessment (CHA) curriculum Recognize the role of faculty, community preceptors, stakeholders and students in self directed CHA project development and implementation Propose means to incorporate CHA project components into longitudinal clerkships

3. Presentation Outline Review of the Univ. of MN RPAP program and our Community Health Assessment (CHA) curriculum Summarize 2011-2012/2012-2013 CHA projects Student feedback on the value of CHA projects Themes & conundrums generated by the CHA requirement Attendee experience with collaborations/curricula that facilitate medical student engagement with the community.

4. RPAP Description 43 yo rural distributed model longitudinal integrated clerkship (LIC) 30-40 3 rd year med students spend 9 mo in a rural setting, 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

7. Rationale for Community Health Assessment Curriculum Comprehensive, continuous care in the context of community Nutting’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 time is right to bridge clinic and community to improve health Nutting ‘90; Rhyne ‘98; Bonafede ‘09; McIntosh ’08 Gourvitch ‘14

8. RPAP CHA Curriculum States goal is to improve the health of a specific population Provides links to CHA references & the COPC process Describes health status indicators Lists resources w/current data on health disparities Promotes teamwork Emphasizes access to care, prevention, lifestyle modification Focuses on measurable outcomes Grading based on presentation of data, stakeholder involvement, implementation, evaluation & lessons learned

9. RPAP CHA Project Timeline September: RPAP orientation October: Students define population and identify 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 implementation and evaluation May: CHA project summary due June: CHA project poster session

11. Recent RPAP CHA Project Categories RPAP Community Health Assessment Curriculum NJ Baker MD, KD Brooks MD, MBA, MPA

12. “My preceptor Suzy Human with me demonstrating making a low fat Caesar salad at the Information Session” USDA Food Desert Map LI = Low Income LA = Low Access to Food Taken from USDA Economic Research Service Interactive Atlas Healthy Cooking for Healthy Communities

13. Adolescent Sexual Health

14. Culturally Competent Care for the Amish

15. Sun Safety

16. Type 2 Diabetes Visits

17. CHA Project Student Feedback “I do feel I provided a good service in the HS with my CHA.” “I also believe I was able to create tangible change with the [CHA] project organization I worked with.” “My CHA project turned out to be very helpful for the clinic and was sincerely appreciated by the diabetic education team.” “I was able to become invested in the community through my CHA project and know I was a large part of getting ‘Project Can-Do’ off the ground.” “Through our CHA we were able to help educate many families about the importance of healthy living.”

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

19. CHA Project Programmatic Conundrums Succession challenges Community vs. student expectations for continuation Research issues/need for IRB approval Funding Additional opportunities for presentation and publication Community perception of the value Need for sensitivity regarding being “used” for education Does this work improve the health of the community?

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

22. Discussion What has been your experience engaging medical students in authentic, self-directed community partnerships? What additional themes and/or conundrums have you seen emerge? Any other comments or questions?

23. Conclusion Completion of a CHA project by 3 rd year medical students on a 9 mo. LIC facilitates community engagement & collaboration Students glean satisfaction from partnering with community stakeholders CHA curricula within the context of longitudinal clinical clerkships prepares medical students to provide optimal care to patients in the context of family and community.

24. Bibliography 1.Nutting, Paul A. Community-oriented primary care: from principle to practice. 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 Association, 1998. 3.Bonafede K, Reed VA, Pipas CF. Self-directed community health assessment projects in a required family medicine clerkship: an effective 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 retention of rural physicians: outcomes from the rural physician associate program in Minnesota. J Rural Health. v. 24(4). 2008. 6.Gourevitch, Marc N. “Population Health and the Academic Medical Center: the Time is Right.” Acad Med. v. 89(4): 2014.