Evaluating the Efficacy of Medical-Legal Partnerships that Address Social Determinants of Health.

BACKGROUND: Medical-legal partnerships (MLPs) are health system-community partnerships composed of multi-disciplinary teams designed to improve patient and community health. MLPs provide legal services to address health-harming legal needs that contribute to health inequities. METHODS: A grant provided by the Association of American Medical Colleges (AAMC) and the Centers for Disease Control and Prevention established the Accelerating Health Equity, Advancing through Discovery (AHEAD) Initiative to identify, evaluate, and disseminate community-based interventions that improve health equity. Three geographically and demographically diverse institutions were chosen to strengthen the evidence-base surrounding MLP by developing standardized evaluation tools in the areas of community health, health system savings, and learner outcomes. RESULTS: The generalizable process leading to evaluation tool development is described herein, and includes the formation of multi-institutional teams, logic model development, and stakeholder interviews. CONCLUSIONS: Although MLP is presented, this process can be used by various types of community health partnerships to develop evaluation tools surrounding social determinants of health (SDOH).

Teaching Public and Population Health in Medical Education: An Evaluation Framework.

Curriculum models and training activities in medical education have been markedly enhanced to prepare physicians to address the health needs of diverse populations and to advance health equity. While different teaching and experiential learning activities in the public health and population health sciences have been implemented, there is no existing framework to measure the effectiveness of public and population health (PPH) education in medical education programs. In 2015, the Association of American Medical Colleges established the Expert Panel on Public and Population Health in Medical Education, which convened 20 U.S. medical faculty members whose goal was to develop an evaluation framework adapted from the New World Kirkpatrick Model. Institutional leaders can use this framework to assess the effectiveness of PPH curricula for learners, faculty, and community partners. It may also assist institutions with identifying opportunities to improve the integration of PPH content into medical education programs. In this article, the authors present outcomes metrics and practical curricular or institutional illustrations at each Kirkpatrick training evaluation level to assist institutions with the measurement of (1) reaction to the PPH education content, (2) learning accomplished, (3) application of knowledge and skills to practice, and (4) outcomes achieved as a result of PPH education and practice. A fifth level was added to measure the benefit of PPH curricula on the health system and population health. The framework may assist with developing a locally relevant evaluation to further integrate and support PPH education at U.S. medical schools and teaching hospitals.

Public health and community medicine instruction and physician practice location.

BACKGROUND: Experts have historically recommended better integration of public health content into medical education. Whether this adoption is associated with physician practice location has not been studied. PURPOSE: To examine the association between medical student perception of their public health and community medicine instruction and practice location in a Health Professional Shortage Area. METHODS: Descriptive analysis and a regression model assessed the significance and strength of the association between medical student perception of their public health and community medicine instruction and practice location using data from the Medical School Graduation Questionnaire 1997-2004, 2013 American Medical Association Physician Masterfile, and 2013 Health Professional Shortage Areas. RESULTS: A higher proportion of medical students with an intent to practice in underserved areas reported inadequate instruction in public health and community medicine than those without such intentions. Students reporting adequate public health and community medicine instruction are slightly more likely to practice in a Health Professional Shortage Area, controlling for their intent to practice in underserved areas. CONCLUSIONS: Findings suggest an association between perceptions of public health and community medicine instruction and practice location. Improved public health and community medicine instruction may support medical students' preparation and ability to integrate public health skills into practices in underserved settings. More research is needed to ascertain factors enabling better incorporation of public health and community medicine in medical education.