Population Health Clerkship: Caring for Populations Within Their Communities

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

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, 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 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. 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.

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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, complete one Population Health Framework assignment 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 determine the final grade.  Details of grading will be available here before October 1.

Team scores

1. Population Health Framework: this worksheet will guide your exploration of existing literature, professional networks and ongoing activities related to your population of focus.  We recommend that you begin to complete the framework early and share learning across the team. 

2. Scholarly poster:  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 one hour of protected time after the immersion 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: 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 (which should be a page or two on initial reflections or even photographs with text explaining what these photos evoke in you, based on the your first experiences 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 and 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 ask 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. 

2. Performing to standards of professionalism:  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 diuring the immersion period. 

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5. Timeline of Student Activities:


Below you’ll find a timeline for PHC activities:
 Students receive team info in August and are asked to rank preferences by 8/25 

8/25 Student preference rankings due  
9/2: Student placements announced
9/16: Introduction to PHC and small group orientation: Population Health Clerkship Teams meet with academic faculty and/or community preceptors for introductions and discussion of students’ specific interests, 3-5pm unless otherwise arranged by team leaders. (medical and GEP One students)

10/20-31/14: Population Health Clerkship Team Field Experience
10/22/14: First reflection due to team leaders
10/31/14: All reflections and frameworks due to team leaders


11/3 (tentative): Final poster PPT or PPTX files submission deadline
11/10/14:  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 (wil be updated before August 2014;lbelow is information from 2013)

Students' team assignments for Fall 2013 were finalized on April 18, 2013. A list of all teams with student assignments can be found here.  Room assignments for small group meetings will be sent by email.  

Download the 2013 PHC Team Directory as a PDF document.  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 using this survey by April 12, 2013. Students should keep in mind that there is no reimbursement for travel or meals.   Housing is provided for Team #16- Latino HIV in New Bedford.

You can browse team titles here; complete descriptions are in the pdf file:

1. ACTION Health Services North County (Fitchburg)
Population of interest: under-served and at-risk people in North Worcester County
Using a combination of mobile health units and a Healthcare for the Homeless clinic, ACTION provides medical, behavioral health, and dental services in Fitchburg and at sites throughout the region.

2. Adolescent Obesity in Rural Settings (Barre)
Population of interest: adolescents in Barre and surrounding communities
Learn about the impact of life in a rural setting on the physical activity and nutritional habits of adolescents.

3. Barnstable County Behavioral Health (Barnstable- housing available)
Population of interest: Residents of Barnstable County (Cape Cod) who are survivors of intimate partner violence (domestic violence) and sexual abuse.
Students will learn about the short- and long-term impact on physical and mental health of surviving intimate partner violence and sexual abuse.

4. Caring for Adults with Intellectual Disabilities (Worcester/Waltham/Springfield)
Population of interest: Adults with Intellectual Disabilities
Students will have the opportunity to understand the unique issues related to caring for adults with intellectual disability - a population that experiences significant disparities in health access, prevention, and outcomes.

5. Children’s Mental Health (Worcester/Boston)
Population of interest: children from birth to 21 years of age living in the Commonwealth of Massachusetts.
Learn about the prevention, early detection and treatment of behavioral health issues through the development of integrated systems of care within the Commonwealth of Massachusetts.

6. Clinical and Translational Research Pathway (Worcester)
This placement site is only available to students in the CTR Pathway and is not available as a choice for ranking.

7. End of Life Care (Worcester)
Population of interest: Patients (of any age) and their caregivers who are facing end of life issues.
Learn about advance care planning, treatment decision making,the roles of multidisciplinary team members in end of life care and more.

8. Fire-related Injuries in Older Adults Smoking While on Long-term Oxygen Therapy (Carlisle)
Population of interest: Patients on Long Term Oxygen Therapy (LTOT)
The goal of this project is to develop a community approach to reduce the risk of fires due to the use of home oxygen devices in senior housing.

9. Geriatrics: Fall Prevention (Worcester)
Population of interest: Geriatrics
Meet and talk with elders, visit elder care sites and meet and learn from a variety of different elder care practitioners, shadow a geriatrician/geriatric nurse practitioner, with a focus on Falls Risk Assessment and Falls Prevention

10. Ghanaian Women’s Health (Worcester)
Population of interest: African Woman’s Health—Ghanaian Women
Learn about African Woman’s Health and Disparities in Infant Mortality while connecting with the local Ghanaian community.

11. Head Start (Worcester)
Population of interest: Head Start children ages 3 – 5 years
Support Head Start healthcare team to conduct federally mandated developmental pediatric screenings; shadow health staff with monitoring of medically involved children and classroom observations; learn about the issues facing these children and their families and the interdisciplinary team that supports them

12. Health Care for the Homeless (Worcester)
Population of interest: Worcester’s homeless population
The average life expectancy for a homeless adult in Boston is 47 years old. This mirrors the mortality rates seen in the US and is a reflection of both profound health care disparity and the inherent risks of being street homeless.

13. Healthy Aging of Year Round Martha's Vineyard Residents (Martha's Vineyard)
This placement site is only available to students in the Rural Health Scholars Pathway and is not available as a choice for ranking.

14. Implementing State and National Health Policy (Worcester/Boston)
Population of interest: Uninsured and underinsured in Massachusetts post health reform.
Learn about access to health care for the under- and uninsured by meeting with key state policymakers, state officials, advocates, health care providers, health insurers, and others involved in health reform implementation.

15. Latinos Living with HIV – Northern MA (Lawrence)
Population of interest: Latinos living with HIV in the socio-cultural context of Lawrence
Using HIV disease as a framework, students will gain knowledge of both risk and protective factors present in Lawrence, and how these factors may affect the Latino community.

16. Latinos Living with HIV – Southern MA (New Bedford– Housing available)
Population of interest: Urban Underserved Community
Learn about HIV/Aids amongst Latino population by attending patient group counseling visits at the health center, local community based agencies, correctional facilities, and in the local neighborhood.

17. LGBT Health, Homophobia & Heterosexism (Worcester/ Boston)
Population of interest: Lesbian, Gay, Bisexual and Transgender Communities
Learn about the health effects of homophobia and heterosexism by working with community agencies and local populations.

18. Living with Disabilities (Worcester)
The primary population of interest is people with physical and sensory (e.g. blindness and deafness) disabilities.
Students will be exposed to a variety of community-based experiences and clinical settings which will provide the opportunity to learn about access to health care, secondary conditions, assistive technology, sexuality, employment, and long-term supports, among other topics.

19. Lowell Community Health Center: Culturally-Sensitive Care (Lowell)
Population of interest: Gay, Lesbian, Bisexual and Transgender population.
Students will will help implement LCHC’s GLBT Task Force performance improvement activities, with a focus on eliminating disparities and improving culturally-senstive care.

20. More than an ounce of prevention: Programs to prevent injury from trauma in all age groups (Worcester)
Population of interest: Children , Teens and Older Adults
In addition to participating in the Mobile Safety Street events at the Worcester Public Schools, Teen RIDE events, a Child Passenger Checkpoint, disaster preparedness and visiting senior centers with the adapted Mobile Safety Street, students will help develop an assessment of the various programs' effectiveness, including ideas for expansion and strengthening.

21. Parenting & Family Stability (Worcester)
Population of interest: Low-income urban families
The Clerkship team will work on understanding and analyzing the causes of poor parenting and health care practices and their ramifications in relation to family stability:

22. Refugee Mental and Physical Health (Worcester/ Boston)
Population of interest: Refugees
Better understand the health and socio-economic issues facing refugees and immigrants, their plight in their homeland and sometimes refugee camps, the migration process, and available services, unmet needs, and policy issues in the US.

23. Screening School Children for BMI (Martha’s Vineyard)
This placement site is only available to students in the Rural Health Scholars Pathway and is not available as a choice for ranking.

24. Urban Working Poor and Incarcerated (Jamaica Plain)
Population of interest: Patients who were, or who are currently confined to a jail or prison, urban, working poor patients with acute and chronic medical conditions, often with co-existing mental health and substance abuse disorders, people living in the community who may have had, or currently in contact with the criminal justice system, Parole and/or Probation Departments.

25. Veterans’ Health (Worcester/Boston/Bedford)
Population of interest: Veterans
Learn more about the health impact of war – behavioral and physical health issues; the impact on veterans and their families; focus on the issue of homelessness

26. Worcester Department of Public Health: Population Served (Worcester)
Population of interest: Public Health in the city of Worcester, MA
Students and Community members will work through an assessment process and help define and prioritize possible areas of improvement. Emphasis will be on integrating social determinants of disease with measures of population health and projecting how this affects demand for services in the health care system.

27. Worcester’s Faces and Places: Family Health Center Worcester (Worcester)
Population of interest: Worcester’s medically underserved
Learn about the challenges of providing primary care to low-income patients and the resources which the community health center model can bring to bear.