Involvement of Family and Community Medicine Professionals in Community Projects

,

Original Research

Involvement of Family and Community Medicine Professionals in Community Projects

J Fam Pract. 2002 April;51(4):1

By

Barbra Beck, PhD

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References

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ABSTRACT

OBJECTIVES: Medical schools are being challenged to continue their excellence in education, research, and patient care while responding to the health needs of the public. The objective of our study was to determine the nature and type of community involvement of professionals in departments of family and community medicine.

STUDY DESIGN: We mailed a 24-item structured survey to a random national sample of family medicine professionals.

POPULATION: Survey recipients included 770 full-time physician and nonphysician active members of the Society of Teachers of Family Medicine.

OUTCOMES MEASURED: Our survey assessed community activities, challenges and incentives to those activities, and desired resources for working in the community.

RESULTS: A total of 446 usable surveys were returned (58% response rate). Ninety-five percent of respondents had participated in a community activity within the previous year. More male respondents precepted medical students or residents and educated faculty on topics regarding community education; more older respondents participated by sitting on community health boards or councils. Insufficient release time and lack of funding were the 2 most frequently cited barriers to community-based activities.

CONCLUSIONS: Most faculty are involved in community-related teaching and service. Reasons for low levels of research and subgroup differences, especially among women and young faculty, merit further research.

For more than 50 years academic medicine has held a privileged position in American society. Medical schools receive significant state and federal support from a variety of sources, including the National Institutes of Health, Public Health Services programs specifically developed to support medical education, the National Science Foundation, Medicare, and Medicaid.^1-4 In return, academic medical centers have provided training to medical students and residents and have made significant contributions to medical research and clinical care.^1,3 Recently, however, concern has been voiced about whether academic health centers have fulfilled important components of their tacit social contract with the American public, caused in part by changes in medical education financing, trends toward a competition model of health care delivery, and the erosion of trust between health care providers and patients.^1,3,5-8

Foreman⁹ suggested changes to medical school education that would help academic health centers fulfill their reciprocal social obligation to improve the public’s health. His recommendations included integrating behavioral and population-based sciences, providing students with learning experiences in community settings where they have the opportunity to work with committed mentors, and developing a critical mass of community-based faculty who are dedicated to addressing the various needs of underserved communities and providing them with the necessary support to continue their community-based efforts. Some academic health centers, including the University of New Mexico School of Medicine, The Johns Hopkins University School of Medicine, the University of Washington School of Medicine, and the Medical College of Pennsylvania/Hahnemann School of Medicine in Philadelphia have begun to implement some of Foreman’s suggestions to strengthen social responsiveness.^3,10-12

Within academic medical centers, departments of family medicine have pioneered placing medical students in community-based settings. Of the 124 medical schools that participated in the annual Liaison Committee on Medical Education survey in 1996, 69% of family practice clerkships had a community-based placement, compared with 40% for internal medicine and 25% for pediatric clerkships.¹³

Family practice residency programs have also striven to respond to the needs of their surrounding communities. In 1999 the Strategic Planning Working Group of the Academic Family Medicine Organization and the Association of Family Practice Residency Directors developed the following list of competencies for family practice residents to acquire during training: (1) family practice residents should understand Community-Oriented Primary Care (COPC) and the practice of population-based medicine; (2) family practice residencies should model COPC or population-based interventions within their practices; and (3) family practice graduates should be capable of recognizing community health needs, developing interventions, and assessing the outcomes.¹⁴ Several family practice residency programs, such as the one at Montefiore Medical Center in New York City have worked to address their communities’ concerns by implementing COPC.¹⁵

Less information is available on the involvement in community activities of individual family medicine professionals, which include faculty medical doctors (MDs), nonfaculty MDs, doctors of philosophy (PhDs), and master’s degree-prepared department members. The objective of our study was to determine the nature and type of community involvement of professionals in departments of family medicine. We also assessed community activities, challenges and incentives to those activities, and desired resources for working in the community. Insights into these topics increase our understanding of how personnel in academic health centers are attempting to meet the challenge of responding to the health care needs of their surrounding communities while they maintain a commitment to the traditional missions of education, research, and clinical service.