Understanding and Addressing the Legal Needs of Refugees

As part of the mini-symposium entitled Utilizing Community Voices to Translate Research into Communities: Results from Three Pilot Studies Conducted by Academic and Community Partnerships, this presentation discusses a study that focuses on understanding the barriers refugees face when obtaining critical support services, benefits and housing. The aim is to improve individual and systemic level advocacy and training strategies designed to reduce the barriers impeding access to public benefits and housing for Worcester’s growing and diverse refugee population

Librarian Participation in Chart Rounds: Final Results of Two Surveys Measuring the Effectiveness of Librarians Working with Family Medicine Residents in a Clinical Setting

OBJECTIVE: To measure the impact of librarian participation at multi-disciplinary chart rounds at three central Massachusetts health centers affiliated with the University of Massachusetts Medical School Worcester Family Medicine residency program. BACKGROUND: Chart rounds, led by Department of Family Medicine and Community Health faculty preceptors, are held daily at each residency practice site. Family Medicine residents present cases based on patients seen that day. New guidelines for chart rounds were developed by residency leadership in 2007 through a grant from AAMC Regional Medicine-Public Health Education Centers. Based on these guidelines, librarians, behavioral health specialists and pharmacists are invited to participate. METHODS: In early 2010, residents (n=32) were invited to complete an IRB-approved Likert-scale (1=strongly disagree to 5=strongly agree) survey asking them to evaluate their satisfaction with chart rounds. The survey included three questions focusing on the effectiveness of library participation. Based on the findings of this first survey, initiatives were undertaken to increase librarian impact. These initiatives specifically reached out to PGY1 residents who had scored library participation lower that PGY2 and PGY3 residents. In 2012, a second survey was distributed (n=24) using the same questions. This poster will present results from both surveys specific to librarian involvement. Both sets of results were analyzed using SPSS 17.0. RESULTS: Results were tabulated for the 2010 survey and the 2012 survey, and were then cross-tabulated to identify changes. The three librarian-related questions posed were -- librarians during rounds: A) changed their [residents] short-term and/or long-term treatment plans; B) helped them locate useful information more efficiently than in the past; and C) helped increase their understanding of identifying and utilizing best-evidence information resources in their practice. Although the sample size was small, following the implementation of the initiatives aimed specifically at first year residents, statistically-significant increases were seen in 2012 survey responses in the first two questions. DISCUSSION: Librarians from the Lamar Soutter Library at UMass Medical School have been participating in chart rounds for many years; at some centers, even before the formal guidelines were developed in 2007. Through these two surveys, the librarian cohort now have quantitative data demonstrating their effectiveness in these clinical settings

Being there, there and there: using research methodology to evaluate the effectiveness of librarians embedded in chart rounds within a multi-center Family Medicine residency program

OBJECTIVE: To measure the impact, analyze results and suggest enhancements of librarian participation at multi-disciplinary chart rounds at three central Massachusetts health centers affiliated with the U Mass Medical School Worcester Family Medicine residency program. METHODS: Chart rounds, led by Department of Family Medicine and Community Health faculty preceptors, are held daily at each residency practice site. Family Medicine residents present cases based on patients seen that day. New guidelines for chart rounds were developed by residency leadership in 2007. Based on these guidelines, librarians, behavioral health specialists and pharmacists are invited to participate. In early 2010, residents (n=32) were invited to complete an IRB-approved survey asking them to evaluate their satisfaction with chart rounds. The survey consisted of ten questions, three of which focused on the effectiveness of library participation. Other questions sought feedback on the value of chart rounds as an educational tool as well as questions about the participation of other specialists. This paper reports results from this survey specific to librarian involvement, analyzed using SPSS 17.0. RESULTS: Survey results were crosstabulated by practice site and by post-graduate year (PGY) across all sites. Of greatest significance were satisfaction reports by PGY. Residents in the third year of training were more likely than those in earlier years to report that information provided by librarians during rounds: A) changed their short-term and/or long-term treatment plans (chi2=13.61, p=.009); B) helped them locate useful information more efficiently than in the past (chi2=10.99, p=.027); and C) helped increase their knowledge about a medical or community health issue (chi2=16.15, p=.003). CONCLUSIONS: After reviewing these results and discussing possible interpretations by site and by PGY, several changes have been made or are proposed for this and the 2011-2012 academic year, e.g. participation of librarians in PGY1 practice settings such as inpatient morning report. These changes will address areas where lower satisfaction scores were reported. A specific follow-up survey targeting librarian participation is planned for 2012

Eat Walk Sleep for Health: Primary Prevention in a Refugee Community

Background: Refugees resettling in the US historically follow a trajectory of declining health as they adopt American diet and physical activity. Methods: This participatory research study explored health beliefs and behaviors of refugees from Burma currently resettling in New England. Community members and researchers adapted a healthy living bilingual educational flipchart, which was piloted in two workshops with a total of 20 adult men and women. An interpreter translated the audio taped discussions which were transcribed and analyzed using standard qualitative methods. Conclusions/ Discussion: Refugee camps constrain food and physical activity related health behaviors. Refugees rely on traditional healing practices but are familiar with western public health care and preventive education. In camps, close living quarters encouraged social interaction and group play. Physical activity was built into daily life as transportation, occupation and food gathering method. Exercise was a byproduct of a busy day, walking to work or school, collecting bamboo in the woods. New arrivals are often housebound and isolated; they seek simple maps that assist in locating resources in their new communities. Asking about sleep appears to open the conversation about emotional and mental health problems. Refugees want specific information about healthy foods and better understanding of how to determine need for exercise. They also seek consistent information on prevention of health problems common in the US coupled with assistance preserving their traditional beliefs. Discussion: Post-settlement in the US, retaining good health is challenging. Flipcharts and neighborhood map drawing provide avenues for open discussion leading to areas for Prevention Research Centers to partner for health

Primary care renewal: regional faculty development and organizational change

BACKGROUND: Many reports, including the Future of Family Medicine, have called for change in primary care, but few have defined, implemented, and evaluated mechanisms to address such change. The regional, interdisciplinary Primary Care Renewal Project was designed to address problems in primary care practice and teaching related to practice management, compensation, increasing responsibility for teaching, and faculty development. METHODS: Twelve northeastern US medical schools assembled a conference attended by teams of key stakeholders representing both clinical and educational missions. Teams developed and implemented an institutional plan to address identified needs. Outcome data was collected during, and for 1 year after, the conference. RESULTS: Findings demonstrate novel ways of improving learning experiences, coordinating and centralizing planning efforts, and addressing faculty needs. The magnitude of organizational change ranged from establishing new administrative units with significant institutional authority (eg, restructuring dean\u27s office) to enhancing the strategic planning process and refining mission statements to reflect emphasis on primary care. CONCLUSIONS: A well-planned, regional interdisciplinary effort that fosters the development of concrete plans can be associated with significant change in medical education. A central theme emerged--that primary care medicine will survive only if institutions align their educational and clinical missions and foster system-wide change

Mapping Patient Distributions Informs Community-Oriented Primary Care in Four Community Health Centers in Central Massachusetts

Background Based on the philosophy that family medicine training should occur in community-based practices and hospitals, the Worcester Family Medicine Residency (WFMR) training program was structured to combine learning opportunities in an academic medical center with outpatient care training in three unique community-based practices: the Barre Family Health Center, a rural site thirty miles west of Worcester, the Family Health Center of Worcester, a federally funded community health center serving a poor and culturally diverse urban population, and the Hahnemann Family Health Center, a hospital-owned health center serving a socioeconomically diverse population in the northeast part of Worcester. The WFMR received an AAMC “Regional Medicine-Public Health Education Centers-Graduate Medical Education (RMPHEC-GME)” grant to further integrate public health training into the clinical training experience. As part of the effort, collaboration was begun between the department of Family Medicine and Community Health at UMASS Medical School, the academic home of the WFMR, and geographers at Clark University, a local resource providing expertise in mapping of data using Geographic Information Systems (GIS). Mapping Patient Distribution A series of thematic maps were generated from actual practice data on the patients being served by each residency site and also by Fitchburg Community Health Center. Faculty champions from each site attended two training sessions to learn more about the capabilities of mapping. They were then asked to lead faculty at their site in discussion to define five maps they would like to see made from their own patient data. Most sites chose a map showing the distribution of the entire patient population, some requested a map of their pediatric patients, and then the rest were designed to depict the spread of certain chronic diseases, including asthma, hypertension, coronary disease, and diabetes. Maps were generated using geocoding and point density tools in ArcGIS Desktop software. The main goal of this mapping activity was to educate physicians in training about where their patients live and facilitate discussion about environmental factors that impact health. These maps can also be used by practitioners to communicate important information to their patients about available community resources such as gyms, parks, health clinics, and supermarkets (as shown on some maps). Making Maps Available Online One element of the grant initiative was to build an online resource to aid faculty in teaching about population health concepts. This portal, the Community Health Toolkit (http://www.umassmed.edu/fmch/toolkit.aspx), provides three types of information to aid clinicians in both their teaching and their practice. The “Data on Communities” section was developed as part of the UMMS/Clark University collaboration. In total, 24 thematic maps were generated by the GIS team at Clark University and uploaded to the “Data on Communities” web section of the Community Health Toolkit. Other sections of the Community Health Toolkit include “Learning about Populations” which provides links to a variety of local, regional and national health indicators, and a “Community Resources” section which provides links to community resources for patients. The Toolkit is presented to learners along the continuum of medical education, including second year students in the Population Health Clerkship, first year residents in the Family Medicine and Community Health rotation, then used as a resource by residents as they complete presentations and research projects

Changing the Face of an Institution: Creative Partnerships for Women’s Professional Development

Purpose of program/study/research:To accelerate the advancement of women professionals at an academic medical center through creative collaboration. Methodology (including study design, analysis, and evaluation):The UMass Medical School Women’s Faculty Committee (WFC) initiated a partnership with the medical library to compete successfully to host the traveling exhibition “Changing the Face of Medicine: Celebrating America’s Women Physicians.” Concurrent with the 6-week exhibition, fifteen events brought local and nationally prominent women together for mentoring activities, an original dramatic production, and an awards luncheon for women faculty. Women featured in the exhibit as well as its Visiting Curator spoke at UMMS about their research and career challenges, read from their published works, and were featured at graduation and a regional medical society event. Results:Application-writing and event planning sessions forged robust working relationships among top-ranking administrators, senior and junior faculty, and staff. The exhibition increased opportunities for administration, faculty, and students to understand the impact of women in medicine, their leadership potential, and historical contributions. It also generated new mentor/mentee relationships and grant-writing collaborations. The exhibition’s national recognition helped draw a larger, more diverse and gender-balanced audience (575+ people) to the events enhancing the visibility of the WFC, as evidenced by institutional funding for women faculty to attend the AAMC WIM professional development workshops and ELAM for the first time. Conclusion(s):Creative partnerships, motivated by the opportunity to host “Changing the Face of Medicine,” produced greater than expected gains for women faculty, generating new awareness and understanding of women’s accomplishments and leadership potential. This partnership allowed for a wide range of multi-disciplinary efforts, strengthening networking across silos, and advancing the goals of women in an academic medical center. Presented October 29, 2006 at AAMC 2006 Annaul Meeting, Seattle, WA

Multi-Disciplinary Experts Supporting Graduate Medical Education through Participation in COMPLETE Chart Rounds

Learning Objective: As a result of this presentation, attendees will learn skills that they can use to implement collaborative graduate medical education learning experiences using a community of multi-disciplinary professionals within their own institutions. Background: Inter-professional Chart Rounds were implemented to provide residents an opportunity to review and present patient cases utilizing “COMPLETE” guidelines developed by residency leadership as the result of a “Regional Medicine – Public Health Education Centers” grant. COMPLETE guidelines explicitly direct residents to include consideration of: - Context – Culture of context – who is the patient? - Outside Visitors/Resources – incorporate visitors/experts such as librarians, pharmacists and psychologists and utilize their resources - Mental Health – assess behavioral health aspects of the case - Population Perspective – address prevalence of the condition in the community - Learn From Others – consider specialists, home care, and complementary therapies - Expectations – clear goals set between physician and patient - Time – Start on time, end on time. Respect everyone’s time. - End with “Culture of Continuity” – what are the key lessons? Is there a follow-up plan? Through the attendance of librarians, psychologists, pharmacologists, medical students and other faculty, discussion ensues which leads to continued resident education and support. Methods: Chart Rounds are held daily at each residency practice site. Residents are required to attend along with medical and pharmacy students rotating at the centers. The preceptor leads Chart Rounds and other faculty physicians join as they are able. Residents present cases while maintaining patient confidentiality. The preceptor leads the group discussion of the case. Faculty members discuss clinical and administrative implications, the psychologist addresses potential behavioral aspects of the case, the librarian searches for Evidence-Based information to support decisions and the pharmacologist advises on medication management. The group also discusses how individual patient care reflects the public health needs and profile of the community. Residents (n=32) were invited to complete a survey asking them to evaluate their experience with multi-disciplinary COMPLETE Chart Rounds. Results: Survey results as well as observational analysis will be used to improve the resident’s experience at Chart Rounds with the goal of making this experience an even more rewarding collaborative educational experience. Some sample findings include: - 66% of residents report satisfaction of Chart Rounds challenging the academic aspects of their work - 100% of residents in the early portion of their program report that Chart Rounds assists them in building collaborative relationships with faculty and other providers/experts - Residents report the greatest satisfaction (92% overall) with pharmacist participation in Chart Rounds across all Post Graduate Years - Satisfaction with librarian participation increases through each year (from only 10% in PGY1 to over 60% in PGY3) , possibly due to limited exposure early in the program Although these guidelines were developed for use in a Family Medicine Graduate Medical Education program and fit well into this practice model, the findings can be utilized in other resident training programs. Presented at the Patients and Populations: Public Health in Medical Education conference sponsored by the Association of American Medical Colleges (AAMC) and the Centers for Disease Control and Prevention (CDC), held September 14-15, 2010, in Cleveland, OH

Eat Walk Sleep Discuss: Building a Multi-Dimensional Participatory Relationship

A multi-faceted relationship has developed between UMass Worcester and the Worcester Refugee Assistance Project (WRAP). The relationship has its roots in student engagement, and has grown to include faculty, students and community members in a range of community-based participatory activities, which can be shaped in response to needs as they are identified and defined. This poster describes the different ways student engagement and community partnerships worked together in a research project

The Role of Relationships in the Professional Formation of Physicians

BACKGROUND: Studies of the professional development of physicians highlight the important effect that the learning environment, or \ hidden curriculum,\ has in shaping student attitudes, behaviors, and values. We conducted this study to better understand the role that relationships have in mediating these effects of the hidden curriculum. [See PDF for complete abstract