Extensive Care Unit: An experiential, service learning approach to teaching urban health to medical students

Objective: Describe the “Extensive Care Unit” (ECU), an experiential, service learning urban health curriculum designed to introduce medical students to epidemiology, biostatistics, community assessment, health risk behavior, health advocacy, and social determinants of health. Background: While the Intensive Care Unit is often considered the hotbed of medicine, the health of our nation demands that student physicians apply a comparable level of rigor to understanding the sciences that contribute to health improvement in urban populations. Medical curricula emphasize basis and consequences of disease by examining the cellular and molecular level. While this knowledge is essential, effective urban health also requires “extensive care,” a systems focus on patterns of illness; prevention; recognition of social, behavioral and environmental factors; and the capacity to communicate with cultural competence. Methods: The ECU is a required component of the population health block of a revised medical curriculum at a private research-oriented university. It is conducted during the first 5 weeks of the medical student education with students divided into 20 inquiry groups, each assigned to conduct a comprehensive, multilevel neighborhood assessment of a high need urban neighborhood. Results: ECU groups analyze publicly available demographic data that influences urban health; use GIS mapping to identify social demographics by census tract; interview key community contacts; conduct a windshield survey; administer a food source checklist (examining availability of healthy foods in urban grocery stores); perform secondary analysis of Youth Risk Behavior Survey based data (including violence, substance use; sexual behavior; fitness and nutrition; mental health and health quality of life) from a public middle or high school in their neighborhood; generate a report made available to the community; and write a “Community SOAP Note” (applying this clinical convention to their neighborhood assessment). Groups are facilitated by experts in neighborhood assessment and urban health. This session will report on curriculum design; required resources; student response; and findings from ECU community assessments. Barriers and benefits of implementation will be emphasized. Implications for interprofessional education are discussed. Conclusion: The ECU emphasizes the science and practice of urban health, offering students the opportunity to learn about the community they will practice in and the science required to understand and influence patterns of health within that community. Implementing this curriculum in one of the poorest cities in the US offers medical students a vivid observation of social determinants of health and opportunities for community service and health advocacy as a foundation of medical education.