Health and illness in context: a pragmatic, interdisciplinary approach to teaching and learning applied public health within an urban safety net system.

BACKGROUND: Academic centers and community programs are too often separated by institutional and cultural chasms. Such divides weaken our capacity to develop a diverse public health-oriented, community-based workforce. This article describes one bridge designed to connect the academy to local safety net systems and the lessons learned during its construction. PROGRAM DESCRIPTION: "Health & Illness in Context" is an interdisciplinary program developed in 2008 by students at Oregon Health & Science University and staff at Portland's Central City Concern. Over a 7-week period, small cohorts of medical, nursing, and public health students gain an intimate, street-level understanding of the local safety net and the structural forces that shape it. Guided by program faculty, they traverse the maze of urban social services-following clients' pathways from homelessness and addiction to treatment, recovery, and social reintegration. In each 4-hour session, students: (1) apply key concepts from public health to challenging real-world contexts, (2) explore effective, innovative approaches to addressing complex health and social issues, and (3) directly engage members of underserved communities and the diverse professionals that serve them. OUTCOMES: Although too early to formally assess its impact on career choice, Health & Illness in Context is already serving as an incubator for novel public health-oriented experiences, curricula, and activism that are further narrowing the community-university divide. Citing Health & Illness in Context as a primary inspiration, students have developed complementary elective courses, community-outreach activities, and long-term community collaborations. Meanwhile, program faculty members, now formally advise student initiatives, serve as mentors/preceptors, and have expanded their involvement at the university.

Evaluation of a community-based, service-oriented social medicine residency curriculum.

BACKGROUND: Educators can create opportunities for physicians-in-training to learn about the health care needs of the underserved and expose learners to models of care and opportunities for service. OBJECTIVES: We evaluated a community-based, service-oriented Social Medicine curriculum for Internal Medicine interns and residents initiated in 2007. METHODS: Qualitative data were collected through focus groups. CONCLUSIONS: Potent community-based experiential learning with adequate time and encouragement to hear clients' stories allowed residents to gain an understanding of some of the complex factors that contribute to ill health in this population and seemed to influence residents' confidence in their skills in working with an undeserved population, particularly a population struggling with addiction. However, the curriculum did not provide adequate time for facilitated, personal reflection. These data will assist community health partnerships in developing their own curricula to address health needs of the underserved.