There’s a timeless rule in real estate: Location, location, location. Maybe not surprisingly, public health has an analogue: Community, community, community, which is an emphasis of some medical education.

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Following are highlights from “Community Health in Action: The A.T. Still University’s School of Osteopathic Medicine in Arizona,” Chapter 10 of Value-Added Roles for Medical Students, which explores real-world examples of successful student-led community-oriented primary care projects.

Value-Added Roles for Medical Students is part of the AMA MedEd Innovation Series, which provides practical guidance for local implementation of the education innovations tested and refined by the AMA Accelerating Change in Medical Education Consortium. In addition to presenting case studies, the textbook lays out the historical background and conceptual foundations that underpin roles for medical students that add value to the health system as well as their education.

When A.T. Still University (ATSU) established its School of Osteopathic Medicine in Arizona (SOMA), in 2007, it forged a partnership with the National Association of Community Health Centers through which students are embedded full time in community health centers for the second, third and fourth years of their undergraduate medical education. By 2020, ATSU-SOMA had 15 partner sites in 11 states.

“By working and living in these settings, ATSU-SOMA students develop an authentic perspective regarding the challenges patients experience when trying to access care,” wrote the authors, Joy H. Lewis, DO, PhD, professor of medicine and public health, and Kate Whelihan, MPH, instructor of public health at ATSU-SOMA. The challenges may be financial, linguistic, cultural, geographic or mobility-related.

“Thus, they learn how to actively contribute to improving the health outcomes of vulnerable individuals and populations,” they wrote.

Learn more with the AMA about how value-added roles can transform medical education.

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To get a better understanding of population health, all second-year ATSU-SOMA students participate in a yearlong course sequence in epidemiology, biostatistics and preventive medicine.

Simultaneously, they work with health-center leaders, community members and other stakeholders to develop, implement and evaluate primary care projects that address social determinants of health.

Community-oriented primary care projects represent “an ideal structure for medical students,” the authors wrote, noting that students use their early medical knowledge and various life skills to provide services and programs that meet local needs.

The community-oriented primary care “projects serve as experiential learning opportunities,” they added. “These allow students to become familiar with community health, research methods, program development and evaluation.”

Students work in groups and are taught to follow all the steps required of any investigator, including conducting needs assessments, performing literature reviews, developing detailed project proposals and submitting their projects for human subjects review.

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Projects have addressed unintended pregnancy, adverse childhood experiences, poor connections to community resources and the physical and mental well-being of refugees.

“The vast majority of students rate their experiences with the projects as favorable,” the authors wrote. “Students have consistently expressed that they understand the value of the community project as a learning experience and as a way of giving back to their CHC community.”

The chapter includes a readiness assessment checklist for partner sites and a summary of the toolkit used by students and faculty to implement the projects, as well as key advice for feasibility and sustainability.

Value-Added Roles for Medical Students features case studies of additional longitudinal experiences, as well as guidance for planning, launching, sustaining and growing value-added roles.

In addition, in 2020 the AMA released the second edition of the Health Systems Science textbook. A companion, Health Systems Science Review, provides case-based questions followed by discussions of answers and suggested readings.

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