University of California, San Francisco, Fresno Latino Center for Medical Education and Research Health Professions Pipeline Program

Abstract

The University of California, San Francisco, (UCSF) School of Medicine Fresno Latino Center for Medical Education and Research (LaCMER) began the development of its pipeline Health Professions Partnership Initiative (HPPI) in 1996. It was the culmination of much reflection on how to meet the health care needs of an increasingly diverse and underserved community in the Central Valley of California. Recognizing that a “home grown” health care workforce would assure cultural competence, we began to identify, motivate, and academically enrich the communities' disadvantaged youth. The UCSF Fresno Medical Education Program (MEP) is located in Fresno and is the School of Medicine's largest community campus residency program. LaCMER is a unit of the MEP. The targeted region is rural, and by all accounts the residents are among the poorest and most medically underserved of any in the state. Forty-four percent of the population is Latino, 6% is African American, and a significant percentage is from Southeast Asia. In contrast, less than 7% of the region's physicians are from these groups. Students enrolled in Fresno Unified Schools speak more than 120 languages and dialects in their homes. Poverty, especially among children, is a major barrier to health care and to scholastic performance. In the Central Valley, one child in four lives in poverty, and in Fresno County, the per capita income is slightly above $15,500 (32% below the state's per capita income average). At least 92% of students enrolled in the four feeder middle schools, which serve as the entry point into our educational pipeline, qualify for free or reduced lunch programs. The UCSF School of Medicine established the LaCMER to address the persistent gaps in access to health care among the underserved residents in the Central San Joaquin Valley and to diversify the health care workforce to reflect the characteristics of the population. A partnership with the community was created to create and sustain an educational pipeline in schools with many students from disadvantaged backgrounds. Building a Pipeline The pipeline's governance structure reflects a true collaboration formed by assuring a strong sense of community ownership among institutional partners. Our partnership council meets on a biannual basis, but communication amongst the partners occurs continuously. The council members are: UCSF School of Medicine; UCSF-Fresno Medical Education Program; University of California Office of the President; University of California, Merced; California State University, Fresno; State Center Community College District; Superintendent of Schools - Fresno County Office of Education; Superintendent of Schools—Fresno Unified School District; Community Hospitals of Central California; Sequoia Community Health Centers and the San Joaquin Valley Health Consortium, Inc., which is the local Area Health Education Center. In selecting target schools, we intended to work with a student population that mirrored the general community. We selected sites because of their demographics and their high economic need. Although our initial focus was at the university level, it was apparent that a strong academic math and science foundation in high school was needed. We began the Health Professions Preparatory Academy, or the Doctors Academy as it more generally became known. The “school within a school” design was endorsed because we wanted our kids to have access to a “full” high school experience. Students who attend the Doctors Academy are also involved in music, drama, leadership, and athletics. After the first year of the Doctors Academy, it became evident that many of our students were not academically prepared for the rigors of an accelerated high school program. Thus, in 2000, the Junior Doctors Academy was developed, which essentially mirrors the Doctors Academy program at the seventh and eighth grade levels. In this case study, we focus our description on Junior Doctors Academy activities. Partnership Programs Our pipeline begins with approximately 120 Junior Doctors Academy students from four middle schools, where educational enrichment and motivational activities are provided by the LaCMER and school staff. Partnership activities are detailed in Table 1. Drawing upon the pool of feeder middle schools, including selected county schools, recruitment and selection into the Sunnyside Doctors Academy generates a cohort of 50 high school freshmen each year. Math, science, and English comprise the core curricular focus of the Junior Doctors Academy and the Doctors Academy programs, where tutorials, mentoring, and counseling are offered to further help students excel in their studies. Saturday Academies, field trips, and summer internships serve to augment the challenging coursework. The strong partner relationship with the school administration and with school district leaders augments LaCMER's efforts with the Junior Doctors Academy and Doctors Academy students.Table 1: Programs