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

 

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 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.  

Team scores

1. Population Health Framework (25 points): 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 (25 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 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 (20 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 (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 (30 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 diuring the immersion period. 

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5. Timeline of Student Activities:

 

Below you’ll find a timeline for PHC activities:
August/September
 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: 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.  


October

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

November 

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 

 

**Update 9/2/14 Teams are announced.  You can download and view this file sorted by student or by team

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.

The direct link to the 2014 Team Catalog is: http://umassmed.edu/PageFiles/27208/PHC_TeamCatalog2014.pdf

Students are asked to rank their top five choices by October 25, 2014.  Students should keep in mind that there is no reimbursement for travel or meals.   Housing is provided for the teams in New Bedford, on Martha's Vineyard, and the Outer Cape, as described in the catalog. 

The direct link for ranking of teams is: https://www.surveymonkey.com/s/PHC2014_ranking

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

Team Title:

Summary

Pop of focus

Location

Asthma in Southern Worcester County: Impact and interventions

Work with South County Connects coalition to better understand the population experiencing asthma and how other communities have addressed this issue.

people with asthma

Southbridge

Awareness of testicular cancer in young men

Students will investigate what local male adolescents know about testicular cancer, its symptoms and warning signs, in order to raise awareness among the target population and their parents. They will also look into environmental risk factors present in the community.

adolescents

Carlisle

Caring for 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 preventive screenings and health outcomes.

adults with ID

Worcester/
Waltham/
Wrentham

Correctional health

Students will gain familiarity with common social, medical and mental health issues facing prisoners and detainees, and develop increased understanding of prison culture and how health care is adapted to this setting.

incarcerated population

Worcester/ statewide

Cost containment: The next frontier in health care reform

A deeper look at policy, politics and the impact of affordability on population health. Students will be meeting with policy and political leaders involved in health care delivery and system reform and learning about Massachusetts individuals and families facing economic insecurity as a result of health care costs.

those trying to afford care

Worcester/ Boston

Elder abuse prevention on Martha's Vineyard

Students will be asked to investigate incidence, resources and community needs around the topic of elder abuse, in response to a growing senior population.

elders

Martha’s Vineyard*

End of life care

Students will learn about issues facing patients as they near the end of life, including advance care planning and related tools, medical decision making, the roles of multidisciplinary team members in end of life care and hospice and palliative care options and resources.

people facing end of life

Worcester

Even one is too many: Reducing disparities in infant mortality among Ghanaian women

Students will learn about the history of infant mortality in Worcester and efforts made to address it, and will be introduced to the local Ghanaian community.

Ghanaian women

Worcester

Fall and injury prevention and recovery amongst the elderly and frail on rural Cape Cod

The focus of this project is on prevention of, and recovery from falls and injuries (e.g., burns, severe cuts, and motor vehicle related trauma) among the elderly and frail. We are particularly interested in gaps that may exist in preventive measures and coordination of care, and how OCHS as a primary care provider can continue to improve outcomes for this population.

frail elders on rural Cape Cod

Outer and Lower Cape Cod*

Geriatrics: Fall prevention for older adults

Meet and interact with older adults, care providers, and leaders and staff from community agencies serving older adults to gain a broad perspective on the causes and impact of falls. Students will learn and practice fall risk assessment techniques.

elders

Worcester

Health care for the homeless

We will accept 5 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.

People who are homeless

Worcester

Hector Reyes House: Serving the needs of Latino men

Spend some time with the residents of this 25 bed residential treatment facility for Latino men. 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 are the barriers and why do these barriers exist.

Latino men

Worcester

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

Students will learn about the population at risk of food insecurity or experiencing food insecurity in the Worcester community, and have opportunity to learn from local families: their perspectives on food insecurity, barriers, cultural attitudes on food and health, etc.

people with food insecurity

Worcester

Incarcerated and urban working poor

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. The medical students will work with medical providers, social workers, psychologists and addiction specialists in a team-based patient care model.

incarcerated and working poor

Jamaica Plain

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

The goal of our Injury Prevention Program is to keep our community healthy by reducing injury and death from predictable and preventable events. This team will focus on a range of population-based interventions designed to reduce injuries.

children, teens and older adults

Worcester

Integrative medicine in cancer care

Explore a range of practices that include yoga, acupuncture, nutrition, reiki, and meditation, with focus on use with oncology patients.

cancer patients

Worcester

Latinos living with HIV in Lawrence

The PHC team will gain knowledge of both risk and protective factors present in Lawrence, and how these factors may affect how the Latino community accesses HIV prevention and care. Working collaboratively with the GLFHC care and prevention programs, the team will assess factors contributing to late entry into care.

Latinos living with HIV

Lawrence

Lesbian, gay, bisexual and transgender communities

This team will focus on the health effects of homophobia, transphobia, and heterosexism. Each team member will be assigned to a community site as the focus of their community experience, to allow for an in-depth community-based experience; required team meetings/seminars will provide opportunities for facilitated group discussion and reflection, as well as seminars on LGBT research, and other relevant topics.

LGBT communities

Worcester/
Boston

Living with 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. They will also learn about community resources that can help individuals with disabilities lead full lives in the community.

people living with disabilities

Worcester

Medical-legal partnership for refugee health

Students will learn about the trend toward integrating medical-legal partnership in clinical settings as a means of addressing the social determinants of health, with a focus on the health needs of refugees that often have legal solutions.

refugees

Worcester

Parenting & family stability

The Clerkship team will work on understanding and analyzing the causes of poor parenting practices, neglect and abuse and their ramifications in relation to family stability.

young parents

Worcester (Pernet Family Health Services)

Patient engagement and chronic disease self-management

Participants in this project will assist health care teams in engaging patients and family members in treatment goals, assess motivation for change and be active participants in implementing self-management strategies.

primary care patients

Mashpee

Patients with HIV/AIDS in Southeastern MA

Students will shadowing clinical visits in Infectious Disease Clinic, attend Woman’s HIV Conference and attend patient group meetings and other community group meetings as appropriate.

Diverse patients with AIDS/HIV

New Bedford*

People with serious mental illness: Recovery-oriented peer supported services

The purpose of this course is to learn about the most recent innovative mental health services that promote recovery, wellness and social integration for people who have historically been institutionalized. . In each program we visit, experienced peer specialists work with people to develop a recovery plan, provide peer support, and serve as an example that recovery is possible.

people with serious mental illness

Worcester/
Boston

Teen sexual health education

“Walk in the shoes of a teenager" as we review the health curriculum at Quabbin Regional High School, and work to better understand the needs of adolescents in this rural area.

teens served by Quabbin Regional Schools

Barre Family Health Center

Veteran/military health issues

Students will focus on the impact of war – including behavioral and physical health issues; the impact on veterans and their families; homelessness and suicide prevention; substance misuse, PTS(D); and traumatic brain injury.

veterans

Worcester/
Boston/
Bedford

Worcester Department of Public Health

Students will receive an overview of the Division’s work and key public health concepts. Their work will be structured around 2 ongoing initiatives within the Division’s Office of Community Health 1) the Greater Worcester Community Health Improvement Plan (CHIP) and 2) the Prevention and Wellness Trust Fund.

residents of Greater Worcester region

Worcester

Worcester’s faces and places: Family Health Center Worcester

This year, the FHCW will focus on asthma, attending home visits and learning about community-level interventions.

FHCW patients, esp those with asthma

Worcester

Worcester Head Start Program

This team will focus on screening and assessment of early growth and development; developmental delays and medical care plans.

preschool children ages 2.9-5

Worcester

YWCA Central MA community worker challenges

The Student Team will interview and observe program participants and/or parents, as well as direct service staff to gain a clear picture of challenges to the populations served by YWCA programs, and the particular physical, mental and emotional challenges faced by direct service staff members. They will also assist in implementation and analysis of a burnout survey for employees.

careworkers

Worcester