248073 Extensive Care Unit: An experiential, service learning approach to teaching urban health to medical students

Monday, October 31, 2011: 10:30 AM

Scott Frank, MD, MS , Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH
David Bruckman, MS, MT(ASCP) , Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, OH
Kristina Knight, MPH , Master of Public Health Program, Case Western Reserve University, Cleveland, OH
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.

Learning Areas:
Advocacy for health and health education
Basic medical science applied in public health
Clinical medicine applied in public health
Diversity and culture
Environmental health sciences
Planning of health education strategies, interventions, and programs

Learning Objectives:
Describe urban health competencies addressed by the Extensive Care Unit curriculum Discuss the value of urban health education within medical curricula Identify advantages of conducting a comprehensive neighborhood assessment in a high need urban setting to both the learner and the community.

Keywords: Urban Health, Community Health Assessment

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an academic family physician and public health practitioner, educator, and researcher practicing in underserved urban settings throughout my career. I serve as director of an MPH program, a local health department, and a community coalition. I am the medical school curriculum leader in population health and serve on the social justice curriculum committee for the University.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.