Pathways: When Learning and Training Overlap with Community Health
Community health outreach is about improving health and quality of life for a community’s population with consideration to the socioeconomic, political and cultural determinants of health. When learners experience care outside the clinical setting, they realize the varying factors that impact health outcomes and mitigating factors can affect a care plan. Community organizations play big roles in eliminating barriers to care and filling gaps.
In recent years, UICOMP has developed community health electives to provide both medical students and residents with the opportunity to gain understanding and appreciation for community health and to nurture the symbiotic relationship between healthcare providers and com-munity-based organizations in improving the health of the populations they serve.
Clerkship Elective for Medical Students
Nationally, medical education has placed a deliberate emphasis on incorporating social determinants of health within the curriculum, explains Angela O’Bryant, MSN, RN, director of academic programs and co-director of the community health elective for medical students at UICOMP. “However, when they see a patient in an acute care setting, like the emergency room, for the third time that month, they now have a better understanding of reasons that the patient may have difficulty managing their chronic disease. They have learned to ask questions about things like access to healthy food, a pharmacy, and safe and secure housing,” she says.
But O’Bryant says asking the questions is not enough. “Physicians also need to be able to connect patients with local services that can help them meet these needs. Understanding community health and being connected to the community in which they serve allow physicians to help their patients in ways far beyond the diagnostics of medicine.”
The Community Health Clerkship Elective is a two-week elective for M3 and M4 students who can choose between spending time at two community-based organizations -- Central Illinois Friends and OSF Faith Community Nurses. In the Central Illinois Friends track, students participate in community outreach events as well as care for patients in the organization’s clinic. The focus is on sexual health and HIV care. With the OSF Faith Community Nurses option, students experience a wide variety of experiences that are often tailored to their interests. Opportunities exist at Senior World, The Riverplex (working with medical and cardiac rehabilitation), school nurses, street medicine alongside JOLT Foundation, and the OSF Care-A-Van. This track gives students an overview of community health in Peoria, highlighting services available to patients that they may later see in the hospital or clinical setting.
“With more than 30 students having completed this elective since it was started four years ago, I consistently hear from students that they wish they would have been able to take this elective earlier in their medical school career,” says O’Bryant. Students often see patients in the hospital or clinical setting that need the help of social and community service agencies, but don’t know the services available or organizations to help. Many times the attending and resident physicians working with the students don’t know either. She says this elective provides an up-close look at patients’ lives and puts the classroom topics of healthcare disparities and social determinants of health right in front of them.
“They witness patients having to choose between paying their rent or filling a prescription. They serve food and provide healthcare on the streets of Peoria to people who are experiencing homelessness. They drive through neighborhoods and assess sidewalks, green spaces, grocery stores (or lack thereof) and come to understand why their patients can't get to their appointments, or why patients have difficulty obtaining healthy food to better manage their chronic disease,” O’Bryant says. “It allows them to take off the white coat and get out of the safe and sterile environment to meet patients where they are.”
UICOMP residents may enroll in the Graduate Medical Education (GME) program’s Community Health Elective, an immersive, two-week community engage-ment experience. The elective improves residents’ understanding of the population they serve, priority health issues, health and health care disparities, and factors affecting the health of the population, including social determinants of health.
The main focus of this elective is to connect the physicians with the community organizations that serve a variety of populations, provide clinical and/or social services and serve as advocates on a range of issues. During the two-week experience, the residents visit each collaborating community organization including:
- Peoria City/County Health Department
- Faith Community Nursing (Care-A-Van and Senior World)
- Central Illinois Friends
- Hult Center for Healthy Living
- EP!C Foundation of Central Illinois
- Peoria Proud
- Children’s Home Association of Central Illinois
- Heart of Illinois Big Brothers Big Sisters
- House of Hope Peoria, Inc.
The rotation at Peoria City/County Health Department covers a broad focus and allows residents to learn more on the priority health needs in the community, women-infant-child services, and emergency preparedness. Organizations like Peoria Proud focus on diversity, equity, inclusion and social justice issues through advocacy, education, and outreach. Through OSF Faith Community Nursing Care-A-Van, residents observe and provide care to socially disadvantaged populations, and Senior World visits give insight into geriatric health. Central Illinois Friends rotation equips residents with sexual health and HIV/AIDS information, education, services, and advocacy.
The experience at EP!C allows residents to gain deeper understanding of the issues faced by the individuals and families living with intellectual and developmental disabilities. House of Hope rotation provides insight on trauma informed care, HOI Big Brothers Big Sisters focuses on nurturing children and strengthening families and communities. The Children’s Home Association of Illinois provides support and resources to children and families, especially at-risk youth. At the Hult Center, residents get involved in health education and prevention opportunities for a variety of populations and age groups. Through the discussions with the organizational officials and individuals seeking services at these organizations, residents gain a deeper understanding of the individual, familial, organizational and systemic contexts. This experience better prepares residents to provide compassionate, patient-centered care.
In addition to the rotations, the elective also includes readings, viewings (audio/video), trainings, discussions, reflective writing, and an issue-based paper.
“Residents participating in the elective have the opportunity to connect with the organizations to learn more about the services provided, the populations served, and the needs of the community,” says Gauri Shevatekar, MBBS, who is course director of the GME elective. “This gives residents exposure to the barriers and facilitators to care faced by the organizations and the populations they serve.”
Rotation at these sites foster physician engagement and participation within the community as well as their involvement in broader public health issues. These organizations serve as a valuable resource for the community. Through these collaborations, the physicians are able to connect their patients with the available resources, effectively addressing the social determinants affecting their patient population.
Shevatekar says while learning is key, just as important is the collaboration and future possibilities. “Another goal of the elective is to build long-term collaboration among providers and the community organizations to improve community health. This can be possible through health education and health promotion as well as opening the doors for collaborative research.”
While this elective is broad-based, UICOMP GME programs also offer other community-based health electives with a more focused scope. Examples include electives in Community Health and Advocacy, Community-Based Research, and Global Rural Simulation.
This article is part of the Fall 2022 edition of Pathways. Read the full issue.