An innovative community medicine curriculum: The La Mesa HousecleaningCooperative

Abstract

Even after several years of learning medicine from an individual, disease-oriented approach, senior medical students may be unprepared to learn about community issues.Residents, who encounter additional time demands and the responsibilities of patient care, may be even more resistant to learning about the principles of health care in the community.The standard medical curriculum often fails to address community medicine in a way that residents find constructive and engaging.The Community Health Partnerships program at the University of New Mexico Health Sciences Center, Albuquerque, tries to involve medical residents in communityoriented primary care projects in local communities.Major goals of the program are for the residents to interact with a community and to allow community members to define the objectives of the project. WHAT DETERMINES HEALTH?Among the important determinants of health are socioeconomic status and education, 4-6 social support and networks, 7,8 self-efficacy and empowerment, 9,10 and community development and increased community capacity.11 Along with an appreciation of these complex forces, physicians interested in community health have learned that interventions to improve health that are imposed from the outside, without community participation, are unlikely to succeed.11 The educational approach of the Department of Family and Community Medicine, University of New Mexico, is to allow residents to pursue their own interests.The department focuses on population-based health issues and has facilitated a network of training sites for medical students and residents outside the hospital and throughout the state.The family practice curriculum requires a community project during the second and third years of residency.12 Residents can spend a month intensively working on a project or spread it out over 2 years, working on average half a day each week.The community medicine curriculum has a coordinator who identifies possible projects.Each resident chooses a project and writes a proposal, to which the curriculum coordinator responds with suggestions.At the end of residency, all residents submit a report.A faculty member serves as an advisor for each resident.Residents' projects have varied.Several residents have implemented a curriculum for violence prevention in a local high school.Others have taught health education in primary schools.One project involved assessing the health needs of uninsured Hispanic immigrants.Two residents helped set up a statewide program to prevent domestic violence.In addition to the coordinator for the community medicine curriculum, numerous faculty members in the department have ongoing community projects and are open to working with residents when approached.The Community Health Partnerships program has brought together nurses, social workers, law students, and Glossary of termsCommunity: A group of people with something in common: a language, geographic boundaries, age, attendance at a primary care clinic, a shared cause, or a bond of identity, history, or values.They perceive a commonality among themselves. 1Population perspectives: Assessments and interventions directed at improving the health of groups of people.These perspectives require knowledge about the health of defined populations and determinants of health status for those populations, including physiologic, behavioral, environmental, economic, and social factors.2,3 World Health Organization's definition of health: Includes social, physical, economic, emotional, and spiritual well-being, in addition to the absence of disease. Summary points• Community-oriented health care projects can help medical residents learn to listen, provide support, focus on process more than outcome, and be flexible and patient with group process • Key elements for a successful resident-community project include a long-term time commitment, supportive faculty, didactic sessions on community health issues, close contact and good communication with community members, and discussion and reflection • A successful cooperative might better address important social determinants of health-including socioeconomic status, education, empowerment, social support, and community development-than more traditional approaches to health promotion • Graduate medical education programs should offer training for providers interested in learning about community economic development ......