Addressing Interpersonal Violence as a Health Policy Question Using Interprofessional Community Educators.

INTRODUCTION: The health effects of intimate partner violence (IPV) not only include physical injury, but can also manifest as posttraumatic stress disorder, anxiety, and others. US medical students report receiving inadequate training about IPV. This case-based tutorial for third-year medical students examines: (1) a clinical encounter with a patient experiencing several complex challenges including IPV and homelessness; (2) the implications of existing policy on the delivery of health care services; and (3) the impact of policies on patient choices. METHODS: This case is completed during a family medicine clerkship. The 2-hour case review moves between small- and large-group sessions led by community interprofessional experts at a local family advocacy center. Optimal group size is three to four students and one or two experts per group. The large-group session should be led by a dynamic moderator who is familiar with the Socratic method of teaching to elicit a variety of responses to ad hoc challenge questions. Materials provided include student resources, student case, facilitator guide, moderator guide, and sample brochure of IPV documentation policies. RESULTS: To date, over 200 students have participated in this session. During the most recent iteration the average response to the question, "As a result of the FAC experience, I feel more empowered to care for persons experiencing IPV," was 4.1 out of 5 (5 = strongly agree). DISCUSSION: Public health, health policy, and clinical topics can be effectively taught by an interprofessional team of community experts and lead to improved student understanding of the importance of health policy to both individual and population health outcomes.

Health Policy and Advocacy for New Mexico Medical Students in the Family Medicine Clerkship.

BACKGROUND AND OBJECTIVES: Learners in medical education are often inadequately prepared to address the underlying social determinants of health and disease. The objective of this article is to describe the development, implementation, and evaluation of a Health Policy and Advocacy curriculum incorporated into our family medicine clerkship. METHODS: We developed a Health Policy and Advocacy course for medical students within our family medicine clerkship. We evaluated the curriculum using a survey of our own design administered to students before and after their clerkship year. We created a mean score for each subscale that measured (1) physician's role, (2) knowledge, and (3) confidence in ability and calculated differences between the pre-survey and the post-survey scores for four medical school classes. We also conducted a focus group to get student input on the new curriculum. RESULTS: Mean scores on the pre- and post-surveys were highest for the subscale regarding attitudes about a physician's role in health policy and advocacy and did not change over time. Scores for self-reported knowledge and confidence in abilities increased significantly from the beginning to the end of the clerkship year. Students were generally positive about the curriculum but had some concerns about finding time for advocacy in their future practices. CONCLUSIONS: Training in health care policy and advocacy can be successfully implemented into a medical school curriculum with positive outcomes in students' self-reported knowledge and confidence in their abilities. Work remains on providing advocacy role models for students.

Reuniting public health and medicine: the University of New Mexico School of Medicine Public Health Certificate.

The University of New Mexico School of Medicine (UNMSOM) sought to train medical students in public health concepts, knowledge, and skills as a means of improving the health of communities statewide. Faculty members from every UNMSOM department collaborated to create and integrate a public health focus into all years of the medical school curriculum. They identified key competencies and developed new courses that would synchronize students' learning public health subjects with the mainstream medical school content. New courses include: Health Equity: Principles of Public Health; Epidemiology and Biostatistics; Evidence-Based Practice; Community-Based Service Learning; and Ethics in Public Health. Students experiencing the new courses, first in pilot and then final forms, gave high quantitative ratings to all courses. Some students' qualitative comments suggest that the Public Health Certificate has had a profound transformative effect. Instituting the integrated Public Health Certificate at UNMSOM places it among the first medical schools to require all its medical students to complete medical school with public health training. The new UNMSOM Public Health Certificate courses reunite medicine and public health in a unified curriculum.

Medical students' attitudes toward underserved populations: changing associations with choice of primary care versus non-primary care residency.

The number of medical students entering primary care residencies continues to decrease. The association between student attitudes toward underserved populations and residency choice has received little attention even though primary care physicians see a larger proportion of underserved patients than most other specialists. We evaluated attitudes toward underserved populations in 826 medical students using a standardized survey, and used logistic regression to assess the effect of attitudes, along with other variables, on selection of a primary care residency. We compared results between two groups defined by year of entry to medical school (1993-99 and 2000-05) to determine whether associations differed by time period. Students' attitudes regarding professional responsibility toward underserved populations remained high over the study period; however, there was a statistically. significant association between positive attitudes and primary care residency in the early cohort only. This association was not found in the more recent group.

Decentralized medical education in rural communities: the circuit rider connection.

BACKGROUND AND OBJECTIVES: Successful community-based medical education requires an ongoing relationship among the school, medical students, and community preceptors. The use of medical school faculty as "circuit riders" helps to develop and maintain these relationships. We studied the benefits, challenges, and barriers as seen by faculty participating in circuit riding activities at the University of New Mexico. METHODS: All 43 faculty circuit riders from the most recent academic year were asked to complete an anonymous electronic survey. Ranked responses and free text comments were included. Analysis of ranked items by years as university faculty and years of experience circuit riding was performed. RESULTS: Commonly cited reasons for faculty participation in circuit riding included (1) enjoyment of working with medical students, (2) support for rural/community-based education, and (3) interactions with community preceptors. Barriers primarily related to time included (1) difficulty getting time away from clinical activities and (2) coordinating the faculty members', community preceptors', and students' schedules. CONCLUSIONS: For faculty circuit riders, commitment to medical student education in the community is the most common reason for participation in this program. Schools using this model will need to address the time commitment involved.

"Where have all the students gone?" Retaining medical school graduates through educational innovations.

CONTEXT: New Mexico is a sparsely populated rural state in the USA, with 20% of New Mexicans living in poverty. There is a need for physicians in the state, especially in primary care. New Mexico's only medical school, the University of New Mexico School of Medicine is state supported. New Mexico and its medical school have a vested interest in its graduates returning to the state to practice. OBJECTIVES: Evaluate the effects of early community preceptorships on graduating physicians' specialty choice and subsequent return to practice in the state where they attended medical school. STRATEGIES: A Primary Care Curriculum (PCC) was introduced into the medical school in 1979. Students expressing interest in this programme were considered. Twenty students per year were assigned to the PCC. The remainder went through the traditional curriculum. The PCC used a problem-based learning model. All PCC students participated in a 16-week, one-on-one community preceptorship (Phase 1B) in a small or rural community during their first year. Graduates from 1983-1996 were analysed for specialty and practice location. MAIN OUTCOMES: Of the 294 students doing Phase 1B, 99 (40%) returned to New Mexico to practice compared to 221 (32%) of traditional students. Fifty-eight (23%) of the Phase 1B students practice primary care compared to 112 (16%) of the traditional students. CONCLUSION: Self-selected students choosing and participating in early community-based clinical experiences coupled with problem-based learning are more likely to return to the state and to practice primary care.