Resident Community Engagement - University of …...Resident Community Engagement: Experiences at 3 Programs • Debra Gould, MD, MPH – Central Washington Family Medicine Residency

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Resident Community Engagement:

Experiences at 3 Programs •  Debra Gould, MD, MPH – Central Washington Family Medicine Residency •  Jacqueline Wong, MD – Swedish Family Medicine-Cherry Hill

•  Teresa Wallace, MD – Valley Family Medicine •  Patricia Stern, PhD – Valley Family Medicine

WWAMI Network Webinar | August 3, 2016

Yakima

Ellensburg

Debra A. Gould MD, MPH

Yakima 8,8,8

Ellensburg 2,2,2

Yakima Community: PopulaAon – 93K White – 52%; LaAno – 41% AI – 2% Child in poverty – 30% % GraduaAon – 72% Agriculture

Ellensburg Community: PopulaAon – 19K white – 86% LaAno – 9.7% AI – 1% Child in poverty – 19% % GraduaAon – 77% Agriculture/CWU

10, 10, 10

CHC

CollaboraAon with Public Health

R2 Community Medicine (Month Group Project)

Ambulatory Family Medicine RotaAon (Longitudinal RotaAon Experience)

DescripAon – A]end Needle Exchange Van •  Longitudinal •  Ambulatory Family Medicine Month – R2, R3 yrs. •  Two ½ days per rotaAon •  Wri]en Assignment -‐ (PC-‐3, SBP-‐3, SBP-‐4, PROF-‐1, C-‐3)


Community Gains •  I&D abscesses; vaccinaAons •  Compassionate Care (vs. ED) •  Educate Physicians about IVDU & Harm ReducAon Strategies


Community Gains •  I&D abscesses; vaccinaAons •  Compassionate Care (vs. ED) •  Educate Physicians about IVDU & Harm ReducAon Strategies

Barriers •  LocaAon – mobile unit •  SAgma

DescripAon •  Topic chosen in collaboraAon with

YHD (community liason) •  First month of R2 year •  Three ½ days per week •  DidacAc presentaAon -‐4th week -‐

(PC-‐3, SBP-‐3, PROF-‐2)



(PC-‐3, SBP-‐3, PROF-‐2)

Community Gains •  Help with a Community Project, surveys,

needs assessments •  Residents become more familiar with the

neighborhoods where paAents live •  PresentaAons to local government (city

council) -‐ influence



(PC-‐3, SBP-‐3, PROF-‐2)

Community Gains •  Help with a Community Project, surveys,

needs assessments •  Residents become more familiar with the

neighborhoods where paAents live •  PresentaAons to local government (city

council) -‐ influence

Barriers •  CoordinaAon with stakeholders •  Timing •  Clarifying expectaAons

Swedish Cherry Hill

Jacqueline Wong

Swedish Cherry Hill Family Medicine

u  Seattle, Washington

u  12/12/12

u  Multiple continuity clinics

u  Cherry Hill

u  Seattle Indian Health Board

u  Seamar

u  Carolyn Downs

u  International Community Health Services

Goals

u  Learn sociocultural aspects of patient care

u  Integrate into a community and participating in its organizations

u  Coordinate a community’s health resources in the care of patients

u  Identify and intervene in a community’s health problems

Community Medicine

u  Didactic learning in orientation

u  R-1 month long rotation

u  R-2 and R-3 longitudinal curriculum

Orientation

u  Walking tour of the community

u  Didactic lectures

R-1 Rotation

u  Shadowing experiences

u  Detox and treatment center for substance abuse

u  Methadone clinic

u  Legal clinic

u  Immigration and naturalization classes

u  Short term/crisis housing for adolescents

u  Direct service

u  Residential six month treatment center for pregnant and parenting women with chemical dependency

u  Needle exchange

u  Foodbank

u  Day center and transitional housing for homeless adolescents

u  Inpatient psychiatry

u  Independent study

u  Continuity clinic

Longitudinal curriculum – R2

u  Monthly workshops led by community organizer

u  Class project

u  Home visits

u  Relational meetings

Longitudinal curriculum – R3

u  Monthly meeting with community organizer

u  Relational meetings

Benefits to community

u  Residents and community learn about each other

u  Community organizations receive medical services on site

u  Residents channel energy towards actual community needs

u  Encourages residents to use their standing to work for change that benefits the community

u  On going projects allow momentum to build long term and sustain change

Barriers

u  High turnover rates in community organizations

u  Less flexible rotation within residency

u  Need for faculty to precept at community sites

u  Logistics of practicing medicine off site

u  Less flexibility for individual resident projects

u  Off hours relational meetings

Thank you!

Valley Family Medicine Renton, Washington

v  Teresa Wallace, M.D.

v  Patricia Stern, Ph.D.

Valley Family Medicine (VFM)

ì  VFM Residency is a community based 8-‐8-‐8 program

ì  Valley Medical Center is our ins=tu=onal host and we are a UW Medical affiliate

ì  Located in Renton, Washington ì  Puget Sound Region, 12 miles South of SeaJle, at the southern end of Lake

Washington ì  15 minutes East of Sea-‐Tac Interna=onal Airport

ì  Diverse pa=ent pop (SES, Country of Origin, Ethnicity, and Languages)

ì  Kent School District serves 150 different languages

ì  The United Na=ons / Interna=onal Rescue CommiJee designated South King County as a major refugee reloca=on center

VFM Patient Population

ì  In response to our changing community, we wanted to develop a system that would allow for physician learning while caring for our diverse pa=ent popula=on.

ì  We started a Refugee Medicine Clinic that is run by the second year class.

ì  Ini=al teaching is done in a 2 hour workshop at the end of their first year of residency.

ì  They are precepted during the clinic by the same faculty who teach the workshop.

ì  We are also developing a lecture series on immigrant/refugee health, that is given at noon =me.

VFM Refugee Clinic

Objectives

ì  Introduc=on to refugee/immigrant medicine.

ì  Overview of VOLAG reseJlement process.

ì  Understand SKCPHD evalua=on labs and behavioral health screening.

ì  Overview of immuniza=ons and screening tests for refugee pa=ents.

ì  Educate about common infec=ous diseases affec=ng pa=ents from refugee camps.

ì  Review behavioral health resources and screening.

VFM Refugee Intake Clinic


Goals

ì  Improve understanding of refugee immuniza=on and health screenings.

ì  Organize medical care for newly arrived refugees.

ì  Broaden our scope of medicine – become familiar with immigrant and interna=onal health.

ì  Cul=vate stronger ownership and rela=onships with our pa=ents from foreign countries.

ì  Decrease medical mistakes and negligence within a complicated medical popula=on.

ì  Enhance our cultural competencies.

ì  Take care of our community.



Summary

Challenges

ì  Variability of refugee arrivals

ì  Variability of VOLAG referrals

ì  Administra=ve =me to coordinate with VOLAGs

Strengths

ì  Increased competency in refugee health care

ì  Dedicated clinical =me to provide complex health care services

Contact: [email protected]


VFM Cultural Humility Workshop

ì  90 minute R1/R2 Workshop ì  Facilitated by Dan Herman, MD and Patricia Stern, Ph.D.

ì  Curriculum: Behavioral Science and Popula=on Health

ì  Residents are pre-‐assigned a specific cultural group to research ì  Given explicit instruc=ons to create a brief presenta=on

and highlight teaching pearls

ì  We feature a guest speaker from ‘World Relief’

ì  Each resident is given 7 minutes to present a cultural group

VFM Cultural Humility Workshop Instructions

Include the most surprising learning points that you discovered. Suggested components include:

1.  Map illustra=ng geographic context

2.  Recent poli=cal history contribu=ng to U.S. migra=on

3.  Na=ve languages and religious prac=ces

4.  Beliefs about health and illness

5.  Specific health risks & recommended screening tests

6.  Websites w/ translated pa=ent educa=on materials

VFM Cultural Humility Workshop Group Assignments

Each resident was assigned one of the following cultural groups:

ì  Ukrainian Refugees

ì  Burmese Refugees (Myanmar)

ì  Afghani Refugees

ì  Somali Refugees

ì  Iraqi Refugees

ì  Nepali Speaking Bhutanese Refugees

ì  American Samoa, Pacific Islanders

ì  Hearing Impaired Pa=ents

VFM Cultural Humility Workshop Resources

ì  Mul=lingual Screening Tools

ì  Mul=lingual Pa=ent Educa=on Materials

ì  Local Resources

ì  Refugee Informa=on

ì  Cultural Topics

ì  Language Tools and Addi=onal Pa=ent Educa=on Translated Materials

VFM Cultural Humility Workshop Summary

Challenges ì  Time constraints -‐ resident presenta=ons are limited to 7 minutes ì  Guard against reducing cultural groups to stereo-‐types ì  Variability of guest speakers ì  Year to year, resident presenters and topics must be tracked to

prevent duplica=on of experience ì  Website and resource informa=on requires frequent upda=ng

Strengths ì  Ac=ve learning format ì  Enhance resident and faculty knowledge of cultural groups and

resources ì  Enjoyable and well rated by residents

Contact: [email protected]

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Q&A •  Debra Gould, MD, MPH – Central Washington Family Medicine Residency

•  Jacqueline Wong, MD – Swedish Family Medicine-Cherry Hill

•  Teresa Wallace, MD – Valley Family Medicine

•  Patricia Stern, PhD – Valley Family Medicine

Resident Community Engagement - University of …...Resident Community Engagement: Experiences at 3 Programs • Debra Gould, MD, MPH – Central Washington Family Medicine Residency

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