A medical education initiative to provide physicians for the underserved
There was a major increase in the Latino, Black and Asian communities in Rhode Island (RI) in the decade 2000-2010 and the 2011 RI Department of Health’s report on minority health, detailed numerous racial and ethnic disparities in mortality, health behaviours and access to healthcare. In response to the shortage of physicians providing healthcare for these ‘underserved’ populations, medical educators in RI have made innovative and determined efforts to address this shortfall.
With 5-year funding and support from the Health Resources and Services Administration (HRSA) the Warren Alpert Medical School of Brown University (AMS) put in place a programme to train medical students to provide outstanding care for underserved populations.
The programme, running from 2011 to 2015 had two initial goals: the first was to increase the number of graduating medical students intending to practice primary care in underserved communities; the second goal was to prepare 100% of AMS graduates to care for the underserved, regardless of specialist choice. A third goal, to assess the evolution of medical students’ attitudes towards working with underserved populations, is ongoing.
Goal 1, termed Professional Development, was achieved through a ‘scholarly concentration’ and ‘primary care pipeline activities’. The altruism towards the underserved, felt by many students entering medical school, tends to decline throughout their training. Research suggests that early positive exposure to primary care in underserved settings increases the likelihood of graduates continuing to work in these settings and the AMS scholarly concentration in caring for underserved communities attempts to provide this. It spans 4 years of training, incorporating interactions with mentors and patients at a variety of local community health centre partners, commencing in the first year of training and refined and sustained throughout the subsequent years. In the second year of training, the student ‘concentrators’ attend monthly interactive seminars. These start with a review of “frameworks for understanding health inequity and health disparities” and continue to a broad range of topics, including the impact of social stressors and resilience on health outcomes.
Goal 2, Focused on Curriculum Development, with the project team working to ensure that all students received thorough didactic and clinical training in the care of underserved patients and populations. The ‘Family Medicine Clerkship’ includes two modules – a clinical skills workshop and a series of small group sessions covering a range of topics relevant to vulnerable and underserved patients. The clinical clerkships are provided at the local community health centres, which were recruited and developed by the project team.
Goal 3 is the evaluation of the project. A longitudinal assessment of the students’ attitudes towards working with underserved populations, across the 4 years of the programme is ongoing. It is being conducted through focus groups and the annual administration of a validated survey. In addition, to check the efficacy of the curriculum, the 4th year OSCE (Objective Structured Clinical Examination) has been extended to include three new cases from vulnerable groups. It is necessary for students to succeed at these additional stations in order to pass the summative 4th year OSCE. Although health disparities in Rhode Island continue, so do the efforts of the AMS team to have a real and sustained impact on the health of RI’s underserved communities. This project, including pipline activities, is fully described in: Anthony D, El Rayess F, Esquibel AY, George P and Scott Taylor J. Building a Workforce of Physicians to Care for Underserved Patients. Rhode Island Medical Journal, September 2014. (summary by Deirdre Handy)