Medical students Nithya Setty, left, and Chong Wu describe results of their work on adolescent obesity at the Barre Family Health Center.
A destitute addict who can’t understand English, a fragile elderly person living alone terrified of taking another fall, or a poor obese child surrounded by adults eating fast foods: These scenarios illustrate some of the biggest obstacles to health that face community members, but also illuminate challenges that some physicians seldom address. School of Medicine and Graduate School of Nursing Graduate Entry Pathway (GEP) students get early hands-on experience confronting such problems through the Determinants of Health course and its accompanying Population Health Clerkship. Last week, those students presented the results of almost 30 team immersions through clerkships involving various community endeavors.
The students were almost universally optimistic and eager to discuss their community-based work. “These are challenging issues, but I feel with collaboration and input from the patients served we can play a major role in making a difference,” said second-year GEP student Peter Vecchiarelli.
Medical students in their second year and first-year GEP students are required to take the course. The nursing students can also continue their projects as part of their required “Societal Forces,” coursework. The students also have faculty and often community preceptors who provide valuable connections to local agencies. The clerkship has long been directed by Michael Godkin, PhD, professor of family medicine & community health.
This year, the students were placed into 27 teams that went to different locations across the state and covered issues that included children’s mental health, food insecurity, correctional health, fall prevention, refugee health and end-of-life care. “The students do not get many other opportunities to work as a team, and this helps them think about group dynamics and their role within a team,” said Dr. Godkin.
Most of the teams are interprofessional, with medical school and GEP students working together. “This is the only place in the official curriculum where students from the two schools are learning together,” said Heather-Lyn Haley, PhD, assistant professor of family medicine & community health and medicine, and a member of the clerkship planning group.
“The nursing students have a lot more clinical experience coming into this,” said medical student Aditi Ahlawat, who worked on Ghanaian women’s health in Worcester. “And the medical students are already well prepared to explain biomedical processes,” added her team member, nursing student Lindsey Comer.
“We consistently have students who respond enthusiastically to this program,” said Suzanne Cashman, ScD, professor of family medicine & community health and co-director of the Determinants of Health course with Jeroan Allison, MD, MS, professor of quantitative health sciences and medicine and vice chair of the Department of Quantitative Health Sciences. “Students often tell us that wanting to make a real difference in people’s health is why they came to medical school in the first place, and that they know that by working ‘upstream’ they can take care of problems before they happen, rather than treating them after the fact.”
Godkin added that the course also helps many of the students become more familiar with Worcester and the challenges of advocacy. “They have to connect the dots between social, economic, psychological, medical, personal and cultural issues and how that all impacts health,” he said.
Medical student Paavan Mehta was impressed by the other resources he was introduced to as his group worked on addiction among Worcester’s Latino community. “The police don’t just enforce the law,” he said. “They are also trying to help people get the help they need.” He was encouraged to see how hard community health workers, religious groups and politicians are working on these problems.
“It really opens your mind,” said Anna Zimmerman, a medical student who worked on an adolescent obesity program at the Barre Family Health Center. “For example, not everyone’s perception of what ‘being healthy’ means is the same.”
The one complaint students had was that they felt rushed by having so little time to work on these difficult problems. “In two weeks you sometimes feel like you’ve barely started before you have to leave,” said medical student Nithya Setty, who also did her clerkship at Barre. “But we left with a lot of great ideas and ready to do more.”
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