The STFM Group on Community Medicine Educating the

The STFM Group on Community Medicine Educating the Reflective Community Oriented Practitioner Group on Community Medicine STFM Toronto, May 2004 Presenters: JL Benson, A Perkins, M Stearns, L Michener

Agenda § § History lesson: COPC lit & group on Comm Med activities Play with Allen’s website for curriculum (Perkins/group) § § § COPC & ACGME competencies (Stearns) Making trouble-are we really working with community? (Michener) Future plans-web & beyond (group)

What Is COPC? Four process steps § Identify the community of interest § Identify the health problem § Develop and implement interventions § Conduct ongoing evaluation

One Minute History of COPC § Will Pickles, MD kept diligent records of patient information in 7 rural villages in England “epidemiology in a country practice” 1939.

One Minute History of COPC § Sidney Kark, MD given team & developed “comprehensive, curative, and preventive service” named community oriented primary health care in South Africa, then Israel

One Minute History of COPC § U. S. “Community responsive initiatives” in 1950 s and 60’s for Native Americans, Kentucky rural areas

One Minute History of COPC § OEO mandates to eliminate poverty created funding for neighborhood health centers in 60’s. Geiger goes to Mississippi Mound Bayou in Mississippi delta, Gibson-Columbia point NHC

One Minute History of COPC § IOM 1982 study and 1987 Nutting book on COPC

One Minute History of COPC § APHA 1998 book “COPC Health Care for the 21 st Century”

One Minute History of COPC § Pathman & colleagues describe doctor training 1998

COPC Lit Review, 2001 on § § § Read “community-oriented primary care…. ” 2 part, Longlett, Kruse, Wesley, JABFP 2001. Update search: pub med/medline for “community oriented primary care, 2001 -2004 English only 200 found, only 169 unique and 79 not COPC 90 total COPC or close enough Where and what is being written?

COPC Lit Review, 2001 on § Where done or written? • § What is being described? • § Brazil, Bolivia, Peru, Finland, Netherlands, UK, S Africa, Russia, Saudi Arabia, Jerusalem, India, Canada…. . & DC to NC to CA to Dallas 3 types: service/care, policy, education Service/care: • Comprehensive care, seniors, leprosy, school based health, mental health, child health, oral care, pharmacy, hypertension, diabetes

COPC Lit Review, 2001 on § Policy, history, exhortations

COPC Lit Review, 2001 on § “Vague processes of client representation need to be replaced by robust community based participatory research models”(Cawston 2003)

COPC Lit Review, 2001 on § In 18 wealthy OEDC countries, “strong primary care system and practice characteristics such as geographic regulation, longitudinality, coordination, and community orientation were associated with improved population health” (Macinko 2003)

COPC Lit Review, 2001 on § Sustained community health partnerships display 5 key qualities, “outcomes-based advocacy, visionfocus balance, systems orientation, infrastructural development and community linkages” (Alexander JA 2003)

COPC Literature, 2001 -4 Education and curriculum § § Medical students, nurses, docs, community health workers, teams Longitudinal project work Short-term training, rotations In-service education

Group on Community Medicine Activities § § STFM group since 1990 • HRSA funding preferences inspired new FP curricula experiments Special session, STFM Chicago 1998 • Curriculum from 6 programs

Group on Community Medicine Activities § § § Pre-conference, STFM San Francisco, 2002 • “Art walk” of 18 programs presentations on • Field visit with community activists to environmentally-challenged SF community Plans for web-site to share curriculum Beginning electronic discussion forums • Funding, working with community

So What to Do Next? § Review Community Medicine Competencies • § Reconsider our community medicine work • § How do we make them real, sincere, notjust-a-checklist? What does it take to work sincerely with community? Decide on future community medicine activities, conversations