1. TRIUMPH TRaining In Urban Medicine & Public Health John Brill, MD, MPH; Marjorie Stearns, MA, MPH; Cynthia Haq, MD, & Jeffrey Stearns, MD University of Wisconsin School of Medicine and Public Health Milwaukee Academic Campus

2. Session Goals & Format  Describe TRIUMPH Rationale/Background Curricular Elements Evaluation Methods & Formative evaluation feedback to date Challenges & Opportunities  Discussion—Sharing... Urban medical education experience Insights on addressing challenges

3. What is TRIUMPH? Training in Urban Medicine & Public Health: Combines existing Milwaukee-based M4 electives & M3 Primary Care, OB/GYNE, and IM clerkships Adds a Community And Public Health ENrichment Experience (CAPHENE) Integrates the Longitudinal Preceptorship Experience. TRIUMPH is a 15-month experience for 8 students beginning in January of M3 yr

4. Rationale  Health disparities in Milwaukee  Shortage of physicians serving disadvantaged populations in the urban centers of WI  UW name change in 2005 to School of Medicine and Public Health  Continuation of institutional commitment to the “Wisconsin Idea”

5. Educational Context  Full range of clinical experiences 40 yr partnership with Aurora Health Care— large integrated healthcare delivery system AUWMG clinics Community Health Centers Clinics for uninsured Affiliated physicians  Community-based organizations—full range of partners for longitudinal community health projects  Housing and meals provided by Aurora Health Care

6. Curricular Elements--Historic  Community- Responsive Physician HRSA Grant (2001- 2004)  M3 yr Ob/Gyne (6 wks) Primary Care (8 wks) IM (8 wks total— 4 Madison/4 MKE) Core Days  M4 yr Longitudinal Preceptorship with 4 wks Community Health (July) IM Sub-I Required Surgery M4 electives—up to 8 wks out-of-town Core Days

7. Curricular Elements--New  CAPHENE—2 weeks in February Intro to MKE Healthcare & Public Health Context Cultural Tour—two days of cultural immersion History of Milwaukee Home visits Presentations on projects Adding: ABCD Training in year 2  Revised Community Health clerkship--July  Longitudinal Community Project  Weekly Humanism Rounds—didactic and Balint  NING website—reflection log/social networking

8. Community Partners  Aurora School-based Health/MPS  Bread of Healing Clinic  City of Milwaukee Health Department  Milwaukee Health Services—MLK FQHC  16 th St. Community Health Center  United Community Center  Walker’s Point/Core El Centro  Walnut Way—Lindsay Heights Neighborhood Initiative

9. TRIUMPH Framework Community Health Medical Student/ MD As Person Clinical Patient Care Core Competencies: Cultural humility and sensitivity Knowledge of community health resources Experience working with interdisciplinary teams Skills to engage urban communities and reduce health disparities Curricular Activities Longitudinal Community Projects

10. Student Selection  M2 Recruitment TRIUMPH summer experience Urban Med Interest Group Information sessions Premed Pipeline under construction  Application and Interview  Selection Criteria Based on predictors of working with the medically underserved Evidence of commitment demonstrated by background and past experiences

11. Student Assessment  Traditional UW SMPH clerkship evaluation measures— Exams & OSCE  Personal/Professional Development Longitudinal Preceptorship Evaluation Urban Learning Portfolio Reflection Log and discussions (NING)  Community Projects Milestones outlined in manual—timeline, logic model, workplan, outputs, outcomes, presentations, interim and final reports, and self-evaluation Activity Log—weekly record of time and effort Community mentor & faculty advisor feedback

12. Program Evaluation  Evaluation Consultant  Student, faculty and community input solicited Surveys Focus groups Key informant interviews Recruitment and retention / satisfaction  Reports to funders and accreditation organizations  Outcomes/Impact—Graduate Tracking Survey and community health improvement indicators

13. Formative Feedback  CAPHENE Survey—March Overall Experience rated a 5.0  “Very powerful, enlightening and important! Best experience of all of med school! Learned life lessons.”  Suggestions for improvement—will add focus for next rendition of CAPHENE Mean rating of 13 components=4.5 (Range 3.17-5.00 on scale of 1-5)

14. Focus Group Feedback—May  Enhanced communication, outreach and research skills  Learned directly from patients about their sociologically complex situations  Chance to take responsibility for a community health improvement project and make a difference  Experience with fostering productive collaborations  Practice in juggling clinical duties with community outreach  Made challenge of urban health and pervasive public health issues seem less overwhelming  Reminded them of WHY they wanted to be doctors

15. Observation “ Medical school focuses a lot of attention on providing us with the knowledge we need to treat patients. But it doesn’t take long to realize that in order to truly help patients find health, you need to spend time learning about their culture and lifestyle as well. This is more difficult and not something that can be found in a textbook.” 2009 M3 TRIUMPH student

16. Challenges  Creating a longitudinal experience for students with varied career plans  Developing new M4 electives in Milwaukee  Adding public health content liberally while still focusing on clinical skills  M4 year issues  Scheduling issues  Safety  Student retention for M4 year  Community collaborations  Faculty and community mentor development  Increasing capacity of TRIUMPH

17. Opportunities  Additional funding and resources  Further development of Milwaukee Academic Campus  Implement some recommendations of FMCR  Develop pipeline of physicians for MKE residencies and urban clinics  Improve urban community health  Deeper, sustained community engagement

18. Acknowledgement  Predecessors in urban medical education—rich literature to guide TRIUMPH development!  Community Partners  TRIUMPH Advisory Committee  Adventurous students

19. TRIUMPH in Action

20. Discussion  Urban Medical Education Expertise  Addressing Challenges