BHPR -

Predoctoral Training in Primary Care > FY 2005 Grant Summaries

Alabama

D56HP05226
Larry Henderson, MD
Department of Family Medicine
University of South Alabama
1504 Springhill Ave
Mobile, AL 36604
Tel: 251-434-3482
Email:lhenderson@fammed.usouthal.edu

The University of South Alabama Department of Family Medicine was established in 1977 and has a strong track record of recruiting students to pursue careers in Family Medicine. The University of South Alabama College of Medicine is a fully accredited medical school with roughly 64 graduates per year. Of these 64, more than 25% of 2001 graduates are serving in MUCs. The traditional curriculum consists of two years of didactic teaching followed by two years of clinical training. The Family Medicine Department is responsible for the 2 year On Doctoring Course which is a pass-fail course consisting of 15 lectures, a health fair at a local middle school, and four hours of direct patient contact during the first year. During the 2ndyear of the course, students spend six half-days rotating with primary care preceptors in the community. The 3rdyear family medicine clerkship consists of one day of orientation followed by 6 weeks of direct patient care with community based preceptors and one day of closing discussion. We currently have 53 preceptor sites throughout rural Alabama. Of these 53, over three-fourth are in counties with significant MUAs. The preceptor sites vary from solo practices to small groups of physicians. They also vary in the number and types of patients seen including Pediatrics and Obstetrics. All preceptors are board certified in Family Medicine and serve as adjunct professors at the University of South Alabama.

We have identified several areas in our current, traditional predoctoral training program that require attention: Evidence-based information, professionalism and minority physician recruitment. The overall goal of this proposal is to improve quality of health care delivered across a wide range of patient-physician interactions by promoting early development of exemplary professional attitudes and behaviors in rising medical students including use of evidence-based information at the point of care and addressing health disparities by recruiting minority students to primary care.

This grant proposal will:

Teach professional behaviors to medical students with emphasis on professionalism in the context of the patient-physician interaction and early use of evidence-based information at the point of care. This will be accomplished by supplying dedicated computers with Internet access and appropriate training to our rural preceptors who currently are unable or unwilling to purchase computers for this purpose;
Develop a novel patient, nurse and preceptor assessments of student professionalism that will be incorporated into students evaluation at the end of the 3^rdyear family medicine clerkship; and
Increase the number of minority medical students that pursue careers in family medicine. This will be accomplished by actively recruiting high quality minority preceptors from the surrounding communities, providing them resources to access evidence-based information at the point of care, and pairing them with minority medical students during their 3^rdyear family medicine clerkship.

Arkansas

D56HP05215
Kent McKelvey, MD
Department of Family and Preventive Medicine
University of Arkansas for Medical Sciences
4301 W. Markham St. #530
Little Rock, AR 72205-7199
Tel: 501-686-6564
Email: McKelveyKentD@uams.edu

The purpose of this project is to develop and implement a medical genetics curriculum into the family and preventive medicine junior year clerkship and senior year primary care selective. The completion of the Human Genome Project has brought about the dawn of individualized medicine with dramatic implications for the practice of preventive medicine; however, without a clear pathway for its implementation, this wealth of information will remain underutilized and confusing. A curriculum at the University of Arkansas for Medical Sciences (UAMS) in both the junior and senior years of medical school is needed to link the potential of genetics for use in primary care. The proposed project has two objectives (junior year curriculum and senior year curriculum) and would take place over three years. In objective 1, the junior year curriculum will focus on the ethical, legal and social implications unique to genetics. Year one will involve curriculum planning, development and production of the web-based format (WebCT). An initial needs assessment focusing on medical genetics and the role of the primary care physician is already being piloted and will help in curriculum development. We will pilot one case in the web-based format at all clerkship sites in the 1^stquarter of year two and gather data needed to refine and revise the curriculum. The other cases will be introduced into the curriculum throughout the 2nd year of the grant with on-going evaluation. Year three will involve monitored student discussion, continuing evaluation, and revisions of the curriculum. In objective 2, the senior year curriculum will focus on developing the clinical skills and knowledge necessary for assimilation of genetics into practice. The training will reinforce and expand on junior year curriculum and allow for lengthy and supervised student/patient interactions. The senior selective will provide an opportunity to work in the Adult Genetics Clinic, to synthesize bits and pieces of molecular genetics and biochemistry learned in the early years of medical school and to apply these principles to the clinical setting. The curriculum in both years will consist of relevant literature, didactic instruction, case-based implementation and knowledge assessment. The importance of family history as a genetic screening tool will be emphasized through didactics and the implementation of a novel computer assisted family history program into our electronic medical record. The project will become a major component of the family and preventive medicine curriculum and will be broadly applicable to all medical specialties at UAMS. By integrating concepts of genetics into primary care, the project will create a unique curriculum which should become fundamental knowledge for the next generation of physicians.

Colorado

D56HP05236
Mark Earnest MD, PhD
General Internal Medicine / General Pediatrics
University of Colorado School of Medicine
4200 E. ^9thAve., Box B-212
Denver, CO 80262
Tel:303-372-3100
Email:Mark.Earnest@uchsc.edu

Many of our students come to medical school with long records of service to their communities, interest in primary care, and a desire to be an agent of positive change in the world. Yet each year, fewer are pursuing careers in primary care and more are choosing careers with a narrow subspecialty focus. Ultimately, most will enter a practice focused on treating the consequences of an unhealthy community rather than promoting a healthier community in a way that prevents illness. We propose a novel, long-term approach to increase the number and effectiveness of primary care physicians by giving students a broader understanding of health and illness, exposing them to influential leaders, mentors, and role models, training them in leadership and advocacy skills, and providing them with opportunities to apply their knowledge, skills, and values in tangible projects in the community. While training a cadre of future leaders for the academic, medical and general communities, the program will raise the profile of leadership and community service at the School of Medicine and in doing so, shift the traditional paradigm of a physician's role in society.

Objective A: Develop a community of scholars focused on leadership and advocacy by providing a forum for discussion between faculty, students, and prominent physician and community leaders regarding issues related to health and leadership by implementing the Leadership Education and Advocacy Development (LEAD) Seminar Series (4 students per semester). The LEAD program is a multifaceted curriculum designed to expose medical students to the social, cultural, and economic antecedents of health and illness and provide them with the vision and skills to work effectively in their communities to promote health. The monthly LEAD Seminar Series will feature prominent leaders from the medical, business, legal, non-profit, faith, or political communities who will lead a discussion on leadership and the promotion of healthy communities.

Objective B: Develop and implement 2 LEAD Courses in leadership, advocacy, and community service designed to:

Promote awareness of underserved and vulnerable populations;
Promote awareness of the social and cultural antecedents of health and illness;
Address barriers to care and disparities in health; and
Promote diversity at the SOM.

Objective C: Develop and implement an 8-week summer leadership and service learning experience (The LEAD Summer Community Internship) for LEAD Scholars where students are partnered with a community based organization, implementing a project that promotes the health or well-being of the client population. The LEAD Summer Internship will be offered competitively to a maximum of 16 students a year who will be designated LEAD Scholars. LEAD Scholars must participate in all the LEAD Seminars and both LEAD Courses. Students selecting a focus in leadership, advocacy, and community service can elect to participate in a LEAD Capstone project during their fourth year which will entail completing a scholarly project related to community health or vulnerable populations. This collaborative project between the departments of Medicine and Pediatrics supports BHPr goals to eliminate barriers to care and health disparities and the goals of Healthy People 2010.

Georgia

D56HP05232
Obafemi Okuwobi, MD
Department of Family Medicine
Morehouse School of Medicine
1513 E. Cleveland Avenue Bldg # 100
Third Floor, Suite 300-A
East Point, GA 30344
Tel: 404-756-1219
Email:Okuwobi@msm.edu

The proposal addresses four areas to improve the current third year Family Medicine clerkship:

Ensure the uniformity and quality of preceptor instruction at ambulatory preceptor sites for the third year clerkship in family medicine through a faculty development program for faculty and community preceptors;
Enhance the quality of instruction within the didactic portion of the third year clerkship through the concepts of problem-based learning (PBL) cases that demonstrate the practice of evidence based medicine (EBM) and provide consistent instruction on medical errors prevention, cultural competence, and professionalism. The clerkship's core curriculum will evolve around the use of PBL with the goal of enhancing students' knowledge base and improving their mini-board and USMLE performance;
Enhance the consistency of exposure to the core curriculum's clinical content and reference materials across clerkship sites by using computerized clinical logs to document students' clinical experience and to provide standardized computerized educational resources, including evidence-based medicine resources, at the preceptor sites through the use of software for Personal Digital Assistants (PDA); and
To sustain the currently funded Summer Research Assistantship Program.

Hawaii

D56HP05216
Jill S.M. Omori, MD
Department of Family Medicine and Community Health
University of Hawaii
John A. Burns School of Medicine
95-390 Kuahelani Street
Mililani, HI 96789
Tel: 808-627-3260
Email: jomori@uhfpres.org

Currently it is estimated that 3.5 million persons in the U.S. will experience homelessness within the year and many will also be uninsured. The homeless numbers in the State of Hawaii are also worsening with an average of 6,029 homeless individuals on any given day in the summer. Over 50% of the homeless individuals in Hawaii are located in the city of Honolulu and the largest percentage of homeless individuals by ethnic group are the Native Hawaiians at 38.7% who have the worst health care indicators of all ethnic groups in Hawaii. Caring for the underserved is a large part of the mission of both the University of Hawaii John A. Burns School of Medicine (JABSOM) and the Department of Family Medicine and Community Health (DFMCH). The medical school and the department have consistently emphasized the importance of primary care and rural medicine. However, one area that needs to be addressed in our current curriculum is the issue of homeless health and the preparation of our students to care for homeless individuals. The goal of our grant project is to fill this gap in our current curriculum by providing our students with more exposure to homeless health issues and by providing hands-on clinical experiences at established homeless care clinics.

The best way to encourage students to contribute to the care of the homeless is to educate them regarding the social issues surrounding homelessness, the health care disparities that homeless individuals face, and the unique aspects of providing health care for homeless patients.

Our proposed project will add a much needed component to the current medical school curriculum by 1) expanding the PBL homeless health curriculum in the pre-clinical years; 2) adding a clinical experience at a homeless clinic for all third year medical students; 3) introducing a 9-month community health elective for first year students to explore community resources for the homeless; and 4) providing an elective experience for fourth year students to expand their knowledge and skills in caring for the homeless through extended clinical time in a homeless care clinic and participating in case management sessions.

We will also collaborate in partnership with the two major medical clinics in Hawaii for people who are homeless: the Health Care for the Homeless Program (HCHP) clinics which are located at the Institute for Human Services (IHS) Homeless Men's Shelter and the IHS Homeless Women and Family Shelter. These HCHP clinics are both run by the Kalihi-Palama Community Health Center. We will also actively educate family practice residents and primary care physicians in the community regarding homeless health issues and actively recruit them to volunteer with our students in the homeless clinics.

Illinois

D56HP05227
Donald J. Sefcik, DO, MBA
Family Medicine
Midwestern University
Chicago College of Osteopathic Medicine
555 31^st Street
Downers Grove, IL 60515
Tel: 630-515-6046
Email:dsefci@midwestern.edu

Our Department of Family Medicine has been very successful in implementing the objectives of our currently funded project. The majority of our new initiatives have focused on our third year students during their new 12-week clerkship in family medicine/community health. To help ensure that our students graduate with a thorough understanding of the issues of health disparities, health promotion/disease prevention, cultural competency, serving underserved populations, and the objectives of Healthy People 2010, we now propose to develop programming that will focus primarily on our first and second year medical students. The proposed project builds upon the strong primary care educational base that we have established with our current funding, and will allow us to develop, implement, and refine new, innovative teaching and assessment methodologies that will prepare our medical students for the practice of medicine in underserved communities, training and encouraging them to become community responsive physicians. Our objectives are:

In collaboration with the MWU Behavioral Medicine Program, establish an enhanced clinical behavioral science curriculum with a biopsychosocial perspective that will include small-group case studies with facilitators trained in behavioral sciences, supplemental on-line case studies, and a pilot experiential program in a primary care setting to reinforce the content. The curriculum will emphasize the role of culture, gender, sexual orientation, aging, ethnicity, socio-economics, health literacy, and disability on patient adherence and outcomes;
Develop, implement and assess a new coordinated four-year service learning curriculum, including new simulated patient exercises that focus on care for the underserved, health disparities, health literacy, health promotion/disease prevention, cultural competency, and the goals of Healthy People 2010; and
In collaboration with the Illinois Health Education Consortium/AHEC (IHEC/AHEC) enhance our Spanish Language and Cultural Immersion elective to include monthly half-day "mini-immersion" sessions throughout the year for program participants and other interested students.

The enhanced clinical behavioral science curriculum will provide our students with the knowledge, skills and attitudes necessary to practice in racially, ethnically, culturally, and socioeconomically diverse communities. A new service learning curriculum will be designed for our medical students preparing them to teach health literacy and health promotion/disease prevention, as well as to promote healthcare careers, to children in K-12 public schools, focusing on those schools with large numbers of low-income minority students. We will place our students in clinics that serve the homeless, low-income minority, and other vulnerable populations.

Kentucky

D56HP05232
Jennifer Joyce, MD
Department of Family Practice and Community Medicine
University of Kentucky
Lexington, KY 40536
Tel : 859-323-6711
Email: jmioyce@email.uky.edu

Both the American Board of Internal Medicine's Professionalism Project and the Collaborative Curriculum Project of the Family Medicine Curriculum Resource, which was funded by HRSA, suggest that professionalism is a central tenet of care and recommend increased emphasis on professionalism in medical training. This project will: (1) create a broad-based, integrated, professionalism curriculum that is initiated in the first two years of predoctoral medical education centered on activities and competencies delineated in the Competency-based Curriculum Resource for Pre-Clerkship Education (CCRPCE) document to better prepare all students for their clinical years; and (2) expand the rural training track to provide an additional site for student training.

The professionalism curriculum will be woven into the core non-biomedical pre-clinical courses in the first two years for all students. This component will include experiences and exercises designed to instill self-reflection as a necessary skill for professionalism and life long learning. Building on the success of the UKCOM rural training track (RTT), which was developed with a 2002 HRSA grant, we will also cultivate a third site for the third-year rural primary care clerkship. This will increase the number of students who are able to emphasize rural health care and disparities in their training. They will also be able to explore professionalism contextually in a rural environment. The RTT allows students who have pre-existing interest in rural health care to perpetuate and build on this interest via the longitudinal focus and enhanced activities of the RTT. As a rural state with a persistent and progressively worsening shortage of physicians, it is imperative to provide these students with opportunities to explore their interests in rural medicine. Our project will also develop and test new evaluation methods to hold students accountable to core professionalism competencies in the curriculum. Development of innovative evaluation processes for the core professionalism competencies has national importance.

Michigan

D56HP05214
David J Solomon, PhD
General Internal Medicine
Michigan State University
B-338 Clinical Center, MSU
Lansing, MI 48824
Tel: 517-353-2037
Email: dsolomon@msu.edu

CHM matriculates approximately 105 students per year. Students complete their basic science training on Michigan State University's home campus in East Lansing. They receive their clinical training in one of six community campuses located through out Michigan. Each community contains a variety of teaching sites including community hospitals, outpatient clinics, private physicians' offices, community health centers and other clinical sites specific to each community.

Our broad goal for this proposed project is to enhance our ability within the required internal medicine clerkships to provide students with a consistent high quality clinical education in our decentralized community-integrated medical school and ensure our students have the skills to provide comprehensive high quality and compassionate care to patients from all walks of life and especially those who currently lack adequate health care. The major vehicle for achieving this goal is through developing novel ways to make efficient and effective use of information technology.

The project includes three objectives: (1) create a new faculty orientation and development program based on distance learning techniques to prepare volunteer faculty for precepting internal medicine clerkship students; (2) continued development of a PDA-based tool that adds an assessment component to a competency resource guide based on the CDIM internal medicine clerkship curriculum guide; and (3) the implementation of a comprehensive curriculum on health disparities, barriers to care, and how they can be addressed.

D56HP05214
Mary Noel, PhD
Department of Family Practice
Michigan State University, College of Human Medicine
B 101 Clinical Center
East Lansing, MI 48824
Tel: 517-353-3544 X 451
Email: mary.noel@hc.msu.edu

The goal for this project is to improve medical student evaluation through development, pilot-testing, and institutionalization of a program of summative "gateway assessment" evaluation, which should then address health professional education to improve the care of patients. "Gateway assessments" are competency-based student performance evaluations that must be successfully passed by all students at different stages in their medical training. The gateway assessment will ultimately be applied to students at the College of Human Medicine, Michigan State University, during the 2nd, 3rd, and 4^thyears of training, for a yearly total of approximately 315 students being assessed.

This application proposed the following objectives:

Develop, pilot test, and evaluate three gateway assessments in the areas of patient care, evidence-based medicine/practice-based learning and improvement (EBM/PBL&I), and applying information to groups/systems-based practice (AIG/SBP);
Develop a series of manuals for students, staff and faculty to guide gateway assessment implementation;
Develop and implement faculty and staff training programs and materials in support of the gateway assessment program; and
Disseminate results at national meetings and in the peer-reviewed literature, and through the development of CD-ROM based materials suitable for use by other medical schools.

Mississippi

D56HP05221
Thais Tonore, MD
Department of Family Medicine
University of Mississippi Medical Center
2500 N. State Street
Jackson, MS 39216-4505
Tel: 601-984-5422
Email: ttonore@familymed.umsmed.edu

Our proposal is framed around an emphasis on evidence-based medicine (EBM) curricula in health promotion and chronic disease management that will prepare medical students to provide quality healthcare that addresses the diverse needs of our underserved and disadvantaged citizens. Students will experience increased exposure to primary care and clinical skills through two objectives: 1) expand development of an innovative web-based Family Medicine electronic curriculum to augment clinical experiences across all four years of medical school training; and 2) utilize electronic logging and data entry systems for evaluating relationships between rural clerkship variation and student outcomes.

We believe that training our students and residents within rural community-based sites increases the likelihood that these future practitioners will be drawn to practice in underserved areas. Drawing upon preceptor faculty working in private practice or community-based clinic settings offers students further exposure to the realities of economics and geographic location on patient health care and the need for medical information at the point of service.

Greater emphasis on technology-driven education will enable medical students training at rural community sites to practice evidence-based medicine at the point of care. Access to proposed e-learning instructional modules and educational information will give students, as well as their supervising preceptors up to date evidence-based diagnostic and treatment guidelines for common diseases seen within our rural state (diabetes, hypertension, cancer, asthma). The Department of Family Medicine will utilize the Blackboard 5 software to disseminate educational materials to medical students. Blackboard is a comprehensive e-learning system that allows educators to enhance their learning product using the Internet. Logging exposure to clinical procedures via a handheld device and using practice patient-based exercises to teach and assess basic clinical skills are innovative approaches within our institution. Electronic logging of clinical encounters will enable project faculty to monitor the types of clinical experiences and exposure that students are provided during their preceptorship/clerkship experiences. Implementation of this electronic clinical encounter tracking will enable us with a means to study uniformity in the types of clinical procedures students are exposed to at precepting sites, as well as enable us to further develop clinical activities on-campus for students not experiencing a broader range of procedures during their community-based experiences.

North Carolina

D56HP05213
Robert E. Gwyther, MD
The University of North Carolina at Chapel Hill
Department of Family Medicine
104 Airport Dr., Ste. 2200, CB 1350
Chapel Hill, NC 27599-1350
Tel: 919-966-3711
Email: robert_gwyther@med.unc.edu

This project addresses a major goal of Healthy People 2010, eliminating health disparities. Experts draw clear links between cultural competence, structural barriers, and the elimination of racial or ethnic disparities in care. We will strengthen the cultural competence training our medical students receive and develop their leadership skills to prepare them to better address structural issues associated health disparities. We will:

Significantly redesign the third-year family medicine clerkship to incorporate knowledge, attitudes, and skills necessary to provide culturally effective care using a new curriculum, Multiculturalism in Clinical Care for 160 third-year students (100% of the class) each year of the project;
Increase the number of graduates who can independently care for Spanish-speaking populations, without the use of an interpreter, enrolling at least 20 first-year students each year of the project; and
Prepare a select group of physicians in training for leadership roles in eliminating health disparities by developing and implementing a new program “Leadership in Addressing Health Disparities,” for 10 students each year of the project.

These objectives represent a comprehensive approach that will prepare UNC medical students to address a major goal of Healthy People 2010, eliminating health disparities.

New Jersey

D56HP05233
Chantal Brazeau, MD
Family Medicine
New Jersey Medical School
MSB room B 648, 185 South Orange Avenue
Newark, NJ 07103
Tel: 973-972-2494 or 7979
Email: brazeacm@umdnj.edu

The overall purpose of this project is to increase the number of students entering Family Medicine by enhancing role modeling of quality care by preceptors, and using the enhanced experience at preceptors’ offices to teach students about the New Model of Family Medicine recommended by the Future of Family Medicine Project. This new model of care involves use of technology and evidence-based practice (EBP), and the physician as a leader of team work and systems management to improve quality of care in primary care practices. A summer research program will also be used as an additional method to introduce this new model of care to students and as part of the evaluation of this project.

To accomplish our goal, we will create an appropriate learning environment and culture in preceptors’ offices, by providing PDAs, appropriate software to improve EBP and quality of care at point of service, in-office technological support, chronic disease registries, workshops and individual academic detailing for preceptors. After the preceptor and preceptors' office are prepared, we will provide workshops for third year clerkship students about EBP and quality management, to reinforce the role modeling received from their preceptors and engage students in problem solving about EBP and systems issues in quality of care. We propose an extensive evaluation for this project, including an innovative qualitative/observational research study where we will add 3 medical students to our existing summer research program and train them to do field research in preceptors’ offices to evaluate the teaching and role modeling preceptors provide to students in EBP and quality management. Through this research, summer students will be introduced to the New Model of Family Medicine.

This project is divided into three objectives:

Prepare community preceptors and their offices to effectively role model EBP and quality management in keeping with the New Model of Family Medicine;
Integrate evidence-based practice and quality management into the clerkship curriculum; and
Enhance the summer research program to introduce students to qualitative primary care research and the New Model of Family Medicine.

D56HP05234
Thomas A. Cavalieri, DO
General Internal Medicine
University of Medicine & Dentistry of NJ-School of Osteopathic Med.
University Doctors Pavilion
42 E. Laurel Rd.-Suite 3100
Stratford, NJ 08084
Tel: 856-566-7109
Email: cavalita@umdnj.edu

This project proposes several curriculum innovations at the University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine (UMDNJ-SOM) aimed at enhancing its students knowledge, skills and attitudes in the areas of public health, cultural competency, health disparities and barriers to care, particularly in relationship to the Latino community, in order to adequately prepare them to appropriately serve the primary health needs of the culturally diverse and underserved communities of NJ. These enhancements are integrated throughout the entire four years of the curriculum and are being developed and delivered in collaboration with the UMDNJ-School of Public Health (SPH), UMDNJ-Institute for the Elimination of Health Disparities, UMDNJ-Hispanic Center of Excellence, and Shore AHEC. They include: (1) Clinical and Population Based Prevention Course in the first year; (2) Latino Culture/Medical Spanish Course elective for first or second year students; (3) Primary Care Underserved Clinical Experience incorporated into their third year required general internal medicine rotation; (4) Latino Health Web Based Training Program for completion during the Primary Care Underserved Clinical Experience; (5) Urban Underserved Elective during the fourth year; and (6) Primary Care Research Elective in the fourth year.

Physicians in training must be adequately prepared to address the emerging health care needs that they will face as they enter practice, such as increased diversity among their patients and seemingly intractable health disparities. The physician of the future must be culturally competent to provide high quality, sensitive, primary care. NJ's increasingly diverse population is specifically characterized by a rapid rise in the Latino community. Increased attention nationally has been placed on significant health disparities and barriers to care. Similarly physicians in training must be knowledgeable in public health issues in order to adequately address health disparities. The Institute of Medicine has documented the important relationship of public health to the training of future physicians.

Objectives:The overarching goalof this project is to prepare medical students to appropriately serve the primary health needs of the culturally diverse and underserved communities of NJ.

The objectives are:

Enhance the students' knowledge, skills, and attitudes in the area of public health Aimed at emphasizing clinical prevention and population based medicine;
Enhance the students' knowledge, in the area of cultural competency, particularly in relationship o the Latino/Hispanic community;
Enhance the students' skills and attitudes in the area of cultural competency, particularly in relationship to the Latino/Hispanic community; and
Increase the students' awareness of barriers to care, and learn about interventions for the elimination of health disparities.

New York

D56HP05212
John Smucny, MD
Department of Family Medicine
The Research Foundation of SUNY
P.O. Box 9
Albany, NY 12201
Tel: 315-464-7010
Email: smucnyj@upstate.edu

The purpose of the project is to significantly increase the number of medical students choosing to practice in rural areas following completion of training by implementing a comprehensive plan for a continuum of contact with prospective, enrolled and graduated students from rural areas. The project has three objectives:

Increase the enrollment in the college of medicine of students from rural areas through collaboration with regional AHECs and the University's Office of Admissions to identify and actively recruit students from rural areas to the College of Medicine;
Significantly expand the number of medical students participating in clinical training experiences in rural underserved areas through 1) development of model Teaching Community Health Centers (CHCs) at two existing federally qualified rural CHCs; 2) development of new clinical training sites in five additional regional rural communities; 3) development of a rural component of our Family Medicine clerkship, with placement of up to 26 students per year in rural training sites; and 4) development of a preclinical elective with placement of 10 students per year in rural training sites;
Recruit medical school graduates to regional rural communities to practice through collaboration with the University Alumni Office, regional AHECs and rural hospitals to track and communicate with graduates during their post-graduate training and proactively recruit them back to the region.

NOTE: Funding is requested only for support of Goal 2. Goals 1 and 3 are included in the application to illustrate the comprehensive nature of our overall plan and will be supported by the Department of Family Medicine and regional AHECs.

Training facilities:Two federally qualified rural Community Health Centers and five additional private practices in rural underserved communities.

D56HP05219
Darwin Deen, MD, MS
Albert Einstein College of Medicine
Department of Family and Social Medicine
1300 Morris Park Ave.
Bronx, NY 10461
Tel: 718-430-2900
Email: deen@aecom.yu.edu

The Albert Einstein College of Medicine (AECOM) is a private medical school located in a multiethnic urban neighborhood in the Bronx, New York. A total enrollment of more than 800 M.D. and Ph.D. students makes AECOM New York State's largest private medical school. The school has a long-standing commitment to urban primary care and was the first private medical school in New York to establish a Department of Family Medicine. The AECOM Department of Family and Social Medicine (DFSM) offers the Residency Program in Social Medicine (RPSM), created to address the shortage of primary care clinicians trained to work in underserved communities which was the first administrative unit in the U.S. to sponsor residencies in all three primary care disciplines. Established in 1970 at Montefiore Medical Center, AECOM's major teaching affiliate, this program includes faculty physicians working in seven clinical practice sites in medically underserved communities throughout the borough of the Bronx. The Department's mission is to improve the health of underserved communities. Over two-thirds of the physicians trained in the RPSM are practicing primary care and the majority of these continue to practice in underserved communities.

The Department of Family and Social Medicine at the Albert Einstein College of Medicine seeks to create a Generalist Careers Pathway program (GCP) with the goal of reducing health disparities and improving the health of medically underserved communities by improving medical students' recognition of the importance of primary care in American health care, providing students with a vision of how they can contribute to shaping a new health care system, and supporting and encouraging students interested in primary care to maintain that interest. In addition, we anticipate changing students' attitudes toward providing culturally competent care to all patients, regardless of their chosen practice specialty.

The Generalist Career Pathway program at (AECOM) that will accomplish the following objectives:

To increase the exposure of AECOM medical students to primary care faculty by creating a Generalist Career Pathway program (GCP), which will include faculty-student mentoring for all four years of medical school and a co-curricular primary care curriculum delivered during the pre-clinical years;
To increase the visibility and improve the stature of the primary care disciplines within the medical school by establishing a quarterly Interdisciplinary Grand Rounds series and by sending students in the GCP to national primary care conferences who will then share their experiences as part of the GCP curriculum;
To increase students' awareness of the need for primary care clinicians in Medically Underserved Communities (MUCs) and positively affect their attitudes toward working in these settings; and
To increase the number of students who select generalist faculty to work on community-based primary care oriented service learning or research projects and foster student interest in primary care research throughout their undergraduate medical education.

Ohio

D56HP05225
Mamta K. Singh, MD
General Internal Medicine
Case Western Reserve University School of Medicine
10900 Euclid Avenue
Cleveland, OH 44106
Tel: 216-778-3428
Email: msingh@metrohealth.org

Case Western Reserve University created the Primary Care Track (PCT) in 1992. This predoctoral track, an interdisciplinary four-year program of the departments of Family Medicine, Internal Medicine, and Pediatrics, included a longitudinal preceptorship in the second year and continuity clinic in the third year, two separate programs without connection. With the help of a HRSA grant in 2001, the PCT faculty combined these two experiences into a two-year longitudinal ambulatory primary care program, supported by a defined curriculum and advanced technology called the Community Primary Care Preceptorship (CPCP). This course has been very successful and has received excellent feedback from community preceptors and students alike. Although the course is mandatory for all primary care track students, it has recently seen growing popularity amongst non primary care track students. In addition, Quality Improvement education has been part of Case's curriculum, but only on an elective basis without strong integration in patient care. Recent mandates from national educational organizations calls on medical educators to better inform medical students about Quality Improvement (QI). With the help of this grant we plan to increase the breadth and depth of primary care education with: (1) the expansion of the CPCP clinical preceptorship to include all second year medical students as part of a newly required Foundations of Clinical Medicine (FCM) course; (2) the reconfiguration of the CPCP online curriculum to conform to these changes in students' clinical experiences; and (3) the creation of an innovative and comprehensive curriculum in Quality Improvement combining electronic learning and hands-on projects as an additional component of FCM. As we expand the preceptorship, we will develop a strong web-based infrastructure to accommodate all faculty and students and we will use this electronic database for data collection, communication, evaluation and systems improvement. Furthermore, we will build on our primary care modules not only by expanding its audience, but also reconfiguring its content to introduce Quality Improvement principles and to better fit students' clinical experiences. The QI curriculum will include a personal and patient-based improvement project which will be evaluated with the help of faculty expertise. This innovative longitudinal curriculum will serve as a model for others to show successful integration of QI learning with primary care education.

Objectives: The overall goal is to enhance the CWRU medical students’ primary care learning by expanding the Community Primary Care Preceptorship program to include all second year medical students and to enrich the first and second year primary care experience with an innovative and comprehensive curriculum in Quality Improvement.

Pennsylvania

D56HP05224
David E. Fox, DO
Family Medicine, General Internal Medicine, General Pediatrics
Lake Erie College of Osteopathic Medicine (LECOM)
1858 West Grandview Boulevard
Erie, PA 16509
Tel: 814-866-8122
Email: Ckon.nerth@lecom.edu

Now over 10 years old, LECOM always has emphasized primary care. "Cutting edge" efforts have been made to support this mission. Recent examples include: 1) offering three pre-clinical basic learning pathways: Lecture Discussion, Problem-Based Learning, and Independent Study and 2) establishing a Primary Care Education Unit. Staffed by Family Medicine, General Internal Medicine, and General Pediatrics faculty, one of the first initiatives was a major curriculum review, one result of which drives the purpose of this project; to integrate complementary and alternative medicine into the entire medical student curriculum.

To this end, we propose: 1) to modify the three pre-clinical basic science pathways to include learning `strategies regarding complementary and alternative medicine; 2) to plan, design, and implement primary care clerkship experiences in both years of the two-year clinical curriculum regarding complementary and alternative medicine; and 3) to develop web-based virtual educational programming regarding complementary and alternative medicine. Analyses of the pre-clinical and clinical portions of the curriculum will be conducted for ideal areas to integrate complementary and alternative medicine. Appropriate didactic materials and educational experiences will be developed and integrated into the four-year curriculum. All three basic science learning pathways will be targeted plus respective third-year required clerkships of each of the three clinical units and the shared fourth-year Primary Care Selective. To complement clinical education and training, web-based virtual educational programming will be integrated. Precise qualitative and quantitative assessment measures will inform the data collection and analysis strategies to evaluate effectiveness of project processes and outcomes.

D56HP05222
Katherine Margo, MD
Department of Family Medicine
University of Pennsylvania School of Medicine
2 Gates/3400 Spruce St.
Philadelphia, PA 19104
Tel: 215-615-3692
Email: margok@uphs.upenn.edu

The Department of Family Practice and Community Medicine of the University of Pennsylvania seeks funding to integrate the teaching of public health and community medicine into the medical school curriculum across all four years. This will be accomplished by integrating community-focused service learning within a family medicine model of health care. We seek increased Family Medicine impact throughout the medical school core curriculum, additional learning opportunities for targeted students, and the development of a medical student-centered community health clinic in a Medically Underserved Community. As part of the focus on underserved community health concerns we will develop online web cases to meet targeted Healthy People 2010 objectives.

Goal 1: Develop and implement a longitudinal public health and community medicine curriculum for medical students that will occur over four years (150 students/year);

Goal 2: Develop a public health and community medicine component to the Module 4 required clerkship in Family Medicine (150 medical students/year);

Goal 3: Plan and implement a medical education program at a new school-based, education focused, full-service, primary care clinic in a Medically Underserved Community (MUC) in West Philadelphia (48 clerkship medical students/yr, 10 other medical students/year.);

Goal 4: Develop and implement a summer community assistantship that will provide first year medical students with a focused community-based experience in resource-poor urban primary-care settings (3 medical students/summer); and

Goal 5: Track Penn medical students' choice of specialty and practice setting along with the Sayre High School students' choice of profession.

Texas

D56HP05220
Mark J. DeHaven, PhD
University of Texas Southwestern Medical School - Dallas
6263 Harry Hines Blvd.
Dallas, TX 75390-9067
Tel: 214-648-1046
Email mark.dehaven@UTSouthwestern.edu

The Department of Family and Community Medicine seeks to develop a Community-Based Participatory Research Track (CBPRT) in its Division of Community Medicine. The CBPRT will be based on the principles of population medicine with special emphasis on community-based health promotion and disease prevention.

Our proposed project has two objectives:

Develop a comprehensive Community-Based Participatory Research Track (CBPRT) for medical students, by integrating new and existing curricular offerings and experiences with innovative community-based research and service-learning opportunities; and
Develop a longitudinal training curriculum and related community-based training experiences for medical students based on the population medicine perspective, and the principles of health promotion and disease prevention.

The project will develop a replicable and nationally-applicable experience for training medical students in the population medicine perspective. The project will consist of didactic components and applied community-based research and service-learning experiences. An integrated curriculum will be developed combining these types of training approaches, allowing medical students to participate in meaningful community-based research and service projects, with family physicians and other health care professionals. Medical students will receive training in the fundamentals of community-based and practice-based research, and will participate in "hands-on^" projects and training in family practice clinics, public health clinics, and other settings engaged in community-based health care delivery.

The CBPRT training experience will consist of five experiences that define the core curriculum, including the: Core Topics Seminar, Pre-Clinical Electives Program (PEP), Community Medicine Elective, Ambulatory Care Family Medicine Rotation, and Community Service Core. Students participating in the CBPRT will select one of two sub-tracks, leading to either a "Certificate of Knowledge in Community Medicine" or "Distinction in Community Medicine Research." Certificate students will complete all of the CBPRT core training requirements, will be knowledgeable in community-based participatory research techniques, and will have significant skills in applied community medicine principles. Distinction students will complete the same requirements as the certificate sub-track students, but will complete more intensive participatory research training and present their research at a national peer-reviewed conference and/or submit scientific manuscript for publication in a peer-reviewed medical journal.

Utah

D56HP05218
Marc E. Babitz, MD
Claire Clark, PhD
Department of Family and Preventive Medicine
University of Utah School of Medicine
375 Chipeta Way, Suite A
Salt Lake City, UT 84108
Tel: 801-587-3379
Email: Marc.Babitz@hsc.utah.edu

This project is intended to result in improved health care being provided to medically underserved populations and it will build upon the success we have had with our innovative software program to teach Community Oriented Primary Care (COPC) using a rural, "virtual" community. Using our "virtual" community, educational software program, health professions students, residents and/or providers can learn how to assess a community's health, how to prioritize the health problems of the community, how to select appropriate community health interventions, and how to evaluate the impact of those interventions. This highly innovative project has been received with great enthusiasm by other training programs. However, since our first project used a rural model, we have been planning to develop an urban community as a second (companion) "virtual" community in which a learner can practice COPC.

Our urban community will be ethnically diverse and more complex. This "virtual" community will be developed based upon the actual service area of the Salt Lake Community Health Centers (a federally funded community health center) which serves a multi-cultural, bilingual, predominantly Latino population. This virtual, urban community will reflect health care issues found throughout urban America. This grant application seeks the additional funding required to develop our second "virtual" community software program. This educational program will be incorporated into an existing, required course for all senior medical students (the Public/Community Project course), thus impacting approximately 102 students/year.

Objectives:

All senior medical students will be educated on the principles and practice of community-oriented primary care using a lecture-based curriculum followed by a computer-based practicum with a rural and an urban community;
All senior medical students will complete an assessment of their learning of the principles and practice of community-oriented primary care (COPC); and
All senior medical students will gain a greater understanding of the diversity of health care needs for different (culturally, geographically, etc.) types of communities.

Virginia

D56HP05228
Bruce S. Britton, MD
Department of Family Medicine
Eastern Virginia Medical School
P.O. Box 1980
Norfolk, VA 23501
Tel: 757-446-7460
Email: brittonbs@evms.edu

ExPRESS (Excellence in Primary Care Education, Scholarship and Service) is an initiative that will facilitate the development, implementation and evaluation of new educational strategies to train medical students in effective patient-centered approaches to the delivery of care, focused on eliminating cultural and contextual barriers to health care and health disparities in minority and underserved communities. Cultural and contextual competence is a congruent set of behaviors, attitudes and policies that enable professionals to work effectively in cross-socio-cultural situations. During the next three years, the Department of Family and Community Medicine at the Eastern Virginia Medical School (EVMS) will build upon its long-standing tradition of providing innovative primary care instruction and experiences and integrate this new initiative within its current six-week M3 clerkship program. ExPRESS will employ new case-based learning experiences using short video scenarios, active learning with standardized patients and new and enhanced community-based rotations with an emphasis in the areas of physical and mental health of adolescents, women and the elderly. In addition, ExPRESS will feature health literacy as a major focus within the cultural and contextual competency theme. ExPRESS will build and expand partnerships with community health agencies/institutions to provide meaningful public health experiences for the students. The primary goal of ExPRESS is to equip students with knowledge and skills to respect, recognize, educate, treat and partner with patients to incorporate their cultural and contextual influences into their overall health plans. Another goal of ExPRESS is to excite the next generation of physicians to choose community-based primary care career paths. Both ExPRESS goals will contribute to HRSA's national goal to eliminate barriers to health care and health disparities.

The following program objectives facilitate the goals of ExPRESS.

Enhance the infrastructure and administrative support to the Family Medicine M3 Clerkship to enable the development and integration of new curriculum and experiences and to oversee the implementation and evaluation of the ExPRESS initiative;
Develop, integrate and evaluate cultural/contextual competency content for a new ExPRESS Forum in target areas of adolescent, women's and elderly health;
Collaborate with the EVMS' nationally recognized Theresa Thomas Professional Skills and Assessment Center to develop, implement and evaluate simulated case scenarios for training in cultural/contextual competencies;
Develop, implement and evaluate new rotation experiences to advance cultural/contextual competencies;
Develop, implement and evaluate a public health/patient education project that addresses health literacy challenges;
Develop, implement and evaluate a new Evidence Based Medicine (EBM) computer-based module that provides instruction as well as hands on experience with the latest PDA technology; and
Develop, implement and evaluate a new series of community and public health topics to expose students to issues of minority health and health disparities, information concerning local, regional and national needs, government responses, and the positive aspects of work in community-based settings.

Washington

D56HP05231
Tom Greer, MD, MPH
Department of Family Medicine
University of Washington School of Medicine
PO Box 356390
1959 NE Pacific Street
Seattle, WA 98195-6390
Tel: 206-543-9425
Email: tomgreer@u.washington.edu

The traditional role of the physician as prescriber-lecturer-admonisher is in need of change. This proposal trains medical students in patient self-management of chronic illness with a special emphasis on professionalism. We will build upon and reinforce the University of Washington School of Medicine's curriculum reforms begun in 2000 that gave rise to: 1) a group of 30 core college faculty (including 7 family physicians) who model communication, physical examination skills, and professionalism, and provide 4-year mentorship for students; 2) a new 1^stand 2^ndyear continuity preceptorship requirement; 3) a new research requirement broadened to include community oriented primary care projects at rural and underserved family medicine sites; 4) a 4th year chronic care clerkship; and 5) enhancements to our long-established required 3^rd year clerkship and service learning programs.

The project focuses on diabetes management as a model, because of the disease's prevalence (especially among aging, underserved and ethnic minorities), its connection to family dynamics, and its measurable outcomes. The project will support a comprehensive four-year curriculum to enhance faculty, medical student, and selected patients' understanding of the importance, principles and methods of patient self-management, and underscore the meaning of related professionalism values in actual medical practice. We focus on both the acquisition of new knowledge and application of that knowledge to patient encounters. Because of distant teaching sites, parts of the curriculum are web-based, including: 1) learning materials; 2) patient assessment tools; 3) a student-produced video showing doctors as "coaches" for patients; 4) culturally diverse case illustrations; 5) a short written reflection assignment; and 6) an electronically-generated poster summarizing the patient's progress and personal diabetes management goals. Students will internalize through experience, discussion with faculty, and self-reflection the value of patient self-management; primary, continuous, patient-centered, and culturally sensitive care; the rewards of working with the underserved and chronically ill; and the meaning of related professionalism values in actual practice.

West Virginia

D56HP05229
Dorian Williams, MD
Department of Family Medicine
WVU Research Corporation on behalf of West Virginia University
886 Chestnut Ridge Road
PO Box 6845
Morgantown, WV 26506
Tel:304-598-6920
Email:williamsdo@rcbhsc.wvu.edu

The need for training competent health providers who understand and utilize community and public health teachings is strong in a state like West Virginia. Medical students receive minimal exposure to public health issues and experience little instruction in the concept of "community as patient". It is vital that our future physicians are able to recognize and mobilize in order to intervene and treat environmental and community health risks. This is especially true for physicians serving in rural and underserved locations where resources are limited.

Physicians need to be prepared to interview well, diagnose behavioral disorders, and provide appropriate treatment and/or referral for patients in need. As such, communication skills that positively impact Doctor-Patient rapport, effective data gathering, treatment adherence, and clinical outcome are paramount.

By building on the leadership the department has developed in educational innovation and using the inter-departmental faculty network we have nurtured, we will address three key areas in medical education: health literacy, communicationand community health.

Objective 1 will provide students with the skills needed to effectively communicate with their patients, including those with low literacy skills and cultural differences.

Objective 2 will create and integrate a longitudinal community health curriculum by revising first, second and third year courses and adding a new community health experience to the third year Family Medicine Clerkship.

Objective 3 will create a 4^thyear doctor-patient communication skills course to reinforce and better prepare students to assess the psychosocial needs of their patients and provide an avenue for remediation for students identified in need of this skill set.