1. A Longitudinal Multi-Faceted Community Medicine Curriculum Lauren Drake, MD Sarah Coles, MD, University of Arizona College of Medicine – Phoenix Family Medicine Residency

2. Disclosures We do not have any actual or potential conflicts of interest in relation to this program or presentation.

3. Session Objectives Describe the components and benefits a longitudinal, multi-faceted community medicine curriculum. Build and utilize a Community Needs Assessment tool to guide residency and resident advocacy and interventions within a community. Implement a longitudinal community medicine curriculum.

4. Mission Provide residents with needed skills to assess and address the needs of the community in which they practice. Collaboration and experiential learning with community partners throughout residency.

5. Social Determinants of Health

6. Benefits to the Community Produce physicians with a better understanding of barriers to care Increase knowledge of community resources Engage residents with local community Improve community health and outcomes Produce physician leaders to advocate on behalf of community

7. Benefits to the Community Comprehensive Care Team Based Care Empowerment

8. Curricular Structure Longitudinal Multi-experiential Focus on skills and behaviors Mapped to Milestones and EPAs –Builds complexity according to developmental level

9. Milestones! Patient Care: –PC-2 Level 4, 5 –PC-3 Level 2, 3, 5 Medical Knowledge –MK-2 Level 5 Systems Based Practice –SBP-3: All levels Communication –C-2: Level 5

10. Curriculum Didactics Longitudinal Experience in FQHC School based teaching Community Medicine Month Panel Management Pediatric Underserved Mobile Health Healthcare for the Homeless Clinic Initiatives Leadership Roles and Responsibilities

11. Didactics Multiple styles utilized –Noon conference style lectures, small group breakout discussions, peer led presentations Focus on Community Medicine Topics: –Leadership and Advocacy Skills –Health Literacy and Education –Community Resources –Social Determinants of Health –Governmental Policy –Cultural Competence

12. Sample Didactics Topics Community Resources Health Literacy Advocacy Training Leadership Skills Pediatric services (ROAR, developmental testing and services) WIC Refugee Health Dental Care Pregnancy Support Domestic Violence Different living settings and forms of nursing care Sex Trafficking Public Health: Infectious Diseases, Public Health Initiatives, Department of Public Health Alternative practice models

13. FQHC Rotate at our partnered Federally Qualified Health Center –State and federally funded resources and programs –Cost awareness –Barriers faced by the uninsured and underinsured

14. Mini Medical School Partnership with a local middle school Weekly science and medicine lessons after school –Organ systems –Health and Prevention –Practical Skills Sessions are prepared and run by resident teams

15. Mini Medical School Resident Learning Points Health literacy and health beliefs Barriers to care Leadership and mentorship Community engagement

16. Community Medicine Rotation 1 month in second year Format: –Mini-Medical School: Each Wednesday –Home Visits –Community Needs Assessment –Clinical Care Continuity Clinic and FQHC –Public Health Site Visits

17. Home Visit Focus on SDOH and barriers to care – Completes community needs assessment first – Conducted with social worker and pharmacist – Recommendations and resources for addressing unmet needs Specific medical concerns Medical adherence/cost Health Literacy Screen Financial Status Transportation Support system Neighborhood safety Food access Recreational/Exercise access Educational attainment Community Resources

18. Community Needs Assessment Must complete at least 1 Needs Assessment tool during residency Utilizes multiple resources –United States Census –Arizona Legislative Information and websites –CDC Community Health Status Indicators –Arizona School Report Cards –Google Maps or Arizona Government Map Services –Crime Rates by Zip Code Reporting

19. Community Needs Assessment Demographics Educational attainment Housing Employment Insurance coverage Government Info: Legislative, School, and Congressional Districts Health indicators School access and school report cards Crime rates Recreation and green space Public transportation

20. Community Medicine Resources Practical Playbook: https://www.practicalplaybook.org/https://www.practicalplaybook.org/ US Preventive Services Task Force: www.uspreventiveservicestaskforce.org/ www.uspreventiveservicestaskforce.org/ Community Preventive Services Task Force: www.thecommunityguide.org/www.thecommunityguide.org/ Healthy People 2020: www.healthypeople.gov/www.healthypeople.gov/ Maricopa County Department of Public Health: www.maricopa.gov/publichealth/ www.maricopa.gov/publichealth/ Centers for Disease Control and Prevention: www.cdc.govwww.cdc.gov Arizona Department of Health Services: http://www.azdhs.gov/http://www.azdhs.gov/ CDC Community Health Status Indicators: http://wwwn.cdc.gov/CommunityHealth/HomePage.aspx http://wwwn.cdc.gov/CommunityHealth/HomePage.aspx Arizona Department of Health Services Arizona Immunization Program: http://azdhs.gov/phs/immunization/statistics-reports/index.php http://azdhs.gov/phs/immunization/statistics-reports/index.php Arizona Report Cards: https://azreportcards.com/https://azreportcards.com/ Crime Rates and Statistics: http://www.raidsonline.com/http://www.raidsonline.com/

21. Advocacy Question Using the information obtained, please outline a potential intervention to address a need you identified. How might this intervention be implemented? What organizations or individuals would need to be included? How might you advocate for this intervention (this could include government, community partners, or stakeholders)?

22. Panel Management Every resident meets with panel managers 1 hour every other month Focus on their panel regarding a clinic panel management initiative –Diabetes, Colon cancer screening, mammogram, or pneumococcal vaccination Review progress with advisor and CCC every 6 months

23. Cruisin’ Health Mobile Mobile clinic through the Phoenix Children’s Hospital Services displaced youths –Family shelters, Transitional housing –Underserved Schools –Psychiatric facility –Runaway Teen Shelter Makes visible populations who need care but do not have the resources to go to a regular clinic

24. Clinic Initiatives Annual school supply drive –Supply 20+ kids with a loaded backpack with grade-appropriate supplies Holiday Helpers –Holiday gifts for 15-20 children in the clinic who would otherwise not receive them Clothing and infant supplies –Continuous effort to maintain a stock of items for patients in crisis Diabetes Group Visits

25. Healthcare for the Homeless Manage hospitalized patients from Healthcare for the Homeless Work closely with that attending regarding homeless healthcare –Transitions of care –Respite care –Medication management –Resources –Barriers

26. Sports Medicine Outreach Resident Volunteers assigned to local high schools to be their team physician Residents attend sports physical days at local school

27. Leadership and Advocacy PGY1: –Clinical leadership and direct patient care PGY2: –Advocacy and leadership in hospital, community, and local settings PGY3: –Administrative leadership, national advocacy, health care transformation

28. Community Medicine Leadership Each year 1-2 residents are identified as the community service chiefs –Identify community events for residents to volunteer at

29. Questions?

30. Thank You! Please feel free to contact us: Lauren Drake, MD Chief Resident University of Arizona College of Medicine - Phoenix Family Medicine Residency lauren.drake@bannerhealth.com Sarah Coles, MD Clinical Educator University of Arizona College of Medicine - Phoenix Family Medicine Residency sarah.coles@bannerhealth.com

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