Retaining interest in caring for underserved patients among future medicine subspecialists: Underserved Medicine and Public Health (UMPH) program.

BACKGROUND: Accessing subspecialty care is hard for underserved patients in the U.S. Published curricula in underserved medicine for Internal Medicine residents target future-primary care physicians, with unknown impact on future medicine subspecialists. METHODS: The aim was to retain interest in caring for underserved patients among Internal Medicine residents who plan for subspecialist careers at an urban university hospital. The two-year Underserved Medicine and Public Health (UMPH) program features community-based clinics, evening seminars, reflection assignments and practicum projects for 3–7 Internal Medicine residents per year. All may apply regardless of anticipated career plans after residency. Seven years of graduates were surveyed. Data were analyzed using descriptive statistics. RESULTS: According to respondents, UMPH provided a meaningful forum to discuss important issues in underserved medicine, fostered interest in treating underserved populations and provided a sense of belonging to a community of providers committed to underserved medicine. After residency, 48% of UMPH graduates pursued subspecialty training and 34% practiced hospitalist medicine. 65% of respondents disagreed that “UMPH made me more likely to practice primary care” and 59% agreed “UMPH should target residents pursuing subpecialty careers.” CONCLUSIONS: A curriculum in underserved medicine can retain interest in caring for underserved patients among future-medicine subspecialists. Lessons learned include [1] building relationships with local community health centers and community-practicing physicians was important for success and [2] thoughtful scheduling promoted high resident attendance at program events and avoided detracting from other activities required during residency for subspecialist career paths. We hope Internal Medicine residency programs consider training in underserved medicine for all trainees. Future work should investigate sustainability, whether training results in improved subspecialty access, and whether subspecialists face unique barriers caring for underserved patients. Future curricula should include advocacy skills to target systemic barriers

Public health training in internal medicine residency programs: a national survey

BACKGROUND: The IOM recommends public health training for all physicians. Data characterizing such training of internal medicine (IM) residents are lacking. PURPOSE: To describe the current state of public health education at IM residency programs, characterize programs offering public health education, and quantify interest in expanding training opportunities. METHODS: IM residency program directors from the 380 Accreditation Council for Graduate Medical Education-accredited residency programs in the U.S were invited to participate in a cross-sectional survey. Responses were received from 127 programs (33%). Data were collected July-December 2012 and analyzed in January 2013. Participants were queried on domestic public health training offered, perceived resident interest in and satisfaction with this training, and interest in expanding training. RESULTS: Eighty-four respondents (66%) provide some form of public health training, but structure and content vary widely. In many programs offering public health training, few residents (\u3c10%) receive it. Although 93 programs (73%) integrate public health into core curricula, only three topics were common to a majority of these programs. Sixty-six respondents (52%) offer clinical training at community-based health centers. Most residency program directors (90%) are very or somewhat interested in expanding their public health training. CONCLUSIONS: This study characterizes the structures and content of public health training across IM residency programs. The wide range highlights the diverse definition of public health training used by IM residency program directors and lack of universal public health competencies required for IM physicians. Opportunities exist for collaboration among residency programs and between IM and public health educators to share best practices

Clinical Public Health Integration in Medical School Curriculum: Transitioning Medical Student Training from Medical Problems to Health Solutions

The current chronic disease burden, growing health disparities, and evolution of our healthcare system require that medical students be equipped with basic public health education to effectively manage patients, navigate the healthcare system, and advocate for health(1,2,3,4,5,6). The Institute of Medicine and the AAMC emphasize the need for physicians to be trained in public health(1,8). The inaugural year of the revised curriculum at The George Washington University School of Medicine and Health Sciences (GW SMHS) represented a first step at the institution to integrate clinical public health into medical education. As part of this process, the Clinical Public Health (CLiPH) Working Group, a student formed curriculum advisory board, was created to give real time feedback and assess the Public Health & Health Policy theme curriculum in the first year at GW SMHS. The project objectives were: 1.) To review and evaluate the effectiveness of the public health theme curriculum in the first year of the revised curriculum, including first year medical students’ perceptions and knowledge of the public health theme. 2.) To develop a proposal to maximize opportunities and achieve better integration of the public health theme into the curriculum. The group aims toward clinical public health integration across the four year medical degree curriculum and better collaboration with the GW Milken School of Public Health (SPH) to create an expanded scope of practice within public health for practicing physicians. Over the summer, the working group engaged with multiple stakeholders to forward the clinical public health agenda at GW SMHS. To conduct the curriculum assessment, the students developed a template and the group reviewed over fifty sessions, in the Public Health & Health Policy Theme, Clinical Skills and Reasoning Course (CSR), and intersession activities. Outside research was done to supplement resources to recommend and improve integration of the clinical public health material into the revised preclinical curriculum. Recommended revisions and developments were sent to faculty stakeholders as resources for the revision process of the curriculum. Future work to revise the curriculum should include study of the evolution of students’ knowledge, attitudes, and beliefs surrounding clinical public health and the impact it has on their development as a physician. To better inform the development of the curriculum and how best to engage students with clinical public health, major stakeholders, such as health departments, community stakeholders, public health experts, and most importantly students should continue to be a part of the dialogue

The disruption of proteostasis in neurodegenerative diseases

Cells count on surveillance systems to monitor and protect the cellular proteome which, besides being highly heterogeneous, is constantly being challenged by intrinsic and environmental factors. In this context, the proteostasis network (PN) is essential to achieve a stable and functional proteome. Disruption of the PN is associated with aging and can lead to and/or potentiate the occurrence of many neurodegenerative diseases (ND). This not only emphasizes the importance of the PN in health span and aging but also how its modulation can be a potential target for intervention and treatment of human diseases.info:eu-repo/semantics/publishedVersio

Quality Improvement: How Bridge to Care Achieved a 115% Increase in Patient Volume

The Bridge to Care Clinic was started in March 2015 by the George Washington School of Medicine & Health Sciences, the GW Healing Clinic, in partnership with the Prince George’s County Health Department. The clinic was originally modelled after GW Healing Clinic’s previous partnership with Bread for the City, a FQHC in nearby Shaw, where we ran a smaller operation in coordination with their staff. Unlike at Bread for the City however, at Bridge to Care our operations from patient scheduling, patient check-in, phlebotomy, lab processing, prescription placement, follow-up care, triage, referrals, social services are entirely student run. With increased responsibilities we found over the course of our first year open that patient visit lengths were too long, lab errors occurred frequently, our follow-up with patients was documented inconsistently and our student leadership were overworked. Simultaneously during 2016 we noticed an overall rise in patient volume from 8-9 patients/night to over 13-15 patients/night, and an increase in referrals from the Health Department. So with the joint goal of improving patient care and improving capacity to be able to expand we embarked on a project to quantitatively and qualitatively assess the quality of care at Bridge to Care by: (1) assessing patient satisfaction and the quality of patient care received at Bridge to Care using an anonymous patient survey, (2) assessing clinic workflow by process mapping and looking at clinical operations more critically, and (3) creating tools to improve clinic workflow and adjust clinic protocol accordingly. Literature review and patient testing were utilized to optimize a patient survey for our diverse patient population. Process maps were utilized to outline the workflow for clinic lab and prescription processing. A combination of literature review and quality improvement methods were used to devise new tools, actions and objectives for the clinic. Improvements from the summer included a medication education tracking sheet, a new clinic space, assigned managerial roles and a new leadership plan. As a result, the Bridge to Care clinic expanded from one night to two nights per week, experienced a 115% increase in patient volume, and a 90% increase in blood draws. With our new expanded leadership, workflow, and capacity Bridge to Care is looking forward to continuing quality improvement and furthering expansion of our services to continue to better reach the needs of our community. Our current objectives include introducing specialty nights, incorporating undergraduate volunteers and furthering sustainability for our role in the community

Developing Community Health Providers of the Future: GW Healing Clinic Professional Development Series

Given the rising shortage of primary care and community health physicians in the United States, medical and physician assistant students, now, more than ever, need to be exposed to community health settings and actively learn the practice of medicine within them1. The GW University School of Medicine and Health Sciences Healing Clinic, a student-run free primary care clinic based in the DC metropolitan area, involves approximately 160 student volunteers per year. Students spearhead clinic operations, provide primary care at two community-based clinical sites, and navigate patients through the health system. With only three evening clinic shifts available to each student volunteer per semester, the GW Healing Clinic struggles to provide continuity in training and longitudinal exposure to the systems challenges of community health settings. To address the specific needs of our novice learners, student leadership developed the “Healing Clinic Professional Development Series” to enhance knowledge and skills. Given the autonomous structure of the new clinical site in Prince George’s County, MD, expectations for students’ skills were increased. Student leaders assessed clinic services and patient demographics to identify focus areas for the professional development series. First, student volunteers received blood draw training to provide lab services in low-resource settings. In partnership with the medical Spanish language group, SALUD, students received a workshop on Hispanic/Latino/Immigrant health and appropriate approaches to documentation status in clinical settings. Students received a session on the safety net health system and specialty health care access points in Prince George’s County, MD, a highly medically underserved population in the DC area2. In addition, workshops on the patient-centered medical home model and LGBTQ Youth Health, topics seldom included in medical school curricula, were conducted. Of 160 annual volunteers, 87 students attended at least one professional development session with 52 students attending more than 2 sessions over the Fall 2015 semester. Student leadership will develop session evaluations to determine the immediate and long-term effectiveness of the series. Future work must evaluate how students are applying these skills during their Healing Clinic shifts, clerkship years, and career paths

Bridge to Care: How a Medical School can Partner with a Public Health Department

On the border of DC, Prince George\u27s County, Maryland has a substantially low per capita number of primary care physicians (83 per 100,000 residents), lacking a primary care safety net for residents(1). Approximately 80,000 residents are uninsured, with high rates of chronic disease (asthma, obesity, HIV/AIDS) and low rates of preventative care(1). To address these disparities, The GW University School of Medicine and Health Sciences Healing Clinic, a student-run free clinic, created a unique partnership with the Prince George\u27s County Health Department to form the “Bridge to Care” Clinic. The partnership has two objectives: 1. to link those with insurance to a primary care physician within the county and 2. to be the only primary care access point for the uninsured within the Health Department. Student directed projects were undertaken to address each of the following obstacles: 1. limited no-cost or affordable care delivery options within the health department, and the county for referrals, 2. recognition of the spectrum of volunteer clinical experience and clinic capacity, 3. complex patient population with multiple chronic comorbidities, limited resources, and frequent language barriers. First, an assessment of the community health system sought to identify community partners where patients could be referred at no cost for services unattainable through the health department, such as: specialty care, legal services, or HIV support services. Second, a volunteer resource manual was developed to assist students through language barriers, simple protocols in clinic, history and physical exam, differential diagnoses, EMR documentation, and screening tools at the point of care. Lastly, a patient navigator program was created to address patients’ complex needs through adequate education, referrals, and follow up. Future work of the GW Healing Clinic must evaluate the impact of the student-directed initiatives on the partnership and primary care delivery to those underserved in the DC metro area