The Urban Medicine Program: Developing Physician-Leaders to Serve Underserved Urban Communities

Leadership Training in Undergraduate Medical Education: A Systematic Review

Background: This review seeks to characterize existing curricular interventions implemented to develop leadership skills in undergraduate medical students at LCME-accredited medical schools and elucidate best practices for leadership curriculum development. Methods: PRISMA guidelines were used to guide the review. Comprehensive literature searches of five databases retrieved peer-reviewed journal articles with empirical data published in English. Two phases of screening were conducted to identify studies describing leadership development curricular interventions, followed by data extraction and synthesis. Results: Comprehensive literature searching and hand searching identified 977 articles potentially eligible for inclusion, with a final set of 16 articles selected for the review. A majority of the leadership development programs targeted preclinical students, while others spanned the entire curriculum. "Mixed settings," including both classroom and clinical and community components were common. There was a wide range of cohort sizes spanning from over 100 students to fewer than 10. Using the competencies defined by Mangrulkar et al, we determined that all of the programs described leadership skills development, including conflict management and emotional intelligence. Out of the 16 selected studies, curricula that emphasized the development of skills were evidence-based medicine and practice, and 6 curricula targeted interprofessionalism. Conclusions: Leadership development needs to be standardized in undergraduate medical education, ideally using a competency-based framework to develop these standards. Longitudinal programs that had a didactic and project-based component received consistently high quality and effectiveness scores, as did programs with smaller cohort sizes that received more consistent mentorship and monetary investment from institutions.

Teaching social determinants through geographic information system mapping

BACKGROUND

Many institutions in undergraduate medical education have developed unique curricula to teach social determinants of health (SDOH). Geographic information system (GIS) mapping is one tool that learners could use to understand our built environment and its correlation with health outcomes through data analysis, visualization and active learning.

APPROACH

At the University of North Carolina School of Medicine, medical students participate in a 4-year longitudinal curriculum on social and health systems science with the final year dedicated to self-directed learning. This final year course incorporates a GIS-based online module to help students apply their understanding of the health impacts of SDOH. Students create online maps with simulated patient data and identify 'hotspots' with map overlays using ArcGIS software. Students write reflections on their maps based on the implications of SDOH. Thematic analysis of these reflections identified patterns within the narrative data.

EVALUATION

From March 2020 to February 2021, 148 fourth-year medical students participated in the GIS learning module. Five major themes were identified: Explored Social Determinant Topics, Inclusion of Geo-mapping in Curriculum, Utility of Geo-mapping in Healthcare, Future Application of ArcGIS for Personal Use, Impressions of ArcGIS Software. Students showed engagement and interest in the exercise, and responses were overall positive. Responses showed understanding of the application of ArcGIS and demonstrated knowledge of social determinants of health.

IMPLICATIONS

A self-directed, active learning online module using GIS mapping offers a generally popular, eye-opening and unique method for teaching SDOH in undergraduate medical education.

Implementing a Social Determinants of Health Curriculum in Undergraduate Medical Education: A Qualitative Analysis of Faculty Experience

PURPOSE

Following shifts that broadened the medical profession's conceptualization of the underlying drivers of health, medical schools are required to integrate curricula on health disparities and the social context of medicine into undergraduate medical education. Although previous research has focused on student experiences and outcomes in these curricula, less attention has been paid to the experiences of the physician-faculty involved. This study aimed to capture faculty insights to improve understanding of the challenges and opportunities of implementing this curricular reform.

METHOD

In-depth, semistructured interviews were conducted with 10 faculty members at one U.S. medical school in spring 2019 to capture their experiences designing and teaching a new curriculum related to the social determinants of health and health disparities. Study design, including interview guide development, was informed by the critical pedagogy perspective and social constructionist approaches to curriculum implementation. With the use of a constructivist grounded theory approach, interview transcripts were analyzed using open, thematic, and axial coding techniques. Primary themes were categorized as professional, organizational, interactional, or intrapersonal and organized into the final model.

RESULTS

Participants processed their experiences at 4 concentric levels: professional, organizational, interactional, and intrapersonal. Faculty generally embraced the movement to incorporate more discussion of social context as a driver of health outcomes. However, they struggled with the shortcomings of their training and navigating structural constraints within their school when developing and delivering content. When confronted with these limitations, faculty experienced unexpected tension in the classroom setting that catalyzed self-reflection and reconstruction of their teaching approach.

CONCLUSIONS

Findings highlight the challenges that faculty encounter when integrating social determinants of health and related curricula into undergraduate medical education. They also speak to the need for a broader conceptualization of relevant expertise and have implications for how medical schools select, train, and support medical educators in this work.

The experiences of community organizations partnering with a medical school to improve students' understanding of the social determinants of health: A qualitative study

PURPOSE

There has been increasing interest among national organizations for medical schools to provide students experiential training in the social determinants of health (SDH) through community partnerships. Despite this interest, there is limited data about how these experiential activities can be designed most effectively, and community organizations' views of partnering with medical schools on these curricula is unknown. The authors' objective was to determine community organizations' and clinical clerkship directors' perceptions of the benefits and challenges of utilizing academic-community partnerships to improve medical students' understanding of the SDH.

METHODS

The authors conducted a qualitative study consisting of open-ended, semi-structured interviews (between 2018 and 2021). All community organizations and clinical clerkship directors who partnered with a health equity curriculum were eligible to participate. Semi-structured interviews elicited participants' perceptions of the academic-community partnership; experience with the curriculum and the students; and recommendations for improving the curriculum. All interviews were audio recorded and transcribed. The authors used a directed content analysis approach to code the interviews inductively and identified emerging themes through an iterative process.

RESULTS

Of the fifteen participants interviewed, ten were from community organizations and five from clinical clerkships. Three primary themes emerged: (1) community organizations felt educating students about the SDH aligned with the organization's mission and they benefited from consistent access to volunteers; (2) students benefited through greater exposure to the SDH; (3) participants suggested standardizing students' experiences, ensuring the students and organizations are clear about the goals and expectations, and working with organizations that have experience with or the capacity for a large volume of volunteers as ways to improve the experiential activity.

CONCLUSION

This study found that community organizations were very willing to partner with a medical school to provide students experiential learning about the SDH, and this partnership was beneficial for both the students and the organizations.

Educational Outcomes of a 4-Year MD-MPH Dual-Degree Program: High Completion Rates and Higher Likelihood of Primary Care Residency

PURPOSE

In 2007, University of Texas Health Science Center Houston School of Public Health at San Antonio (UTHealth SPH) and UT Health San Antonio Long School of Medicine (LSOM) designed and implemented a 4-year dual MD and Master of Public Health (MPH) program. Dual MD-MPH programs wherein students can receive both degrees within 4 years are unique, and programmatic evaluation may have generalizable implications for accredited MD-MPH programs.

METHOD

Demographic information was collected from UTHealth SPH and LSOM student data. The primary outcome variable was MD-MPH program completion in 4 years. Comprehensive Basic Science Examination (CBSE) scores, United States Medical Licensing Examination Step 1 and Step 2 scores, and successful primary care residency match data were compared between MD-MPH and MD-only students. Family medicine, internal medicine, obstetrics-gynecology, and pediatrics were considered primary care residencies, and an analysis excluding obstetrics-gynecology was also conducted.

RESULTS

Of 241 MD-MPH students enrolled 2007-2017, 66% were women, 22% Hispanic, and 10% African American. Four-year MD-MPH program completion occurred for 202 (93% of eligible) students; 9 (4.1%) received MD only, 3 (1.4%) received MPH only; and 4 (1.8%) received neither. MD-MPH students' median CBSE score was 2 points lower than for MD-only students (P = .035), but Step 1 and 2 scores did not differ. Primary care residency match was more likely compared with MD-only students, both including and excluding obstetrics-gynecology (odds ratio [OR]: 1.75; 95% confidence interval [CI]: 1.31, 2.33; and OR: 1.36; 95% CI: 1.02, 1.82, respectively).

CONCLUSIONS

The 4-year MD-MPH program retains and graduates a socioeconomically and racial/ethnically diverse group of students with a 93% success rate. MD-MPH graduates were more likely to pursue primary care residency than non-dual-degree students, which may have implications for addressing population health disparities.

Student Voices on Leadership Training Needs to Care for Underserved Populations

INTRODUCTION

Experts suggest that leadership education should begin during medical school. However, little information exists on preferences of medical students on leadership development and particularly of those who want to work with underserved communities. This student-led study surveyed medical students on leadership development skills and perceptions on curricular needs.

METHODS

We conducted a cross-sectional study using a 26-question survey with Likert scales, multiple choice, and open-ended questions. We anonymously surveyed 83 students (medical school years 1 through 4) at the Keck School of Medicine of University of Southern California and conducted a one-time focus group with six students to assess leadership aspirations and training needs. We compared student responses based their desire to serve in underserved communities in their careers.

RESULTS

Medical student desire to practice in underserved communities was greatest among respondents in their first 2 years (62% and 67%), compared to 36% and 53% for respondents in third and fourth year, respectively. Students interested in underserved communities were statistically more likely (t test 2.07, P=.04) to indicate "My well-being may need to be sacrificed in order to serve as a leader," based on the survey. The survey showed similar top-five leader characteristics (competent, dependable, honest, inspiring, supportive) were valued among all respondents. Optional leadership modules were selected to enhance medical education by the most respondents and could potentially meet their curricular needs.

CONCLUSION

Our findings show that medical students welcome leadership training opportunities and prefer optional longitudinal modules. Students who plan to practice in underserved communities have similar preferences on training but may need additional support related to maintaining their well-being.

Association of a Health Equity Curriculum With Medical Students' Knowledge of Social Determinants of Health and Confidence in Working With Underserved Populations

IMPORTANCE

National organizations recommend that medical schools train students in the social determinants of health.

OBJECTIVE

To develop and evaluate a longitudinal health equity curriculum that was integrated into third-year clinical clerkships and provided experiential learning in partnership with community organizations.

DESIGN, SETTING, AND PARTICIPANTS

This longitudinal cohort study was conducted from June 2017 to October 2020 to evaluate the association of the curriculum with medical students' self-reported knowledge of social determinants of health and confidence working with underserved populations. Students from 1 large medical school in the southeastern US were included. Students in the class of 2019 and class of 2020 were surveyed at baseline (before the start of their third year), end of the third year, and graduation. The class of 2018 (No curriculum) was surveyed at graduation to serve as a control. Data analysis was conducted from June to September 2020.

EXPOSURES

The curriculum began with a health equity simulation followed by a series of modules. The class of 2019 participated in the simulation and piloted the initial 3 modules (pilot), and the class of 2020 participated in the simulation and the full 9 modules (full).

MAIN OUTCOMES AND MEASURES

A linear mixed-effects model was used to evaluate the change in the self-reported knowledge and confidence scores over time (potential scores ranged from 0 to 32, with higher scores indicating higher self-reported knowledge and confidence working with underserved populations). In secondary analyses, a Kruskal-Wallis test was conducted to compare graduation scores between the no, pilot, and full curriculum classes.

RESULTS

A total of 314 students (160 women [51.0%], 205 [65.3%] non-Hispanic White participants) completed at least 1 survey, including 125 students in the pilot, 121 in the full, and 68 in the no curriculum classes. One hundred forty-one students (44.9%) were interested in primary care. Total self-reported knowledge and confidence scores increased between baseline and end of clerkship (15.4 vs 23.7, P = .001) and baseline and graduation (15.4 vs 23.7, P = .001) for the pilot and full curriculum classes. Total scores at graduation were higher for the pilot curriculum (median, 24.0; interquartile range [IQR], 21.0-27.0; P = .001) and full curriculum classes (median, 23.0; IQR, 20.0-26.0; P = .01) compared with the no curriculum class (median, 20.5; IQR, 16.25-24.0).

CONCLUSIONS AND RELEVANCE

In this cohort study of medical students, a dedicated health equity curriculum was associated with a significant improvement in students' self-reported knowledge of social determinants of health and confidence working with underserved populations.

Third-Year Medical Students' Self-perceived Knowledge About Health Disparities and Community Medicine

INTRODUCTION

Medical providers' attitudes about caring for vulnerable populations have significant implications for persistent health disparities. Therefore, assessing medical students' self-perceived knowledge about community-based medicine and care for underserved populations can provide insights for improving health care delivery to achieve health equity. We evaluated third-year medical students' perceptions of their knowledge and attitudes about community medicine, and addressing health care needs of vulnerable populations.

METHODS

From October 2, 2017 to July 12, 2019, third-year medical students at a private, urban medical school were asked to complete an assessment survey during their family medicine clerkship orientation. The anonymous survey assessed students' self-perceived knowledge and attitudes regarding community medicine and care of vulnerable populations. We examined differences in survey responses by student demographics.

RESULTS

A total of 401 students participated in the survey; 50.5% of respondents agreed that they had knowledge to assess health literacy of the patient, while only 22.2% of students agreed that they had knowledge about how to identify a community and conduct a community health needs assessment. Additionally, students agreed with being most comfortable providing care to adolescents (73.0%) and the elderly (69.5%), and that they were least comfortable caring for incarcerated individuals (31.7%) and immigrants/refugees (44.1%).

CONCLUSION

Assessment of learners' self-perceived knowledge can help highlight areas for educational interventions. Our findings suggest the need for improving medical student knowledge in areas of community health and health care for specific vulnerable populations.

Medical students attitudes toward and intention to work with the underserved: a systematic review and meta-analysis

BACKGROUND

Experts in the field of medical education emphasized the need for curricula that improve students' attitudes toward the underserved. However, some studies have shown that medical education tends to worsen these attitudes in students. We aimed at systematically reviewing the literature assessing the change in medical students' attitudes toward the underserved and intention to work with the underserved throughout medical education, the sociodemographic and educational factors associated with favorable medical student attitudes toward and/or intention to work with the underserved and the effectiveness of educational interventions to improve medical student attitudes toward and/or intention to work with the underserved.

METHOD

We conducted a systematic review on MEDLINE, Scopus, and Web of Science databases. Three investigators independently conducted the electronic search. We assessed the change in medical students attitudes toward the underserved by computing a weighted mean effect size of studies reporting scores from validated scales. The research team performed a meta-analysis for the sociodemographic and educational factors associated with medical students attitudes toward and/or intention to work with the underserved.

RESULTS

Fifty-five articles met the inclusion criteria, including a total of 109,647 medical students. The average response rate was 73.2%. Most of the studies were performed in the USA (n = 45). We observed a significant decline of medical students attitudes toward the underserved throughout medical education, in both US and non-US studies. A moderate effect size was observed between the first and fourth years (d = 0.51). Higher favorable medical students attitudes toward or intention to work with the underserved were significantly associated with female gender, being from an underserved community or ethnic minority, exposure to the underserved during medical education and intent to practice in primary care. Regarding educational interventions, the effectiveness of experiential community-based learning and curricula dedicated to social accountability showed the most positive outcome.

CONCLUSIONS

Medical students attitudes toward the underserved decline throughout medical education. Educational interventions dedicated to improving the attitudes or intentions of medical students show encouraging but mixed results. The generalizability of our results is impeded by the high number of studies from the global-North included in the review.

Does it make a difference? Exploring the value of combining public health and nursing education

BACKGROUND

Within the evolving United States healthcare system, there is a need to strengthen the public health nursing workforce. Historical and more recent trends within nursing education have demonstrated this need. Nurses who obtain a Master of Public Health (MPH) contribute to this workforce's development.

PURPOSE

This study aimed to describe nurses' educational and professional experiences with an MPH and better understand how professionals use this combination in practice.

METHODS

This study utilized a phenomenological, qualitative research method. Researchers interviewed 11 nurses with an MPH via the telephone. The researchers independently coded the interview transcripts and developed a codebook. Qualitative analysis facilitated the emergence of subsequent themes.

RESULTS

Four themes emerged: (1) educational pathway decisions, (2) education experience, (3) role in the workforce, and (4) nursing and public health in practice. Participants worked in a variety of settings, including primary care, academia, and administration. All participants reported utilizing their nursing and public health skills and described the actual integration of these skills in the workplace.

CONCLUSION

These findings suggest that nurses with an MPH value the education and report being better equipped to promote health on both the individual and community levels.

A Role-Playing Activity for Medical Students Demonstrates Economic Factors Affecting Health in Underprivileged Communities

BACKGROUND

Innovative teaching-learning strategies are necessary to promote community orientation and foster awareness of the social determinants of health among millennial learners in the health professions.

METHODS

The authors designed a role-playing simulation activity that aims to highlight the multidimensional nature of health and develop in students an appreciation of the day-to-day experiences of underserved populations. The current investigation aimed to evaluate the utility of the role-playing activity and guided reflection in terms of the students' appreciation of economic factors that affect health and health-seeking behavior of patients and their recognition of the role of healthcare professionals with respect to issues related to poverty and health. Thematic analyses of the insights and observations of the students immediately after the activity and the anonymized reflection papers were done to identify recurring ideas that made an impression on them.

RESULTS

The students were able to identify that in a setting with limited employment opportunities and low-income potential, the residents prioritized food and shelter over everything else. They also chose cheaper products over healthier options. Practically everyone forewent out-of-pocket healthcare expenditure in order to minimize its disruptive consequences. In these settings, the students highlighted the role of society and government in the provision of services and in community development. The students also emphasized the necessity for competition among a number of providers of goods and services to reduce prices. When asked if healthcare professionals are contributing to the widening gap between rich and poor, 70% agreed, 9% disagreed, 14% did not give a direct answer, and 7% said that healthcare professionals contributed in some ways and alleviated in other ways. The most commonly cited behavior that contribute to this disparity are the decision to seek highly specialized training, the congregation of practitioners in highly urbanized centers, and inattention to the economic difficulties of most patients. Those who disagreed with the statement cited systemic problems as the driving force that widens the disparity. In particular, these students cited the commodification of healthcare and related services, inappropriate policies, and insufficient funding specifically for services and health human resources.

CONCLUSION

The evolving landscape in healthcare financing requires more preparation among our medical students and trainees. Innovative strategies such as role-playing activities and guided reflection are useful in demonstrating economic factors that influence health and promote better understanding of externalities that shape the health status of individuals and communities.

Teaching the Social Determinants of Health in Undergraduate Medical Education: a Scoping Review

BACKGROUND

To provide optimal care, medical students should understand that the social determinants of health (SDH) impact their patients' well-being. Those charged with teaching SDH to future physicians, however, face a paucity of curricular guidance.

OBJECTIVE

This review's objective is to map key characteristics from publications about teaching SDH to students in undergraduate medical education (UME).

METHODS

In 2016, the authors searched PubMed, Embase, Web of Science, the Cochrane and ERIC databases, bibliographies, and MedEdPORTAL for articles published between January 2010 and November 2016. Four reviewers screened articles for eligibility then extracted and analyzed data descriptively. Scoping review methodology was used to map key concepts and curricular logistics as well as educator and student characteristics.

RESULTS

The authors screened 3571 unique articles of which 22 were included in the final review. Many articles focused on community engagement (15). Experiential learning was a common instructional strategy (17) and typically took the form of community or clinic-based learning. Nearly half (10) of the manuscripts described school-wide curricula, of which only three spanned a full year. The majority of assessment was self-reported (20) and often related to affective change. Few studies objectively assessed learner outcomes (2).

CONCLUSIONS

The abundance of initial articles screened highlights the growing interest in SDH in medical education. The small number of selected articles with sufficient detail for abstraction demonstrates limited SDH curricular dissemination. A lack of accepted tools or practices that limit development of robust learner or program evaluation was noted. Future research should focus on identifying and evaluating effective instructional and assessment methodologies to address this gap, exploring additional innovative teaching frameworks, and examining the specific contexts and characteristics of marginalized and underserved populations and their coverage in medical education.

The Beyond the Books Program: Improving Medical Student Attitudes Toward the Underserved

Purpose: To determine the impact of the Beyond the Books (BTB) program, a short-term pre-clinical intervention, on medical student attitudes toward the underserved (MSATU). Methods: BTB was evaluated through a prospective cohort study using the validated MSATU questionnaire. Results: There were no significant MSATU total score differences between BTB students (n=13) and student controls (n=29) at the beginning of the program. At the program's conclusion, BTB participant MSATU total scores were significantly higher than those of controls (p<0.001). Conclusion: Although limited by selection methods, our MSATU data support the capability of short-term pre-clinical interventions to significantly improve medical student attitudes toward underserved communities.

The Beyond the Books Program: Improving Medical Student Attitudes Toward the Underserved

Purpose: To determine the impact of the Beyond the Books (BTB) program, a short-term pre-clinical intervention, on medical student attitudes toward the underserved (MSATU). Methods: BTB was evaluated through a prospective cohort study using the validated MSATU questionnaire. Results: There were no significant MSATU total score differences between BTB students (n=13) and student controls (n=29) at the beginning of the program. At the program's conclusion, BTB participant MSATU total scores were significantly higher than those of controls (p<0.001). Conclusion: Although limited by selection methods, our MSATU data support the capability of short-term pre-clinical interventions to significantly improve medical student attitudes toward underserved communities.

Community Health, Advocacy, and Managing Populations (CHAMP) Longitudinal Residency Education and Evaluation

Purpose

Longitudinal education initiatives designed to prepare residents to address health disparities and social determinants of health (SDH) are needed. This report addresses this gap by describing a family medicine residency's Community Health, Advocacy, and Managing Populations (CHAMP) curriculum and its evaluation by learners, faculty, and community partners. The CHAMP longitudinal curriculum is explicitly designed to prepare residents to address health disparities and SDH. We report early outcomes, including community partner feedback, of this innovative curriculum.

Methods

Data were obtained through standardized rotation evaluations, thematic analysis of structured group and individual interviews, and aggregated competency milestone data. Kirkpatrick's four-level model to evaluate effectiveness of training was used to frame design and analysis of learner, faculty, and community partner evaluations.

Results

Twenty residents have completed the year-one curriculum, 8 residents the year-two curriculum, and 8 residents the year-two and year-three elective. Community partners, residents, faculty, and leadership all were satisfied with the curriculum, particularly regarding relationship building and mentorship. Overall satisfaction with the rotation, quantitatively and qualitatively, was positive. Competency milestone ratings improved within each year of training: first-year residents by 0.6 (3.0 for 2015-2016 and 3.6 for 2016-2017) and second-year residents by 0.1 (5.2 vs 5.3).

Conclusions

The CHAMP curriculum uniquely a) spans all three years of residency; b) combines block mandatory rotations with a longitudinal elective experience; and c) integrates community health, advocacy, and managing populations to meet accreditation requirements and prepare residents to address health disparities and SDH.

Self-efficacy of Osteopathic Medical Students in a Rural-Urban Underserved Pathway Program

Context

Self-efficacy has been shown to play a role in medical students' choice of practice location. More physicians are needed in rural and urban underserved communities. Ohio University Heritage College of Osteopathic Medicine has a co-curricular training program in rural and urban underserved practice to address this shortage.

Objective

To assess whether participation in the co-curricular program in rural and urban underserved practice affects self-efficacy related to rural and underserved urban practice.

Methods

This cross-sectional study explored self-efficacy using Bandura's 5 sources of self-efficacy (vicarious learning, verbal persuasion, positive emotional arousal, negative emotional arousal, and performance accomplishments). A validated scale on self-efficacy for rural practice was expanded to include self-efficacy for urban underserved practice and e-mailed to all 707 medical students across 4 years of medical school. Composite rural and urban underserved self-efficacy scores were calculated. Scores from participants in the rural and urban underserved training program were compared with those who were not in the program.

Results

Data were obtained from 277 students. In the overall sample, students who indicated that they grew up in a rural community reported significantly higher rural self-efficacy scores than those who did not grow up in a rural community (F1,250=27.56, P<.001). Conversely, students who indicated that they grew up in a nonrural community reported significantly higher urban underserved self-efficacy scores than those who grew up in a rural community (F1,237=7.50, P=.007). The participants who stated primary care as their career interest (n=122) had higher rural self-efficacy scores than the participants who reported a preference for generalist specialties (general surgery, general psychiatry, and general obstetrics and gynecology) or other specialties (n=155) (F2,249=7.16, P=.001). Students who participated in the rural and urban underserved training program (n=49) reported higher rural self-efficacy scores (mean [SD], 21.06 [5.06]) than those who were not in the program (19.22 [4.22]) (t65=2.36; P=.022; equal variances not assumed). The weakest source of self-efficacy for rural practice in participants was vicarious experience. The weakest source of urban underserved self-efficacy was verbal persuasion.

Conclusion

Opportunities exist for strengthening weaker sources of self-efficacy for rural practice, including vicarious experience and verbal persuasion. The findings suggest a need for longitudinal research into self-efficacy and practice type interest in osteopathic medical students.

Increasing Medical Trainees' Empathy Through Volunteerism and Mentorship

BACKGROUND

Within medical education, there have been recent calls for increased understanding and exposure to poverty to increase trainees' empathy toward the underserved. Students participating in Michigan Cardiovascular Outcomes Research and Reporting Program research program volunteered at World Medical Relief (WMR) in Detroit, Michigan, a nonprofit organization which recycles medical equipment for developing countries and within greater Detroit. Participants' perceptions of the underserved were measured before and after the experience.

METHODS

Preliminary questionnaires were given to participants prior to and after exposures at WMR. Questionnaires examined participants' attitudes toward the underserved, knowledge of medical supply reuse, and their perceived ability to impact change. P values of <.025 were considered significant.

RESULTS

A total of 39 participants completed the survey, 77% previously volunteered, 33% had volunteered internationally. Participants were >4× more likely than previously to have knowledge of the variety of recycled medical supplies at WMR. Prior to volunteering, 48.7% of participants gave little thought to how excess medical supplies could be collected versus 0% after exposure. Participants were 1.5× more likely to agree that the experience was enhanced working with their peers and 2.7× more likely to consider starting their own organization/intervention for medical supply donations. Those participants that never previously volunteered were 1.3× more likely to do so with encouragement from a mentor.

CONCLUSIONS

Encouraging exposure to such service programs resulted in enhanced knowledge of community resources and increased motivation to participate in outreach and belief of individual responsibility to care for the underserved. Incorporating volunteerism into traditional education programs offers the opportunity to build awareness and interest in students reaching out to the underserved.

Impacting Health Disparities in Urban Communities: Preparing Future Healthcare Providers for "Neighborhood-Engaged Care" Through a Community Engagement Course Intervention

It is well known that health disparities exist and that a significant majority of patients who suffer disproportionately from them are lower income, non-white residents of dense, and diverse urban neighborhoods. It is our belief that factors hindering the reduction of health disparities in these neighborhoods are a lack of a framework and preparation needed to engage these communities in identifying specific health care needs. This paper describes one curricular intervention, a graduate level community engagement course, developed within an academic medical center located in an urban setting, that demonstrates promise in effecting change in the extent to which clinicians are able to engage communities and practice "neighborhood-engaged care" with the central goal of mitigating disparities.