Education
Family Medicine Special Elective: “Care for the Underserved” -- Course Syllabus

INTRODUCTION

As recently reported by the Kaiser Family Foundation, over 40 million non-elderly individuals are uninsured. People of color, who now make up 33 percent of those under 65 years of age, comprise a little over half of the uninsured, in part because they are more likely to be in low income families. (Key Facts race, ethnicity and medical care, update June 2003) The report also showed that the percentage of individuals with no usual source of care is higher among people with incomes below the poverty level than among those with incomes above 200 percent of poverty.

This special elective is being created to provide medical students and residents an opportunity to gain experience in caring for underserved populations at well established community health centers. A majority of these clinics are located in inner city Indianapolis where a large number of working poor, minorities, and limited English proficiency people live.

A special focus for interested students will be on the status of Hispanic patients in Indianapolis. In recent local research, Barriers to Health Care faced by the Hispanic Community of Indianapolis (Sevilla, unpublished, 2003), 39% of the participants assessed their own health status as “fair”; 71% had no health insurance. Only 36% of the participants had had a comprehensive medical exam within the past year, but 39% had visited an ER. The most common barriers found were cost of service (52%), lack of insurance (44%), language (38%), fear of system (28%), transportation (8%), lack of knowledge of available services (5%), and other (4%).

The month long experience will emphasize high quality of care for underserved populations, cultural competence, and medical Spanish utilizing clinical experience in a full spectrum Family Medicine practice in a community health center setting.

Students will meet with the course director the first day of the elective course to be oriented, discuss objectives, schedules, assignments, and the evaluation process.

1. Quality of care for underserved populations and health disparities

Students will select a research project related to the care of underserved populations and/or Hispanic/Latino health issues. Students will be provided with key readings, such as Unequal Treatment (Institute of Medicine) and the Commonwealth Report, which discuss the role of race and ethnicity on quality of health care.

Clinical care will be provided at three different community health centers located in the inner city area of Indianapolis 3 days a week. During this time, students will have the opportunity to provide care for a very diverse population with large numbers of Hispanic/Latino recent immigrants with limited English proficiency (LEP) and no health coverage. Emphasis will be made on understanding socio-economic issues and how to make the most of the medical encounter when caring for underserved populations. Students will be encouraged to actively participate in the care process with appropriate follow up of selected cases.

Evaluation

Students will be evaluated on their clinical skills during patient care sessions. This will be determined by direct preceptor observation and discussion of select cases as part of a seminar discussion session.

2. Cultural competence

During the introduction, the course director will present lecture/discussion on cultural competence with emphasis on caring for the Hispanic community and provide and suggested reading materials. Ongoing discussions will be generated through the duration of the course.

Evaluation

Students will be evaluated on their cultural competence and interpersonal skills demonstrated during patient-physician interaction as assessed by patients, course director, nurses, medical assistants, office staff, and the students’ own analysis of his/her interaction with diverse patients.

3. Medical Spanish

During the introduction, Spanish materials will be distributed and reading materials will be suggested. One half day per week will be assigned to work on Spanish self study materials and write a selected medical encounter in Spanish.

Students will conduct medical encounters in Spanish (with available assistance by faculty as needed) and discuss diagnosis and management in Spanish as well.

Evaluation

Students will be evaluated on their ability to interview patients, demonstrating command of the Spanish language as assessed by course preceptor and the student’s own analysis of her/his ability to communicate in Spanish and progress made during the course. This will be attained by interviewing selected patients after encounters, direct observation by course director/preceptor and student written medical encounter in Spanish (best written encounters will be selected for a pool of examples of the most common problems seen in family medicine).

4. Research project

Evaluation

A final presentation of research topic related to underserved populations, health disparities, and/or Hispanic/Latino health issues on the last Thursday of the course. Students will be expected to present projects to their peers and faculty. Students who select Level 3 competency in communication will receive ratings by audience members of their presentation skills, and will be expected to write an additional self-analysis of communication and cross-cultural experiences for this additional competency credit.

Students may also choose to create a new health education material in Spanish, participate in planning a community health fair; deliver a Smoking cessation session or a chronic illness to community audiences in Spanish (i.e. Diabetes, Arthritis, Asthma).