1. Community Health Assessment at a Family Medicine Clerkship Site
Kristen Kelly MPH, MS-IV

2. Topics of Presentation
Why am I involved in clerkship education?
Background: Need for a Community Health Learning Experience
Development of Learning Experience
Recommendations

3. How did a student become involved in community health education in medical school?

4. Community Health Accepted part of FM residency education
Community Oriented Primary Care (COPC) projects
Needs assessments
Other community involvement
Increasingly part of medical student education

5. Challenges
Few examples of community health in clinical practice for students to see
Little consensus on content and format
Difficult to measure outcomes and quantify importance

6. Student Interest 3rd year FCM clerkship community health requirement
Pursued interest during Masters in Public Health between 3rd and 4th years
Clerkship site required a community health component

7. Background: Need for a Community Health Learning Experience

8. FCM Core Clerkship at UCSF
6 week block during third year
6 physical locations, 3 outside San Francisco
Different formats
COPC
Student-designed and led
Placements with community organizations
Community health component at all sites but one

9. Goal
Propose a model for a feasible community health experience at out-of-town site

10. Guiding Questions
Is community health exposure a vital aspect of the clerkship that should be required of all students?
What are the goals of the community health experience ?
What curricular models offer the best potential to meet these goals and are logistically feasible?

11. Development of
Community Health
Learning Experience

12. Project Methods Background research: community health
Review of student evaluations of existing community health requirements
Focus groups with students
Open-format interviews with preceptors and faculty
Participant observation student presentations of community health projects

13. Interviews Open-format Interviews:
6 faculty members
7 community health preceptors
Administrator of community health projects
5 additional individuals with community health expertise
Experiences working with community health projects

14. Focus Groups
3 focus groups of medical students who had completed the FCM clerkships
Variety of FCM sites
Structured format with pre-determined questions

15. Evaluation of Data
Coding of interviews and focus groups using N-Vivo® program for qualitative analysis
Evaluated for themes
Used this data to develop proposal for project structure at out-of-town clerkship site

16. Themes Valuable to have community component
Context, advocacy, exposure
Community groups have links to university
Time period is very short (6 half-days – or three days total)
Different interpretations of community health
Goals often vague or too ambitious

17. Quote
“If you look at issues of community health, they are …probably more important than issues in primary care. If you’ve got someone sleeping in a bathtub because…they are shooting at each other with rifles every night…then it’s hard to not have stress-related health problems…But the idea that…medical students working for 6 weeks eight hours a week can actually accomplish anything is kind-of absurd. You’re not going to accomplish anything…in terms of large skill issues…and…you’re a complete outsider to the community…”

18. Basic Goals
Provide students with a basic skill set that can be applied in other settings
Provide opportunity to discuss/think about how community factors impact health
Dr. H. Jack Geiger

19. Assessment of Options Community Preceptor Placements Didactics
Student-Chosen Projects
Systems-Based Projects
Community Health Assessment
Logistical Feasibility* D F A
Meets Community Learning Goals B C
Anticipated Student Satisfaction
Anticipated Faculty Satisfaction
Anticipated Community Satisfaction
Ease of Start-Up/Implementation
Sustainability Over Time
Average Grade
D (1.7)
F (0.6)
C (2.7)
B (3.0)
B (3.4)
* Based on the administrative support and other logistical constraints at the sixth FCM site
** Average Grade calculated by assigning a number value to each letter and averaging the values: A=4, B=3, C=2, D=1, F=0

20. And the winner is…. Community health assessment Logistically feasible
Meets goals
Easy to start and implement
Sustainable over time
Home visit in Bolivar
County, MS 1967

21. Recommendations for Community Health Experience

22. Healthy Community Assessment
Based on recommendations from Community Organizing and Community Building for Health, 2nd Edition. Ed. Meredith Minkler
Chapter 8: “Community Health Assessment or Healthy Community Assessment: Whose Community? Whose Health? Whose Assessment?” (Trevor Hancock and Meredith Minkler)

23. Central Question Posed
Pretend that you are done with residency and have just started a new job at this clinic. You are new to the area and do not know anything about one of the communities that many of your patients are from.
What features of the community either promote or detract from health and well-being?

24. Guidelines Students work together in groups
Students identify a community represented by patients in the FCM clinic
Students read relevant chapters from Community Organizing and Community Building for Health
Focus on assets as well as deficits

25. Nitty-Gritty
Students should use at least one of each of the following methods: no-contact, minimal-contact/observational, and interactive contact
No-contact: e.g., internet
Minimal contact: walks, visits to local churches
Interactive: talking to people
From Hancock, T and M. Minkler “Community Health Assessment or Healthy Community Assessment.” Community Organizing
and Community Building for Health. Chapter 8.

26. End-Product
Informal presentation to faculty member about what the students learned about the community
Students will be asked to find a way to share the information with a community member who assisted with assessment
Encourage discussion
Should be fun, low-stress!

27. Elements of a Healthy Community
Do people in the community have access to basic prerequisites for health (e.g., food, shelter, education, clean water, clean and safe environments)?
How strong is civic or associational life?
How rich is the cultural life of the community?
What are community members’ perceptions of strengths of the community as well as areas of need?
From Hancock, T and M. Minkler “Community Health Assessment or Healthy Community Assessment.” Community Organizing
and Community Building for Health. Chapter 8:

28. Positives to Structure
Skills and defined approach
Limited faculty/administrative support
Take away focus on physician as point person
Focus on community strengths as well as needs
Opportunity to discuss relevance and future work with communities

29. Drawbacks to Structure
Communities “assessed” many times
Feeling of wanting to build on the information gathered
Some students may find it too abstract

30. Final Notes Presentation made to FCM faculty members and site director
Currently student project-based structured being implemented
Individual hired to oversee projects

31. Future Directions
Learned about community-oriented processes: e.g., COPC, community-based participatory research
Idea of community control and involvement in health
Hope to build on these ideas in future practice

32. Thank you!
Dr. William Shore MD, UCSF Department of Family and Community Medicine
Nap Hosang MD, MPH, MBA, UC Berkeley School of Public Health
Community medicine preceptors
UCSF Department of Family and Community Medicine faculty members and students

34. Why Community Health?
Issues difficult to address in purely clinical environment:
Health disparities by race, class, neighborhood/ community
Chronic “lifestyle” illnesses
Social determinants of health
Movement to involve communities in own health

35. Health Beyond the Clinic
1978 International Conference on Primary Health Care in Alma Ata, USSR (WHO). Primary health care:
Involves community development (education, housing, public works, and many other sectors)
Strives towards maximal community participation and control over primary health care and fosters the ability of communities to participate

36. A Little History
Sidney and Emily Kark in rural South Africa in the 1940s, Community-Oriented Primary Care
1950s-70s: Growth of Community Health Center movement in the US
Dr. H. Jack Geiger in the impoverished Mississippi Delta in the 1960s, Community-Oriented Primary Care