Population Health Clerkship: Caring for Populations Within Their Communities

Medical School Determinants of Health FOM 210        
Graduate School of Nursing N/NG 603C

1. Course goals
2. Objectives
3. Educational methodology
4. Assignments, evaluation and assessment
5. Timeline of student activities
6. Reading list
7. Useful links
8. Team listing



 1. Course goals

This is a two-week immersion course (with several preparatory meetings) required of all second year medical and first year graduate nursing students. Its aim is to introduce students to public health concepts and to communities as a unit of care.  Community engagement in this course allows students to develop and nurture relationships with community organizations for the mutually beneficial exchange of knowledge and resources, in a context of equitable partnership and reciprocity. 

As a result of this Population Health Clerkship experience, students from the medical school and graduate school of nursing will:
• Gain experience in working collaboratively
• Appreciate the value of looking at populations and communities as units of care rather than just individual patients
• Become aware of available and needed resources for the population
• Become aware of the need to work in teams and collaborate with different professions and disciplines providing care and services and value the role of provider as population advocate

*Students: Please note that the Population Health Clerkship is an important experiential part of your core coursework for medical and graduate nursing school and your participation is required. There is flexibility in the scheduling in order for preceptors to maximize the benefit of the experience; however, this flexibility is not meant for you to schedule dentist visits, court dates, moving days, etc. There are now many courses that are recorded and available for you to access via technology - we suggest that you schedule outside appointments on days when you would miss content that is available through such other means.

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2. Objectives

The Population Health Clerkship strives to achieve objectives related to student learning, community service and service-learning.

Student learning objectives

1. Describe how socio-economic, cultural, policy, behavioral, environmental and biological factors contribute to specific individual and population health outcomes.

2. Collect and review existing data, identify gaps in data, and explain how data can be used to improve the health status of the population of focus (and, as relevant, the mission of an organization that works with the population).

3. Identify the common public health and advocacy strategies and programs for preventing and addressing a health issue in a population.

4. Work collaboratively with other health professional students, health care providers, and community agencies to develop strategies to advocate for a vulnerable population. This is achieved through the development of clerkship products including a service project that is negotiated with the team’s primary agency to meet a need.

5. Demonstrate an ability to be aware of, and reflect on, personal reactions to people with the particular health issues of focus. This is achieved through guided reflection.

Community service objective

Develop a data-driven product that will help a population meet a goal of improved health and/or a product or activity that the organization working with the population identifies as a need to improve health. This is achieved through development of a project, product or proposal.

Service-learning objective 

Articulate specific health professionals' social responsibility related to serving the health needs of a population.

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3. Educational methodology

This course component employs a variety of educational methodologies including small group sessions, a field experience, reflective practice activities, a population health assessment, dissemination of findings (poster presentation) and continuous self-learning activities. This course fosters community engagement, the process by which organizations and individuals develop and nurture relationships for the mutually beneficial exchange of knowledge and resources in a context of equitable partnership and reciprocity.

Small group teams (September – November)

Students rank their top five choices for a clerkship team and are assigned by faculty to enable maximizing the mix of medical and advanced practice nursing students. Students meet for the first small group introduction with academic and community faculty in late September and then convene again in mid-October. Preparatory readings are assigned for all students (located at end of this document) in addition to population-specific readings and resources identified by team leaders.

Field experience (October)

The core field experience occurs over two weeks in October. The field experience is structured to provide the students with ten full days of learning, i.e. 6 hours of active learning, plus 2 hours of additional study per day. There is some flexibility due to travel and scheduling with community agencies.
Early in the field experience, working with the community preceptor and academic faculty team leader, students confirm the focus to develop and implement a service activity. As part of their field experience, students should collect data pertaining to a health related issue faced by the population of focus, and learn about the array of available services and ongoing advocacy initiatives. An optional Population Health Framework worksheet is available to guide teams through this process.  Through reflective exercises, students will demonstrate awareness of background material and ability to reflect on its application in the context of their team-based experiences. Students are expected to participate actively in the clerkship experience and collaborate on a service project, and to create and present a poster to the UMMS community in November, as detailed in the assessment section.

Academic faculty team leaders and community preceptors should help students identify the necessary sources of data, including contacts with other agencies and providers. As relevant, students may spend time at agencies to develop an understanding of the service network. These agencies include those providing direct patient care, and regulatory and other agencies that have an impact on direct service delivery.

When possible, it is expected that community preceptors will provide students with an opportunity to observe the impact of a population health problem at the individual level. Scheduling for this type of opportunity should begin early in the clerkship so that students will be able to interview a patient and perhaps his/her family to understand the impact of the health problem on a patient and understand a patient's experience of receiving care. An understanding of a patient's pathway through the health care system will likely prove invaluable to understanding some of the services provided for a particular problem/issue.

Dissemination to community (November)

A poster session at the end of the immersion experience provides each group an opportunity to synthesize their experiences and findings. It also serves as a means to exchange information among groups. Through the posters, students present an analysis of data gathered within the Framework, as well as a summary of their field experience and service project to fellow students, faculty, and community members.  The most recent batch of posters is available from the left navigation menu on this page.

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4. Assignments, evaluation and assessment

Students are evaluated on a credit/no credit basis. All students are expected to attend all planned meetings, complete the clerkship requirements, and be active contributors to group activities. Each student team will conduct a service project or activity as assigned by the team leader(s) and create an academic poster. Each individual student will complete reflective writing assignments and will receive a professionalism grade determined by the site preceptor based on factors such as attendance, engagement and teamwork. Students' final grades will be determined using each of these criteria to calculate the final grade.  

Team scores

1. Scholarly poster (35 points):  this poster will facilitate sharing of knowledge with colleagues, fellow classmates, academic and community faculty and school administration.  Each team will be expected to present their poster orally to attendees at the poster session in November.  Instruction on how to prepare academic posters for the Population Health Clerkship are available online here.  If students plan to use images from their experiences in the community, they are urged to get permission of all people included in the photos. A permission slip can be downloaded here [link].  There is an optional peer review session scheduled for students to work together on finalizing their posters. During this hour, students will be encouraged to share feedback and make final changes before submitting files for printing. 

Individual scores

1. Reflective writing (30 points): As a part of the Population Health Clerkship, you are required to show written evidence that you have reflected on the experience. The requirement is to write a reflective paper of at least 5 (double-spaced) pages. Your initial submission should be a page or two of initial reflections, and must be received by team leader(s) on Wednesday evening of the first week to allow for early feedback. The second and final submission should include evidence of ongoing reflection during the two week period. Creativity is allowed for this assignment; for example, your submission might include art/photographs with text explaining what these images evoke in you, based on your  experiences.  The final assignment is due to your team leader(s) by 5pm on the Saturday following the clerkship. 
To help you guide your thinking as you continue your reflections, we are providing a reflection guide with several questions to get you started. We strongly recommend that you answer the included questions as indicated for the first and final reflection entries. The other questions are included as a guide and as a way to help prompt your thinking and move beyond description for the rest of your writing during the ten days. Note that some team leaders have developed their own guidelines for reflective assignments, so be sure to attend all meetings and listen carefully to community preceptors. 

2. Performing to standards of professionalism (35 points):  You represent UMass Worcester during this  experience, and are expected to perform up to the standards held in the community for professionalism. You are expected to dress appropriately, attend all sessions, arrive on time and stay until the end of each day's activities.  Preceptors will be looking for full participation and thoughtful interaction, both within your team and with the full range of proessionals and others with whom you come into contact.   They will be asked to provide a professionalism score for each student based on your work during the immersion period. 

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5. Timeline of Student Activities:


Below you’ll find a timeline for PHC activities in 2015:
8/10/15:  Students receive team catalog and are asked to rank preferences
8/17/15:  Student preference rankings due  
8/24/15: Student placements announced
9/15/15: 3-4pm Introduction to PHC and 4-5pm small group orientation: Population Health Clerkship Teams meet with academic faculty and/or community preceptors for introductions and discussion of students’ specific interests,  unless otherwise arranged by team leaders.  


10/19-30/15: Population Health Clerkship Team Field Experience
10/21/15: First reflection due to team leaders
10/31/15: All reflections and poster drafts due to team leaders


11/2/15: Final poster PPT or PPTX files submission deadline (to Heather-Lyn.Haley@umassmed.edu )
11/09/15:  Poster session 3-5pm in Sherman Center, 2nd and 3rd floor Learning Community Suites 

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6. Reading List

These readings are provided for all students; others will be identified by small group team leaders.  We recommend reading a few selections from this list prior to beginning the immersion experience in October.

Betancourt, J.R., Quinlan, J. 2007. Personal Responsibility Versus Responsible Options: Health Care, Community Health Promotion, and and Battle Against Chronic Disease. Prev Chronic Dis 4(3). http://www.cdc.gov/pcd/issues/2007/jul/07_0017.htm. Accessed September 2011.

Fielding, J.E., Teutsch, S.M. 2009. Integrating Clinical Care and Community Health. JAMA 302(3): 317-319.

Gadon, M. 2007. Revisiting the Social Contract: Physicians as Community Health Promoters. Prev Chronic Dis 4(3). http://www.cdc.gov/pcd/issues/2007/jul/06_0195.htm. Accessed September 2011.

Gruen, R. L., Campbell, E.G., Blumenthal, D. 2006. Public Roles of US Physicians: Community Participation, Political Involvement, and Collective Advocacy. JAMA 296(20): 2467-2475.

Hale, Janet. 2011. The Value and Imperative for Health Professions Engaging in Interprofessional Learning. Click here for pdf.

Halfon, Neal, Larson, Kandyce and Shirley Russ. 2010. Theories And Consequences: Why Social Determinants? Healthcare Quarterly, 14(Sp) 2010: 8-20. Available at http://www.longwoods.com/content/21979

Krisberg, Kim. 2013. Medical Schools Integrate Health Disparity Education Across Curriculum. AAMC Reporter, June 2013.  https://www.aamc.org/newsroom/reporter/june2013/346366/health-disparity.html 

Marmot, M. 2007. Achieving Health Equity: From Root Causes to Fair Outcomes. Lancet 370: 1153-1162. 

McGinnis, J.M. 2010. Observations on Incentives to Improve Population Health. Prev Chronic Dis 7(5). http://www.cdc.gov/pcd/issues/2010/sep/10_0078.htm. Accessed August 2011.

Parrish, R.G. 2010. Measuring Population Health Outcomes. Prev Chronic Dis 7(4). http://www.cdc.gov/pcd/issues/2010/jul/10_0005.htm. Accessed August 2011.

Radzyminski, S. 2007. The Concept of Population Health within the Nursing Profession. J Professional Nursing 23(1): 37-46.

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7. Useful links 


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8. Team listing 

The 2015 listing of students placements is available here.

 Information describing each of the teams is compiled into a Team Catalog to help you as you consider your preferences for team placement. Hard copies of the catalog will be available in the Learning Community Suites, and you can download the Team Catalog as a pdf here. This document provides descriptions of the teams, their leaders, planned activities and resources to learn more. 

Students are asked to rank their top five choices .  Students should keep in mind that there is no reimbursement for travel or meals.   Housing is provided for the team on Martha's Vineyard, as described in the catalog. 

The direct link for ranking of teams is: https://www.surveymonkey.com/r/PHC2015preference

You can browse team titles and brief descriptions below. This year's teams include: 

Team Title:



Adolescent sexual health education


The purpose of this clerkship is to expand on our outreach to the regional high school and enhance our “Girl Talk” curriculum, and develop an outreach program for adolescent males in our community.

Adults with Intellectual Disability: Community living and health care experiences


This clerkship includes clinical and community experiences focused on people with intellectual disability. Students will learn about health disparities affecting this population, conditions that are more prevalent, services and supports that currently exist, and the role of the physician in the person's circle of supports.

Asthma Initiative in Southern Worcester County, Stage Two: Patient Education


Students will learn about the approach to asthma management being used in clinical settings, and assist in development of patient education materials.

Clinton Hospital: meeting patient needs close to home


Collect secondary data to characterize and describe the population (14,000) of Clinton, MA as well as of those 1000 residents who travel to Edward M Kennedy CHC to obtain care. Hold focus groups with these residents; develop suggestions for how Clinton Hospital can meet their needs.

Complementary and Integrative Health


The purpose of this population health clerkship experience is to introduce students to different complementary medicine modalities incorporated into UMass Programs (e.g., within Psychiatry, Pediatrics, Cancer Center, etc.), as well as community CAM resources that are available to support patient and staff wellness.

Correctional health


The population of focus for this team is: Individuals incarcerated in the Mass State Prisons. The health issues affecting this population on which this team will focus are: Substance Abuse, Mental Health, HCV, HIV, other chronic medical conditions.

Creating a “people-centered” approach to health care and population health: Advocating for patients and families in Health System Transformation


This clerkship will provide students with a structured opportunity to engage with patients, consumer advocates, and health system and public policy leaders in Massachusetts to gain a better understanding of the opportunities and challenges related to integrating the consumer perspective in health system transformation and promoting population health.

Geriatrics: Fall prevention for older adults


Students will gain an in-depth understanding of the causes and impact of falls on elders and the importance of fall prevention, as well as existing resources and initiatives, from geriatric care providers and advocates. Students will also learn and practice fall risk assessment techniques by interacting directly with elders in a variety of home and community settings in the Worcester area.

Health care for the homeless


We will accept students to join us at Homeless Outreach to gain an understanding of health issues faced by Worcester’s homeless adults. We will visit several shelters and outreach sites and observe how the community shapes the barriers and accessibility to healthcare for the underserved through comparison to Boston for contrast.

Hector Reyes House: Serving the needs of Latino men


These two weeks will be spent in discovery. We will focus on addiction and the Latino community. We will tour the community, learn about some of the issues that affect the community, and see how healthcare affects them. We will discuss what the barriers are and why these barriers exist.

How do I feed my family tonight? Food, health and access within our community


Faculty will guide students through the process of conducting a community assessment and share available resources that provide population metrics. Students will work as detectives to come up with the best way, in their eyes, to characterize the population at risk for experiencing food insecurity.

Incarcerated and urban working poor (Lemuel Shattuck Hospital)

Jamaica Plain

This course will emphasize patient care in a multifaceted approach, treating physical and mental illness simultaneously by providing support for addiction disease and for emotional needs and sufferance. Aa patient will be longitudinally followed from each of the above-mentioned perspectives. The medical student will work with medical providers, social workers, psychologists and addiction specialists in a team-based patient care model.

Injury prevention: Programs to prevent injury from trauma in all age groups


Our Clerkship curriculum is a representation of all of the programs from the Injury Prevention Department as well as a number of themed days when students will have the opportunity to meet with many of the community partners we collaborate with such as the Worcester Police Department/gang unit, the Worcester Juvenile Court System and the District Attorney’s office and South High.

Language Access at Lowell Community Health Center


Lowell Community Health Center’s GSN Population Clerkship will provide the opportunity for students to focus on identifying ways to improve linguistic access utilizing various performance improvement methodologies. As a result, students will be able to define steps to providing appropriate linguistic access, research and recommend strategies to improve the current language access system and present findings and recommendations to Lowell CHC’s Language Access Systems Improvement Team (LASIT).

Latinos living with HIV in Lawrence


Working collaboratively with the GLFHC care and prevention programs, the team will assess factors contributing to late entry into care through review of the literature, interviews with key community representatives including patients, social service agencies, city government, and grass roots organizations. The team will present the results to GLFHC/AHEC staff.

Living with a disability


Students will meet individuals with disabilities and professionals in community-based and clinical settings to learn about providing quality health care, assistive technology, sexuality, and community supports that enable them to lead full lives. Past responses have been very positive. Typical comments include, "I have had more positive exposure to people with disabilities than I have in my whole life and “I now feel much more comfortable and self-assured.”

Medical-legal partnerships for health


Students will explore the use of medical-legal partnerships to improve health by addressing social determinants. They will explore services provided and how these are promoted in the local and health care communities.

Meeting the needs of the LGBT Community in Worcester


Students will investigate what health services are currently available and welcoming to Worcester’s LGBT population. There is a sense that a need for transgender & LGBT-sensitive and appropriate health care exists here in the city – can we find evidence?

Parenting & family stability


The Clerkship team will work on understanding and analyzing the causes of the following issues and their ramifications in relation to family stability:
• Lack of appropriate parenting and how it reflects on the family (both parents and children)
• Negative parent-child interaction (consequences on both children and parents)
• Lack of early medical care

Racism and Health


This team will focus on the healthcare experiences of people of color in the city of Worcester. We will explore what is known about disparities in local provision of care, and learn about what is being done to address these disparities. Service project will include organizing a community conversation on Racism and Health.

Rainbow of Healthy Babies: Worcester Healthy Baby Collaborative


Students will explore culturally-specific approaches to prenatal and newborn care, familiarizing themselves with programs designed for use with African women and working toward adaptation for use with other populations

Refugee Health


Worcester is home to many resettled refugees. Students will learn about the mix of folks resettling in the Worcester area, the resources available to them, and their health concerns on arrival as well as during and following the resettlement process.

Veterans' health


Who is a veteran? What healthcare needs are unique to veterans and why? Who gets healthcare at the VA? What should all clinicians know about caring for veterans and their families? Hear the answers from veterans and those who care for them during this informative, reflective, and powerful clerkship.

Worcester Division of Public Health


This clerkship focuses on the health and wellness of the residents in the city of Worcester and surrounding Central MA Regional Public Health Alliance towns. Programs, projects and efforts focused on prevention of disease and wellness will be addressed.

Worcester Head Start Program


Students will be introduced to the federal Head Start program and the fundamental role of the health and education programs to assess, screen, and refer children at risk of developmental delays. Students will be introduced to the role of community partners to promote optimal childhood growth and development.

Worcester’s faces and places: Family Health Center Worcester


Students will learn about the populations served in the community health center environment and the ways in which CHCs provide care.

YWCA Central MA community care challenges


Gain understanding of challenges faced by both the populations served by YWCA programs, and those of the staff who directly serve these populations.

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