Medical care for immigrants and refugees; training primary care providers to offer quality care to immigrants

Background: Annually, more than 600,000 immigrants and 70,000 refugees enter the United States, mostly from developing regions. 70% of U.S. immigrants are resided in inner city. Primary care providers normally lack formal training in immigrant health and geographic medicine to manage refuges and immigrants' complex problems. This adversely affects immigrants' access to quality health care.

Method/Program: For the last 4 years, in our residency program of Social Medicine/Primary Care we developed a didactic lecture series and a special morning report to advance residents' knowledge and skills in immigrant health. We devoted a separate clinic session per week for immigrants. Skilled clinical educators with experience and qualifications in public health, international and tropical medicine offer didactic interactive sessions with the focus on patients' countries of origin including; a) country profile: society/environment, historical setting, cultural belief/family Life, education, economy, politics, and human rights profiles, b) population-based health: health policies, health system/ resources, epidemiology, health statistics, and environmental health, and c) clinical management of tropical and unfamiliar illnesses. Resident-doctors evaluate and document socio-cultural and health system and belief in a data entry sheet, and screen for human rights abuses. Following a standard history and physical examination, residents are precepted by faculty to develop patient's plan of care. Subsequently, residents fill out a short morning report sheet with some patient-specific clinical questions for preceptors to look up and discuss during the next day session. Using questionnaires we evaluated residents' satisfaction and feedbacks.

Result/Findings

Majority of resident-participants found clinical aspect and epidemiology more interesting, and the clinical, health system, and socio-political backgrounds most helpful.

Conclusion

We documented the usefulness and importance of the novel case-based and carefully designed didactic curriculum for primary care providers that addresses all relevant topics in immigrant health.