Community-Academic Partnerships: Teaching Medical Students Public Health American Public Health Association, November 2004 Jan K Carney MD MPH University of Vermont College of Medicine

Why Public Health Projects? All physicians will face public health issues All physicians will face public health issues Multiple determinants of health Multiple determinants of health Population/community context of individual patients Population/community context of individual patients Increasing need for disease prevention Increasing need for disease prevention Partnerships essential Partnerships essential

Multiple Determinants of Health

Why public health projects? Physicians face a growing list of public health issues in clinical practice today: examples: Physicians face a growing list of public health issues in clinical practice today: examples: –Preventing childhood obesity –Emerging infectious diseases –Preventing and caring for chronic conditions in an aging population IOM recommends that “all medical students receive basic public health training in the population-based prevention approaches to health.” IOM recommends that “all medical students receive basic public health training in the population-based prevention approaches to health.”

Vermont Integrated Curriculum (VIC) Implemented at the UVM College of Medicine fall 2003 Implemented at the UVM College of Medicine fall 2003 Integrates sciences and clinical medicine Integrates sciences and clinical medicine Develops skills for life-long learning Develops skills for life-long learning Public health competencies Public health competencies

Public Health Projects in the Vermont Integrated Curriculum MSLG I = first year MSLG I = first year –Student groups of 8 –May 2004 = project ranking MSLG II = Public Health Projects MSLG II = Public Health Projects September through December September through December –Second year students –Begin September 2004 –13 projects per year

Themes and Competencies Professional development Professional development Learning Learning Leadership and Collaboration Leadership and Collaboration Research and Discovery Research and Discovery

Goals and Objectives

Public Health Projects: Educational Goals Understand the breadth and scope of public health Understand the breadth and scope of public health Understand current and emerging public health issues Understand current and emerging public health issues Understand how public health interfaces with clinical medicine Understand how public health interfaces with clinical medicine Understand and apply public health research methods Understand and apply public health research methods

Public Health Projects Educational Goals Understand the role of the community in improving individuals’ health Understand the role of the community in improving individuals’ health Learn practical ways to improve the health of both individuals and populations Learn practical ways to improve the health of both individuals and populations Be creative and have fun! Be creative and have fun!

For each Public Health Project: 1. must address a public health issue 1. must address a public health issue 2. must ask and answer a scientific question 2. must ask and answer a scientific question 3. must show a public health benefit 3. must show a public health benefit

Public Health Framework

Healthy People 2010 Overarching goals 1. increase quality and years of healthy life 1. increase quality and years of healthy life 2. eliminate health disparities 2. eliminate health disparities

Healthy People 2010 Focus Areas Access to quality health services Access to quality health services Arthritis Arthritis Cancer Cancer Chronic Kidney Disease Chronic Kidney Disease Diabetes Diabetes Disability Disability Educational programs Educational programs Environmental health Environmental health Family planning Family planning Food Safety Food Safety Health Communication Health Communication Heart Disease and Stroke Heart Disease and Stroke HIV HIV Immunization and Infectious Diseases Immunization and Infectious Diseases Injury and violence prevention Injury and violence prevention Maternal, infant and child health Maternal, infant and child health Medical Product Safety Medical Product Safety Mental health Mental health Nutrition and overweight Nutrition and overweight Occupational health Occupational health Oral health Oral health Physical activity Physical activity Public Health Infrastructure Public Health Infrastructure Respiratory Diseases Respiratory Diseases Substance abuse Substance abuse Tobacco Tobacco Vision and Hearing Vision and Hearing

Community-Academic Partnerships Students asked for better way to make a difference Students asked for better way to make a difference Previous project design reversed: Previous project design reversed: “Community First”! “Community First”! Community agencies asked to identify public health needs Community agencies asked to identify public health needs Projects designed to meet community- identified needs Projects designed to meet community- identified needs

Community-Academic Partnerships Link with community agencies Link with community agencies United Way of Chittenden County United Way of Chittenden County Invited proposals – January 2004 Invited proposals – January 2004 Protocols developed to match HP2010 focus areas and educational goals Protocols developed to match HP2010 focus areas and educational goals May 2004 – student rank and match May 2004 – student rank and match IRB process/IRB tutorial IRB process/IRB tutorial

Evaluation Field notes – for peers (COMET) Field notes – for peers (COMET) Written report – Written report – –About 10 pages –Background, Methods, Results, Conclusions –For mentors and agencies Poster presentation – Poster presentation – –Visually appealing summary –Professional quality –Suitable for submission to national meeting –January poster presentation at COM

Evaluation (cont’) Grading = Pass/Fail Grading = Pass/Fail Student self-assessment Student self-assessment Agency assessment Agency assessment Faculty mentor assessment Faculty mentor assessment Midpoint and final Midpoint and final –Individual contribution and group work –Competency based

Project Examples: 2004

Public Health Project Titles: Navigating a 15 minute doctor visit: Helping patients communicate with their physicians 1. Navigating a 15 minute doctor visit: Helping patients communicate with their physicians 2. Public Health for Refugees in Vermont: Public Health in the Home 2. Public Health for Refugees in Vermont: Public Health in the Home 3. Healthy Choice for Teens: the path to well-being through diet and exercise (Woodside) 3. Healthy Choice for Teens: the path to well-being through diet and exercise (Woodside) 4. The Built Environment and Health: Promoting healthy and active Vermont communities (VDH) 4. The Built Environment and Health: Promoting healthy and active Vermont communities (VDH)

Projects – 2004 (cont’) 5. Helping patients to help themselves: educational methods to improve access to health care – Lund family center 5. Helping patients to help themselves: educational methods to improve access to health care – Lund family center 6. Teaching young children about nutrition and physical activity: Improving nutrition and physical fitness in YMCA families 6. Teaching young children about nutrition and physical activity: Improving nutrition and physical fitness in YMCA families 7. Improving health care quality and reducing errors (VNA) 7. Improving health care quality and reducing errors (VNA) 8. Assessing psychiatry needs at a community mental health center (Howard) 8. Assessing psychiatry needs at a community mental health center (Howard)

Projects (cont’) 9. Immunizations are for adults, too: reducing the risk of influenza and pneumococcal disease in a nursing home 9. Immunizations are for adults, too: reducing the risk of influenza and pneumococcal disease in a nursing home 10. Diabetic-friendly food donations: nutritional options for the homebound senior (CCEFS) 10. Diabetic-friendly food donations: nutritional options for the homebound senior (CCEFS) 11. Improving the health of the community: educational strategies at the Community Health Center 11. Improving the health of the community: educational strategies at the Community Health Center

Projects – 2004 (cont’) 12. Improving the health of Puerto Cabezas, Nicaragua, Burlington’s Sister City 12. Improving the health of Puerto Cabezas, Nicaragua, Burlington’s Sister City 13. Complementary and Alternative Medicine: Physician beliefs and patient/doctor communication 13. Complementary and Alternative Medicine: Physician beliefs and patient/doctor communication

Public Health Projects – Healthy People 2010 areas Access to Quality Health Services Access to Quality Health Services Health Communication Health Communication Environmental Health Environmental Health Diabetes Diabetes Immunizations and infectious disease Immunizations and infectious disease Nutrition/Physical Activity Nutrition/Physical Activity Mental Health Mental Health

Jan K Carney, MD MPH, Associate Dean for Public Health, University of Vermont College of Medicine 371 Pearl St, Burlington VT (802)