Concentration in Caring for Underserved Communities

Concentration in Caring for Underserved Communities

Concentration Directors

Fadya El Rayess, MD, MPH
Department of Family Medicine, Alpert Medical School
Email: Fadya_El_Rayess@brown.edu
111 Brewster St
Pawtucket, RI 02860
Ph: (401)523-2439

Joseph Diaz, MD, MPH, FAC
Department of General Internal Medicine, Alpert Medical School
Email: Joseph_Diaz@brown.edu
111 Brewster St
Pawtucket, RI 02860
Ph: (401) 729-2761

Arthur Frazzano, MD, MMS
Department of Family Medicine, Alpert Medical School
AHEC of RI
Email: Arthur_Frazzano@brown.edu
70 Ship St, Box GA-4
Providence, RI 02903
Ph: (401) 863-3598

OVERVIEW

The link between access to primary care and improvement in health and health care has clearly been demonstrated. However the United States is facing a shortage of primary care physicians. This co-insides with a decline in primary care graduates that is likely due to a combination of forces including: decreased reimbursement for primary care services, increasing student debt, problematic structure of primary care practices, perceived prestige and lifestyle preferences.  With recent proposed changes to the health insurance structure in the United States and the planned reliance on community health centers as a primary way to give care to underinsured and uninsured patients, there is a critical need to train physicians with the skills they need to thrive and remain in these settings.

The concentration in Caring for Underserved Communities strives to give students early positive clinical experience with community health centers from their first year of medical school through graduation. We have developed partnerships with such community health centers as East Bay,Thundermist, Crossroads, SSTAR, Clinica Esperanza and the RI Free Clinic, the VA’s homeless clinic and the Department of Corrections, with the goal of having students engage with the same community health setting throughout their 4 years of med school. Students choose a site that reflects their own interests and goals. Many health centers have several sites and faculty mentors practicing Family Medicine, Pediatrics, Internal Medicine and OB/GYN. As a result, a student could have more than one mentor and schedule rotations in more than one discipline at a particular health center. Students will be encouraged to remain within the local network of health centers if possible to facilitate a long term (3-4 year) relationship with a specific underserved community.

In addition to their clinical work concentrators will participate in the health center’s team based care and learn about population management and system based practice from experienced health center directors.The experience will begin with a summer placement between first and second year of medical school and continue with the scholar completing his or her community health and family medicine clerkship at the same site. Based on his/her clinical experiences the student will be mentored to develop a Scholarly Development Project that addresses a need of particular interest to the student and the community he/she is interacting with. The student’s scholarly concentration work will be supported by a curriculum taught by the concentration directors aimed at developing the knowledge and skills needed to provide care, leadership and advocacy for underserved communities.

The student will have the opportunity to carry out some of his/her scholarly project during his/her community health and/or family medicine clerkship. At the end of the concentration, the student will have produced a project consistent with the requirements of the scholarly concentration program. S/he will also have had a longitudinal experience in a community health center or site serving an underserved community with community based preceptors/mentors and the community they serve.

CURRICULUM

Learning Objectives

Learners will;

  • have a longitudinal experience with a specific community health center, health center physician mentor(s), and the patients and community they serve
  • design, implement, evaluate and present at least one scholarly project in response to an identified community need that will benefit the health center and the community it serves
  • be able to describe the organization of community health centers, free clinics and agencies serving underserved communities, including financing, administration, recruitment and retention of providers
  • develop the non-clinical skills needed to practice in underserved communities including population management, leadership and advocacy skills
  •  be able to recognize and discuss the impact of health disparities, access, culture, language and poverty on health status
  •  

    Timeline of Activities

    Year I

    •  Students will choose a mentor and develop a proposal for a summer project in the fall/early spring. Concentration directors will facilitate a series of meetings between the student and his/her community site mentor to develop a summer project proposal by the February deadline for concentration proposals. Possible projects include quality improvement, needs assessment and program development in response to a community/clinical need identified by the student and/or mentor. 

    Summer between Years I & II:

    • The summer project will serve as foundation for scholarly product. The student will receive support and mentoring from the concentration directors to develop the skills needed to complete this summer project. 
    • Students will deliver a power point presentation of their summer work in the fall and a poster presentation in December of their second year.

    Year II:

    During the second year concentrators will continue to implement their projects building on their summer experience.

    • Concentrators will attend monthly concentration seminars held at Clinica Esperanza covering such topics as: impact of social stressors including poverty, racism, environment and sexism on health outcomes; the health care ‘safety net’: community medical and mental health centers, public housing, programs for the homeless, free clinics, correctional system and Department of Children & Friends. Students will develop such specific skills as population/practice management tools, design and implementation of quality improvement projects, - working with medical interpreters, motivational interviewing and the setting of self-management goals. Joint seminars will be held with the scholarly concentration on Advocacy and Activism and Women’s Reproductive Health.
    • Students will also complete one to -two reflective writing assignments to be shared during the monthly meetings.

    Year III and IV:

    • One of the innovative strategies of this scholarly concentration is that students have a built in way to continue their work in the concentration in the setting of some of their required clinical rotations. Towards this end, students will be encouraged to spend one of their core third-year clerkships (such as family medicine , peds or IM) at their ‘matched’ health center/underserved site. While their primary focus will be on meeting the requirements of the clinical rotation, they will also have the opportunity to continue to work on their scholarly project.
    • Third-year students will meet/correspond every 6 months with concentration directors to ensure that they are making progress towards meeting their scholarly goals.
    • Fourth-year students will meet/correspond twice with concentration directors.
    • They will also be included in concentration-related meetings/events as well as invited to participate in any of the ongoing second year curriculum.
    • The majority of the work on the scholarly product will be completed by the end of the 2nd year with time during a 3rd or 4th year elective to complete the analysis and write up of the project.
    • Scholars will also be expected to submit an abstract to a state, regional or national conference and/or journal manuscript for publication in the fall of their 4th year.

    Concentration Related Electives

    Pre-Clinical
    BIOL 6504: Health Care in America
    BIOL 6653: Refugee Health and Advocacy
    BIOL 6650: Medical Students Outreach to MotherS-to-be (MOMS)
    BIOL 6655: Health Care of Underserved 

    Clinical
    Family Medicine Clerkship - integrate scholarly concentration work into project requirements
    Community Health Clerkship - integrate scholarly concentration work into the field experience or project requirement of the Community Health Clerkship.
    Scholarly Elective - Scholars can use this rotation to complete their project.
    Advanced Clinical Mentorship (ACM) - it may be possible to design an ACM that also allows work towards the scholarly product.

    Evaluation

    1. First year: students will be evaluated on their summer project presentations.
    2. Second year: students will be required to attend and actively participate in monthly seminars. They will be evaluated on their participation, their reflective writing, and their application of lessons learned as they develop their concentration project.
    3. Third year students will be required to meet once each semester with concentration directors.
    4. Fourth year students will be required to complete bimonthly progress reports and attend bimonthly meetings with concentration directors.
    5. Students will submit an abstract to a state, regional or national conference and/or journal manuscript for publication in the fall of their 4th year.
    6. Students will submit a written report and give a powerpoint and poster presentation of their final product that will be evaluated using the scholarly concentration product rubric. 

    Maximum Number of Students

    4 per class.

    Faculty Mentors

    • Jennifer Clarke, MD, PhD (IM-MHRI, Prison
      Health)
    • Anne DeGroot, MD, (IM-ID, Director of Clinica
      Esperanza)
    •  Sarah Fessler, MD, (FM, Director of East Bay
      Community Health Center)
    •  Beata Nelkin, MD (Peds, Thundermist Health
      Center)
    •  Thomas O’Toole, MD, MPH (IM, Director of
      National Homeless Veterans PACT Program)
    •  Joe Rabatin, MD (IM, MHRI, RI Free Clinic)
    •  Kimberly Zeller, MD (FM, East Bay CHC) refugee,
      global and HIV medicine

    Funding Opportunities 

    Students can apply for summer assistantship funding.