Doctors for the People: Training Physicians to Work in Under-served Urban Communities Sherenne Simon, MPH, Matthew Anderson, MD, MS, Pablo Joo, MD Department of Family &
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Transcript Doctors for the People: Training Physicians to Work in Under-served Urban Communities Sherenne Simon, MPH, Matthew Anderson, MD, MS, Pablo Joo, MD Department of Family &
Doctors for the People:
Training Physicians to Work in
Under-served Urban Communities
Sherenne Simon, MPH,
Matthew Anderson, MD, MS,
Pablo Joo, MD
Department of Family & Social
Medicine, Montefiore Medical
Center/Albert Einstein College of
Medicine
Project Aim
Montefiore’s Residency Program in
Social Medicine (RPSM), established in
1970, trains clinicians to work in
underserved communities.
In order to improve our own work we
set about to examine similar programs
which train clinicians to work in
underserved communities.
Why do we need such programs?
Higher Education is funded and organized by
the US ruling class:
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Weill-Cornell Medical School
Charles H. Greenberg Pavilion @ NYH
Belfer Building @ AECOM
Interlocking corporate academic directorships
Medical Students are a very privileged group.
Contextual Factors
Well recognized problem for rural areas
US government has attempted to address
through HRSA, NHSC
Literature on financial incentives and specific
curricular elements
Efforts going on at the undergraduate level:
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High School, College, Post-baccalaureate
Locating Programs
Google Search for websites; Google Scholar
for articles
Snow-balling technique (referrals)
HRSA funded programs (1999-2000) to
promote Primary Care
Literature Review
Inclusion Criteria
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Medical Schools & Residency Programs
Mission to accept minority/working class students
and/or train for underserved communities
Published literature about program outcomes
Exclusion criteria:
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High School or College enrichment programs
Rural Programs
Traditionally African American Medical Schools
Interviews (phone/email/website)
How and why program was created
How the program is financed and its cost to students
Educational philosophy & curriculum
Recruitment & retention policies
Evaluation methods of graduates long term success
& programmatic success
Relationship to more traditional training programs
Barriers and successes
Medical Schools
Sophie Davis School of Biomedical
Engineering (CUNY)
Charles R. Drew Program (UCLA)
UC/PRIME programs (5 programs - 1 is rural)
A.T. Still University School of Osteopathic
Medicine (SOMA)
Baylor College (Texas)
Residency Programs (sample)
Arizona
University of Arizona Family & Community Medicine
California
UCLA/Harbor Family Medicine Residency
UCSF/San Francisco General Hospital: Family &
Community Medicine
Florida
University of Miami/Jackson Memorial Family
Medicine & Community Health
Miller School of Medicine: Jay Weiss Residency in
Global Health Equity & Internal Medicine. Also at
Jackson Memorial
Residency Programs (sample)
Illinois
Cook County Internal Medicine Primary Care
Maryland
Johns Hopkins Bloomberg School of Public
Health, General Preventive Medicine Residency
(PM)
Massachusetts
U Mass, Worcester: Family Medicine &
Community Health
Lawrence Family Medicine Residency
Residency Programs (sample)
New York
Residency Program in Social Medicine (FM,IM,PED)
Washington
University of Washington, Tacoma Family Medicine
Justifications offered by programs
US population increasingly diverse
Minority/working class students face growing barriers
getting into medical school
Geographical maldistribution of physicians: both
urban & rural
Minority and working class populations have worse
health care access & outcomes (health disparities)
Structure of Programs
Medical school programs typically associated with
traditional MS, but offer enhanced curriculum (ie.
disparities, community health)
Training often occurs in community settings,
particularly community health centers
Service training sites are in underserved areas
Requirement for research/paper/project/Masters
degree
Special mentorship
Educational Philosophy
Emphasis on Primary Care
Work in communities, specifically
underserved communities
Work in Community Health Centers
Recruitment/Retention
Pairing with college-level pipeline programs
Trainees expected to share program vision of
working in underserved communities
Special mentorship & assistance
Methods of evaluation within programs
Racial/Ethnic/Class composition of trainees
(or) graduates
Intention vs. actual practice in underserved
communities
Practice in primary care
Traditional academic metrics: board scores,
specialization rates; graduates who are faculty
or involved in public health administration
Evaluation Techniques
Use of AAMC survey data on where students intend
to practice
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Measured at 3 time points: MCAT, entrance and exit to
medical school
AMA master file of clinicians to determine practice
sites of graduates
HPSA (Health Professional Shortage Areas)
Follow-up surveys of trainees
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Such surveys are uncommon and cost money
Evaluation:
Charles R. Drew Medical Education Program
Ko M, Edelstein RA, Heslin KC, Rajagopalan S, Wilkerson L, Colburn L, et al. Impact of the University of California, Los
Angeles/Charles R. Drew University medical education program on medical students' intentions to practice in
underserved areas. Acad Med. 2005 Sep;80(9):803-8.
Outcomes
Programs report high levels of training
minority and/or working class physicians
High level of work by graduates in primary
care and underserved areas
Successful academic outcomes
Caveats
Those who make it to medical school are the
“lucky few.”
Selection bias: Students entering these
programs know what they are getting into
What are appropriate comparison groups for
these programs?
These programs are all small, almost
“boutique” programs
Caveats (Contextual issues)
We are losing this battle now….
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Barriers to getting into medical school appear to
have increased since the 1990’s.
Decreasing number of US students choose
primary care.
These programs rely on funding for Primary
Care training programs (Title VII)
A mission to serve the underserved does not
currently characterize most of US academic
medicine (neither does an interest in PC)
Conclusions
Successful programs exist that train
clinicians to work in underserved
communities.
Shared elements
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Mission to serve the underserved (caveat: this
was a selection criteria)
Training in underserved communities.
Community & Primary Care orientation
These findings are similar to those in rural
health programs.
Next Steps/Discussion points
How might this project inform our own work?
What are its broader implications for
academic medical institutions?
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Is the medical school responsible for the
composition of its classes & the future careers of
its doctors?
What are the broader implications for US
education if professional careers are
unavailable to large sections of the
population?
Thank You
Contacts:
Matthew Anderson, MD, MS
[email protected]