At Lawrence FMR we recognize that high quality healthcare is only one component of a healthy community. Health leaders, particularly those committed to addressing health disparities and promoting health in vulnerable communities, must understand and be prepared to intervene upon the social and environmental determinants of health. As the first residency administered by a Federally Qualified Health Center and a leader in the teaching health center movement, we see our residents as leaders in a future where collaboration across sectors to improve community health will be the norm. The curriculum emphasizes experiential learning. Beginning during orientation and continuing throughout their training, residents leave the clinical setting to interact with public and private community health stakeholders in Lawrence. While recognizing the challenges facing Lawrence as a low-income, urban, immigrant community, we emphasize an asset-based approach to community health change. In Lawrence we are fortunate that a culture of collaboration for community health change has been built over many years, and LFMR and Greater Lawrence Family Health Center have been key stakeholders over the past 3 decades. Each new class of residents builds on that foundation when the pursue community health work outside of the clinic. We at LFMR consciously recognize the tremendous resources in terms of knowledge, skills, and passion that our residents bring as members of the Lawrence community. Our goal with the community medicine experience is to grow those resources by creating opportunities for residents to pursue and develop their non-clinical health related interests. We hope that by protecting time during all four years for residents to engage in community health work, we are able to nurture a spirit of solidarity with the community we serve and graduate family physicians who will spend a lifetime pursuing health justice in underserved communities. The Community Medicine curriculum has 5 major components: 1) Outpatient Clinical Experiences. Hands-on clinical and public health oriented experiences outside of our health center. 2) Class Conferences. Interactive and didactic learning experiences in social medicine, clinical care for vulnerable populations, and population approaches to health. 3) Community-Based Placements. Residents are paired with community based organizations or with a community project within the health center based on their interests and experiences. A longitudinal relationship allows for resident learning and collaboration in community health promotion. 4) Community Medicine Components of Areas of Concentration. Residents integrate community oriented education activities and patient-oriented health advocacy into their overall AOC experience. Our goal is to normalize these health-promoting activities of a community physician as resident progress through residency and transition to practice. 5) Area Health Education Center (AHEC) Youth Mentoring.
Integrated Experiences: Clinical experiences include those integrated into other outpatient blocks, including Tuberculosis clinic with the Department of Public Health and working at our health center’s school-based clinic during the Adolescent Health block. Residents participate in early intervention evaluations and Head Start assessments during Pediatric Development block. During the Addiction block, residents work with LFMR faculty at a local methadone clinic, and participate with group therapy for patients transitioning from the county correctional system. Community Medicine Longitudinal Experiences: A separate Community Medicine block includes core experiences in community health. Residents spend time with clinical social workers both in their own clinic, and doing street outreach to the most vulnerable in our city. Residents participate in local municipal public health functions such as food and housing inspections, as well as nutrition education at our local WIC (Women, Infant, and Children) offices. Residents attend meetings of the Lawrence Mayor’s Health Task Force (Massachusetts Dept of Public Health Community Health Network Area 11), where they have an opportunity to network with vibrant community of public health stakeholders. Elective Outpatient Experiences: A menu of optional experiences is also available during outpatient community medicine time. Residents may get a taste for other public health oriented work by experiences such as accompanying our public health nurse on DOT rounds with active TB cases, or spending a session in our hospital’s occupational health clinic. Other residents have chosen to spend elective clinical time pursuing more intensive experiences focusing on vulnerable populations such as with our own 13 site Healthcare for the Homeless program, training in refugee healthcare and assessments, and special training in transgender care.
Conferences are targeted at the learning needs of residents as they progress through the four year curriculum. Initially, the focus is on patient care for vulnerable populations, and taking advantage of community resources in working with individual patients. Community medicine is also integrated with more traditional teaching in afternoon symposia that address such issues as intrapersonal violence, education, and asthma. As residents progress through the four years, the focus broadens to look more at population-based approaches within the clinic and in the community. Residents learn how to access, collect, and use population health information.
Residents are paired with one of a number of partner organizations and initiatives that are related to community health and active in the Lawrence community. Residents become experts in their area of community partnership, and develop connections and outside of the clinic. During outpatient blocks throughout each of their 4 years, residents are given half day sessions to spend with their community partners. The resident is expected to learn about the health promoting assets that exist in Lawrence in their area of community placement, and share that knowledge with other residents and clinicians. Quality improvement, research projects, grant proposals, new programs, and even new municipal legislation have evolved from community partnerships. Below are examples of partner organizations and areas of focus:
|Groundwork Lawrence||Healthy food and green space/environmental health|
|Greater Lawrence Community Action Council||Head Start health committee, WIC nutrition, lead program|
|Habit Opco||Addiction Services, methadone|
|Lawrence Youth Team||Youth violence prevention|
|Lawrence Public Schools||Science education, school health, teen pregnancy prevention|
|Merrimack Valley YMCA||Community-based promotion of physical activity. Support for LGBT youth|
|YWCA of Greater Lawrence||Women’s health disparities, support of victims of domestic and sexual violence|
|Lawrence Community Works||Economic development, housing, promotion of social networks|
|Health Quarters||Sexual and reproductive health|
|GLFHC Prevention and Education Department||Engaging homeless and substance using populations in care, harm reduction|
|City of Lawrence Board of Health||Participate in Board of Health meetings, contribute background research, draft new public health ordinances|
Each resident’s Area of Concentration includes a community medicine component, with required elements of community health advocacy and community based education. Building on their own knowledge and the networks of the faculty, residents engage in advocacy activity that will promote the health of our community. This can take the form of writing a letter to the editor, calling members of congress, or taking a leadership role in national advocacy organizations. We think advocacy is an integral skill for working with the underserved, and most residents come to Lawrence having been involved in health advocacy. By carving out time and creating a structure to engage in advocacy during residency, we support residents in continuing this vital work in their careers. The community education experience within the AOCs also gives residents mentored experience in culturally appropriate and effective communication. Through this experience, residents practice their communication skills, while improving the collective health knowledge of the community we serve. The experience also allows our residency to enrich the programmatic offerings of our partner organizations by making more available the expertise of our resident physicians and faculty. We hope the end results are better prepared family physicians and a more informed and empowered population.