This is a two-week immersion course (with several preparatory meetings) required of all second year medical and first year graduate nursing students. Its aim is to introduce students to public health concepts and to communities as a unit of care. As a result of this Population Health Clerkship experience, students from the medical school and graduate school of nursing will:
• Learn to work collaboratively
• Appreciate the value of looking at populations and communities as units of care rather than just individual patients
• Become aware of available and needed resources for the population
• Become aware of the need to work in teams and collaborate with different professions and disciplines providing care and services and value the role of provider as population advocate
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The Population Health Clerkship strives to achieve objectives related to student learning, community service and service-learning.
Student learning objectives
1. Describe how socio-economic, cultural, policy, behavioral, environmental and biological factors contribute to specific individual and population health outcomes. This is achieved through the use of the Population Health Framework [link].
2. Collect and review existing data, identify gaps in data, and explain how data can be used to improve the health status of the population of focus (and, as relevant, the mission of an organization that works with the population). This is achieved through use of the Population Health Framework [link].
3. Identify the common public health and advocacy strategies and programs for preventing and addressing a health issue in a population. This is achieved through use of the population health framework [link].
4. Work collaboratively with other health professional students, health care providers, and community agencies to develop strategies to advocate for a vulnerable population. This is achieved through the development of clerkship products including a service project that is negotiated with the team’s primary agency to meet a need and the completion of a population health framework that demonstrates an equal delegation of responsibilities to complete, in interprofessional teams.
5. Demonstrate an ability to be aware of, and reflect on, personal reactions to people with the particular health issues of focus. This is achieved through the writing of reflective essays. [link].
Community service objective
1. Develop a data-driven product that will help a population meet a goal of improved health and/or a product that the organization working with the population identifies as a need to improve health. This is achieved through development of a project, product or proposal.
Service-learning objective (as a group, students need to accomplish at least one of the following)
1. Advance the advocacy agenda for a population as requested by an organization working with the population. This is achieved through contributing to an advocacy service project and/or completing the advocacy section in the pop health framework
2. Support an organization's existing plan of action with appropriate strategies. This is achieved through the development and/or implementation of a component of the agency's existing plan.
3. Assist an organization by developing expanded resources from partners that support or advocate for a population. This is achieved through documentation of what services partner agencies can deliver and how they can work in partnership.
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This course component employs a variety of educational methodologies including small group sessions, a field experience, reflective practice activities, a population health assessment (population health framework), dissemination of findings (poster presentation) and continuous self-learning activities.
Small group teams (April – November)
Students rank their top five choices for a clerkship team and are assigned by faculty to enable maximizing the mix of medical and advanced practice nursing students. Students meet for the first small group introduction with academic and community faculty in April and then convene again in mid-October. Preparatory readings are assigned for all students (located at end of this document) in addition to population-specific readings and resources identified by team leaders.
Field experience (October)
The core field experience occurs over ten days in October. The field experience is structured to provide the students with ten full days of learning, i.e. 6 hours, plus 2 hours of additional study per day. There is some flexibility due to travel and scheduling with community agencies.
Early in the field experience, working with the community preceptor and academic faculty team leader, students confirm the focus to develop and implement a service activity. As part of their field experience, students collect data pertaining to a health related issue faced by the population of focus and the array of available services using a structured data gathering template, the Population Health Framework. Through reflective essays, students will demonstrate awareness of background material and ability to reflect on its application in the context of their team-based experiences. Students are expected to participate actively in the clerkship experience and collaborate on the Population Health Framework and a service project, and to create and present a poster to the UMMS community in November, as detailed in the assessment section.
Academic faculty team leaders and community preceptors should help students identify the necessary sources of data, including contacts with other agencies and providers. As relevant, students may spend time at agencies to develop an understanding of the service network. These agencies include those providing direct patient care, and regulatory and other agencies that have an impact on direct service delivery.
When possible, it is expected that community preceptors will provide students with an opportunity to observe the impact of a population health problem at the individual level. Scheduling for this type of opportunity should begin early in the clerkship so that students will be able to interview a patient and perhaps his/her family to understand the impact of the health problem on a patient and understand a patient's experience of receiving care. An understanding of a patient's pathway through the health care system will likely prove invaluable to understanding some of the services provided for a particular problem/issue.
Dissemination to community (November)
A poster session at the end of the immersion experience provides each group an opportunity to synthesize their experiences and findings. It also serves as a means to exchange information among groups. Through the posters, students present an analysis of data gathered within the Framework, as well as a summary of their field experience and service project to fellow students, faculty, and community members.
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Students are evaluated on a credit/no credit basis. All students are expected to attend all planned meetings, complete the clerkship requirements, and be active contributors to group activities.
Students receive a score up to 100 points in this curricular component. A score above 80 constitutes a passinggrade for medical students in this segment of DOH and for nursing students in NG520B. Points are awarded according to the criteria below.
Working as a team, each group completes the Population Health Framework for the population on which it is focused. The Framework serves as a vehicle for collecting data on the community under study, and can be used for the development of the poster. Each team is required to submit a completed Population Health Framework as a word document at the end of the clerkship to the academic faculty team leader, community preceptor and Sherrie Carey at Sherrie.Carey@umassmed.edu. GSN students must also submit a copy to Robin Klar at Robin.Klar@umassmed.edu.
The academic faculty team leader assigns a group score on the basis of the group’s Population Health Framework. Criteria include how well the topic was defined, the community resources identified and the health advocates described. In order to be graded, the completed Framework must include explanation of each team member’s contribution to the final product.
The following guidelines are used for scoring the framework:
20-25 points: Each of the three major sections is completed fully, demonstrating appropriate background research and a high level of understanding of issues affecting the population’s health within each section of the framework.
15-19 points: Each of the three sections is mostly complete, demonstrating moderate background research and the level of understanding of issues affecting the population’s health is adequate in each section.
<15 points: Two or more of the sections are incomplete, demonstrating little or no background research and the level of understanding of issues affecting the population’s health is only rudimentary.
All students are required to write at least four essays guided by the topics below. The first essay has to be emailed to your team leaders by the end of the third day. To help guide you in reflective practice, we have provided several questions that we encourage you to use to prompt written reflections through the course of the two week clerkship.
Reflective Essay One: EXPECTATIONS
You have had access to several preparatory readings and other resources prior to starting the Population Health Clerkship. How did these preparatory resources affirm and/or shape your expectations for this clerkship? How do you think your prior life experiences have shaped your expectations for this clerkship? After your first couple of days have your expectations changed and if so how and why?
Reflective Essay Two: INTERPROFESSIONALISM
You are participating on a team of students for this clerkship; you are also observing teams of different professionals who are involved with the care of the population of focus in your clerkship. What have you learned about yourself as a team member? What are your strengths and challenges?
How do you think you will work/How do you find you are working as a member of this team? What will be/What are the challenges and rewards working as a member of this team?
What have you observed in the teams providing care for this population? How do you think you will you function in the future as a clinician on an interprofessional team?
Reflective Essay Three: ADVOCACY
Advocacy is a core competency for clinicians and is important for vulnerable populations; through this clerkship, we hope that you have begun to see where and how advocacy can be used to influence any of the social determinants of health that affect your clerkship’s population.
What are some of the advocacy issues that have been identified relative to your clerkship population? Which issues do you think you’d be most effective trying to influence? Why?
How do you view the role of advocacy as a competency for health care providers now that you have worked with your population?
How has your view of advocacy changed since beginning the Population Health Clerkship?
Reflective Essay Four: SUMMARY (or team-specific reflection determined by team leader)
In what ways has your understanding of this population changed or deepened? What does this understanding mean for the way you anticipate doing your work as a health care provider? This essay may also address issues raised within the team and/or requested by the team leaders.
Reflections must be emailed to the academic faculty team leader and community preceptor as a Word document at the set deadlines:
The first essay should be emailed after the third day of the clerkship; the aim is for clerkship leaders to provide feedback early in the two-week period,and help students shape their reflective practice. Feedback should be sent via email to the student. The other three essays are due on the Monday following the immersion experience.
The following guidelines are used for grading the essays.
20-25 points: Demonstrates substantial personal reflection on how the experience has developed personal and professional insights, and broadened understanding of the roles of inter-professionalism and advocacy in caring for the population; has reviewed some readings and/or other resources and fully demonstrates how they and prior life experiences have influenced expectations before the clerkship.
15-19 points: Demonstrates some reflection on how the experience has developed personal and professional insights and broadened understanding of the roles of inter-professionalism and advocacy in caring for the population; responds mostly to questions related to readings and shows some understanding of how they and prior life experiences have influenced expectations before the clerkship.
<15 points: Demonstrates little reflection on how the experience has developed personal and professional insights and broadened understanding of the roles of inter-professionalism and advocacy in caring for the population; gives passing acknowledgement of questions related to readings and shows little understanding of how they and prior life experiences have influenced expectations before the clerkship.
When appropriate, the community preceptor and academic faculty team leader collaborate to evaluate a student's performance with respect to items that are listed on the Population Health Clerkship Grading Grid. For groups where there are multiple preceptors, the academic faculty leader will make the evaluation after consultation with community preceptors. Evaluators are asked to consider how successfully each student has met expectations, documenting critical incidents when expectations are either exceeded on the one hand or not met on the other.
The following guidelines are used for grading participation:
20-25 points: The student attended all meetings and other scheduled activities, followed through on suggestions, developed and/or implemented a service project, demonstrated a sound understanding of issues relevant to the population, and worked well with other students and/or staff.
15-19 points: The student attended most of the meetings and other scheduled activities, mostly followed through on suggestions, put some effort into developing and/or implementing a service project, displays a modest degree of understanding about issues related to the population, and worked moderately well with other students and/or staff.
<15 points: The student attended some of the meetings and other scheduled activities, occasionally followed through on suggestions, put lilttle effort into developing and/or implementing a service project, displays a minimal degree of understanding about issues related to the population, and appears to have difficulty working well with other students and/or staff.
Students work as a team to create academic quality posters that highlight the population and services of focus during the 10-day experience. They present these posters to their peers, faculty and community preceptors at a public session in early November held on the University campus following the clerkship. An electronic version of the poster should be sent to Sherrie Carey at Sherrie.Carey@umassmed.edu by the DEADLINE in the Timeline of Student Activities in order to be printed.
All population health clerkship posters should include content from each of these areas:
▫ Student names & affiliations, with UMMS logo and team/poster number in bottom right corner
▫ Abstract/ intro: Definition of the issue and/or population being considered
▫ Methods: Description of activities and service project
▫ Results: Relevant statistics for issue and population described, impact of your service, or that of local agencies, for the population served
▫ Discussion: Insights from experiences, impact of service on learners, Framework content you think is particularly useful to practicing clinicians,
▫ Reference to “Population Health Clerkship 2012, Dept. of Family Medicine and Community Health”
SIZE: Note that posters can be designed at 36x72 or preferably 40x72 - this is a change from the original directions.
Posters are judged by teams of faculty during the poster session using the following criteria:
• Data: relevance, thoroughness
• Analysis: insights, synthesis
• Oral and Visual presentation: organization and reader-friendliness
• Demonstration of the service project
Instruction on how to prepare academic posters are available online here. Also, an educational session on the topic is being planned for inclusion in clerkship activities during the two-week immersion. This session will be held October 22, 2012 from 1:30-3:30pm. Teams can attend in the iTLC or via Adobe Connect from their clerkship sites, and should RSVP to Heather-Lyn Haley.
If students plan to use images from their experiences in the community, they are urged to get permission of all people included in the photos. A permission slip can be downloaded here [link].
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There is a template available for teams to use if they'd like, but this is not required.
Below you’ll find a timeline for PHC activities and how it is embedded into other courses:
April
4/5: Students receive team info and are asked to rank preferences by 4/12
4/10: Determinants of Health lectures: “Stereotyping & Bias in Health Care” and Introduction to Population Health Clerkship
4/11: Student preference rankings due at http://www.surveymonkey.com/s/PHC2012Ranking
4/14: Student placements announced
4/17: Detreminants of Health lecture: Professionalism
4/17-24: Students research primary agency mission, services and population as an assignment
4/24: Population Health Clerkship Teams meet with academic faculty and/or community preceptors for introductions and discussion of students’ specific interests, 3-4pm unless otherwise arranged by team leaders.
August-September
8/16 – 9/15: Epidemiology and Biostatistics (tentative date - will be set over the summer)
October
10/2: Data Workshop with Judy Savageau, 1:30-3:30, Amp 3
10/2: Population Health Clerkship Teams meet for final planning before beginning of field experience 4-5pm (room assignments)
10/15-26: Ten-day Population Health Clerkship Team Field Experience:
10/17: First essay due to team leaders
10/29: All reflective essays are due to team leaders. (Team leaders may request second essay due Oct. 24th.)
10/30: Medical student protected time to work on posters 2:45-4:45pm
10/31: All Framework documents are due to team leaders.
November
11/1: Final poster PDF files due to Sherrie Carey for printing
11/6: Poster session, Faculty Conference Room, 2:45-4:45pm
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These readings are provided for all students; others will be identified by small group team leaders. We recommend reading a few selections from this list prior to beginning the immersion experience in October.
Betancourt, J.R., Quinlan, J. 2007. Personal Responsibility Versus Responsible Options: Health Care, Community Health Promotion, and and Battle Against Chronic Disease. Prev Chronic Dis 4(3). http://www.cdc.gov/pcd/issues/2007/jul/07_0017.htm. Accessed September 2011.
Fielding, J.E., Teutsch, S.M. 2009. Integrating Clinical Care and Community Health. JAMA 302(3): 317-319.
Gadon, M. 2007. Revisiting the Social Contract: Physicians as Community Health Promoters. Prev Chronic Dis 4(3). http://www.cdc.gov/pcd/issues/2007/jul/06_0195.htm. Accessed September 2011.
Gruen, R. L., Campbell, E.G., Blumenthal, D. 2006. Public Roles of US Physicians: Community Participation, Political Involvement, and Collective Advocacy. JAMA 296(20): 2467-2475.
Hale, Janet. 2011. The Value and Imperative for Health Professions Engaging in Interprofessional Learning. Click here for pdf.
Halfon, Neal, Larson, Kandyce and Shirley Russ. 2010. Theories And Consequences: Why Social Determinants? Healthcare Quarterly, 14(Sp) 2010: 8-20. Available at http://www.longwoods.com/content/21979
Marmot, M. 2007. Achieving Health Equity: From Root Causes to Fair Outcomes. Lancet 370: 1153-1162.
McGinnis, J.M. 2010. Observations on Incentives to Improve Population Health. Prev Chronic Dis 7(5). http://www.cdc.gov/pcd/issues/2010/sep/10_0078.htm. Accessed August 2011.
Parrish, R.G. 2010. Measuring Population Health Outcomes. Prev Chronic Dis 7(4). http://www.cdc.gov/pcd/issues/2010/jul/10_0005.htm. Accessed August 2011.
Radzyminski, S. 2007. The Concept of Population Health within the Nursing Profession. J Professional Nursing 23(1): 37-46.
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Students' team assignments for Fall 2012 were finalized on April 18, 2012. A list of all teams, faculty and students can be downloaded here (updated 8/28/12).
Download the 2012 PHC Team Directory as a PDF document. This document provides descriptions of the teams, their leaders, planned activities and resources to learn more.
Students were asked to rank their top five choices using this survey by April 11, 2012. Students should keep in mind that there is no reimbursement for travel or meals. Housing is provided for two teams: #4 - Barnstable County Behavioral Health, and #17- Latino HIV in New Bedford.
You can browse team titles here; complete descriptions are in the pdf file:
1. ACTION Health Services North County (Fitchburg)
Population of interest: under-served and at-risk people in North Worcester County
Using a combination of mobile health units and a Healthcare for the Homeless clinic, ACTION provides medical, behavioral health, and dental services in Fitchburg and at sites throughout the region.
2. Adolescent Obesity in Rural Settings (Barre)
Population of interest: adolescents in Barre and surrounding communities
Learn about the impact of life in a rural setting on the physical activity and nutritional habits of adolescents.
3. Advocacy, Healthcare and Addiction in the Latino (Worcester)
Population of interest: Worcester Latinos
These two weeks will be spent in discovering the Latino community. We will tour the community, learn about some of the issues that affect the community, and see how health care affects them. We will discuss what the barriers are and why these barriers exist.
4. Barnstable County Behavioral Health (Barnstable- housing available)
Population of interest: Residents of Barnstable County (Cape Cod), 18 years and older , experiencing a behavioral health condition (mental health/substance abuse) and not receiving any or sufficient behavioral health care.
Learn about the psychosocial factors that impact the behavioral health of the region’s residents, several factors which are unique to this region of Massachusetts.
5. Caring for Adults with Intellectual Disabilities (Worcester/Waltham)
Population of interest: Adults with Intellectual Disabilities
Students will have the opportunity to understand the unique issues related to caring for adults with intellectual disability - a population that experiences significant disparities in health access, prevention, and outcomes.
6. Children’s Mental Health (Worcester/Boston)
Population of interest: children from birth to 21 years of age living in the Commonwealth of Massachusetts.
Learn about the prevention, early detection and treatment of behavioral health issues through the development of integrated systems of care within the Commonwealth of Massachusetts.
7. Clinical and Translational Research Pathway (Worcester)
Population of interest: For students in the CTR Pathway only
This clerkship will allow students to learn survey research methods and data analysis and implement patient surveys related to the Patient Centered Medical Home (PCMH) in several UMMHC clinical sites and/or Community Health Centers.
8. Correctional Health (State-wide)
Population of interest: incarcerated people
Experience the typical day of physicians, physician assistants, and nurse practitioners working in teams to provide optimum care for their inmate population to achieve quality outcomes.
9. End of Life Care (Worcester)
Population of interest: Patients (of any age) and their caregivers who are facing end of life issues.
Learn about advance care planning, treatment decision making,the roles of multidisciplinary team members in end of life care and more.
10. Food Insecurity (Worcester)
Population of interest: Populations at risk for hunger
Medical and graduate nursing students will become familiar with hunger and food insecurity, from policy aspects to programs and agencies that address food insecurity.
11. Geriatrics: Fall Prevention (Worcester)
Population of interest: Geriatrics
Meet and talk with elders, visit elder care sites and meet and learn from a variety of different elder care practitioners, shadow a geriatrician/geriatric nurse practitioner, with a focus on Falls Risk Assessment and Falls Prevention
12. Ghanaian Women’s Health (Worcester)
Population of interest: African Woman’s Health—Ghanaian Women
Learn about African Woman’s Health and Disparities in Infant Mortality while connecting with the local Ghanaian community.
13. Head Start (Worcester)
Population of interest: Head Start children ages 3 – 5 years
Support Head Start healthcare team to conduct federally mandated developmental pediatric screenings; shadow health staff with monitoring of medically involved children and classroom observations; learn about the issues facing these children and their families and the interdisciplinary team that supports them
14. Health Care Access for Persons with Disabilities (Worcester/Boston)
Population of interest: Persons with disabilities
Learn about health disparities and access to health care and related services necessary for people with disabilities to live and work in the community.
15. Health Care for the Homeless (Worcester)
Population of interest: Worcester’s homeless population
The average life expectancy for a homeless adult in Boston is 47 years old. This mirrors the mortality rates seen in the US and is a reflection of both profound health care disparity and the inherent risks of being street homeless.
16. Incarcerated and Urban Working Poor (Jamaica Plain)
Population of interest: Patients who were, or who are currently confined to a jail or prison, urban, working poor patients with acute and chronic medical conditions, often with co-existing mental health and substance abuse disorders, people living in the community who may have had, or currently in contact with the criminal justice system, Parole and/or Probation Departments.
17. Latinos Living with HIV – Northern MA (Lawrence)
Population of interest: Latinos living with HIV in the socio-cultural context of Lawrence
Using HIV disease as a framework, students will gain knowledge of both risk and protective factors present in Lawrence, and how these factors may affect the Latino community.
18. Latinos Living with HIV – Southern MA (New Bedford– Housing available)
Population of interest: Urban Underserved Community
Learn about HIV/Aids amongst Latino population by attending patient group counseling visits at the health center, local community based agencies, correctional facilities, and in the local neighborhood.
19. LGBT Health, Homophobia & Heterosexism (Worcester/ Boston)
Population of interest: Lesbian, Gay, Bisexual and Transgender Communities
Learn about the health effects of homophobia and heterosexism by working with community agencies and local populations.
20. More than an ounce of prevention: Programs to prevent injury from trauma in all age groups (Worcester)
Population of interest: Children , Teens and Older Adults
In addition to participating in the Mobile Safety Street events at the Worcester Public Schools, Teen RIDE events, a Child Passenger Checkpoint, disaster preparedness and visiting senior centers with the adapted Mobile Safety Street, students will help develop an assessment of the various programs' effectiveness, including ideas for expansion and strengthening.
21. Oral Health in Diverse Populations: A Community Perspective (Worcester)
Population of interest: diverse population from all backgrounds and ages with a specific focus on pediatric, special needs and geriatric patients as they are at higher risk. Access to oral health care in MA is a major problem for citizens of Massachusetts.
22. Parenting & Family Stability (Worcester)
Population of interest: Low-income urban families
The Clerkship team will work on understanding and analyzing the causes of poor parenting and health care practices and their ramifications in relation to family stability:
23. Population Health Policy and Politics: Health Reform and the Uninsured (Worcester/ Boston)
Population of interest: Uninsured and underinsured in Massachusetts post health reform.
Learn about access to health care for the under- and uninsured by meeting with key state policymakers, state officials, advocates, health care providers, health insurers, and others involved in health reform implementation.
24. Refugee Mental and Physical Health (Worcester/ Boston)
Population of interest: Refugees
Better understand the health and socio-economic issues facing refugees and immigrants, their plight in their homeland and sometimes refugee camps, the migration process, and available services, unmet needs, and policy issues in the US.
25. Rural Health Scholars (Martha’s Vineyard)
Population of interest: For Rural Health Scholars only
26. Tick-Borne Illness (Carlisle)
Population of interest: Carlisle Residents and visitors and workers in town
The Carlisle Board of Health has noticed a disparity in treatment and outcomes among residents who have been diagnosed with a tick borne illness (Lyme disease and associated co-infections). The Board would like evidence based data on the incidence of tick borne illnesses in Carlisle and whether there is a real or perceived difference in outcomes.
27. Veterans’ Health (Worcester/Boston/Bedford)
Population of interest: Veterans
Learn more about the health impact of war – behavioral and physical health issues; the impact on veterans and their families; focus on the issue of homelessness
28. Worcester Department of Public Health: Population Served (Worcester)
Population of interest: Public Health in the city of Worcester, MA
Students and Community members will work through an assessment process and help define and prioritize possible areas of improvement. Emphasis will be on integrating social determinants of disease with measures of population health and projecting how this affects demand for services in the health care system.
29. Worcester’s Faces and Places: Family Health Center Worcester (Worcester)
Population of interest: Worcester’s medically underserved
Learn about the challenges of providing primary care to low-income patients and the resources which the community health center model can bring to bear.
You can access information about the 2011 Population Health Clerkship here.