Since 2004 the University of Rochester School of Medicine and Dentistry has required a one-month course for all fourth year medical students called the Community Health Improvement Course (CHIC), to focus on the practice of community health and preventive medicine. The purpose of CHIC is clear: to teach medical students that good health includes more than health care, and that prevention begins where patients live, work and play. The objectives for the CHIC course are derived from the AAMC Population Health Competencies for Medical Students[1], all of which are included in the APTR Clinical Prevention and Population Health Curriculum Framework.
The effectiveness of the newly revised CHIC curriculum was evaluated to measure success at three levels:
1. Is the course well received and delivered in a way that supports self-determination theory?
2. Does the course have a positive impact on the students’ career and appreciation for social determinants of health?
3. What impact does the students’ service learning have on the community health delivery system?
Students rated the overall quality of the CHIC course as good to very good (3.11 + 1.1 on a scale of 1=poor to 5=excellent) with highest ratings on the projects (4.0) and community sessions (3.9). Students confirmed that the course promoted self-determination theory and agreed that autonomy, relatedness and competency were evident during CHIC. Of the students who took the course this year, 80.5% were confident to extremely confident that their CHIC community projects will be impactful to the target community, and 45.5% stated that the course material is very or extremely likely to impact their future career as a physician. A qualitative assessment of students’ descriptive analysis identified three prominent themes including an increased knowledge of community health concepts, greater awareness of the social determinants of health and awareness of programs and resources. Students contributed a minimum of 8,000 community service hours in 21 community partner agencies and programs, 7 of which were added in 2015-6 evaluation year. Community partners list several examples of sustainable community health improvements initiated by CHIC medical students.
Reference:
[1] Maeshiro R, Johnson I, Koo D, Parboosingh J, Carney JK, Gesundheit N, Ho ET, Butler-Jones D, Donovan D, Finkelstein JA, Bennett NM, Shore B, McCurdy SA, Novick LE, Velarde LD, Dent MM, Banchoff A, Cohen L. Medical Education for a Healthier Population: Reflections on the Flexner Report From a Public Health Perspective. Acad Med. 2010; 85(2): p. 215.
The effectiveness of the newly revised CHIC curriculum was evaluated to measure success at three levels:
1. Is the course well received and delivered in a way that supports self-determination theory?
2. Does the course have a positive impact on the students’ career and appreciation for social determinants of health?
3. What impact does the students’ service learning have on the community health delivery system?
Students rated the overall quality of the CHIC course as good to very good (3.11 + 1.1 on a scale of 1=poor to 5=excellent) with highest ratings on the projects (4.0) and community sessions (3.9). Students confirmed that the course promoted self-determination theory and agreed that autonomy, relatedness and competency were evident during CHIC. Of the students who took the course this year, 80.5% were confident to extremely confident that their CHIC community projects will be impactful to the target community, and 45.5% stated that the course material is very or extremely likely to impact their future career as a physician. A qualitative assessment of students’ descriptive analysis identified three prominent themes including an increased knowledge of community health concepts, greater awareness of the social determinants of health and awareness of programs and resources. Students contributed a minimum of 8,000 community service hours in 21 community partner agencies and programs, 7 of which were added in 2015-6 evaluation year. Community partners list several examples of sustainable community health improvements initiated by CHIC medical students.
Reference:
[1] Maeshiro R, Johnson I, Koo D, Parboosingh J, Carney JK, Gesundheit N, Ho ET, Butler-Jones D, Donovan D, Finkelstein JA, Bennett NM, Shore B, McCurdy SA, Novick LE, Velarde LD, Dent MM, Banchoff A, Cohen L. Medical Education for a Healthier Population: Reflections on the Flexner Report From a Public Health Perspective. Acad Med. 2010; 85(2): p. 215.
impact
Strengthened ties with community partners through community health service learning. Each student is required during CHIC to complete at least 20-25 hours per week for four weeks with community partners. |
Community leaders report sustainable change in food delivery, Head Start, school recess observation, Boy Scout first aid training, homelessness, teen education and empowerment, cancer services outreach, etc. |
CURRENT ACTIVITY/PROJECT DESCRIPTION
The University of Rochester Medical Center (URMC) initiated the Community Health Improvement Clerkship in 2004 to focus on the practice of community health and preventive medicine[2]. Although changed to a course rather than a clerkship, the material remains as a required four-week module for all 100 fourth year medical students. The Community Health Improvement Course (CHIC) has undergone several modifications including flipping the classroom, adding on-line learning modules, webinars and videos, and clearly defining effective service-learning opportunities with community partners.
The CHIC is a prevention education program focusing on primary prevention and the social and environmental determinants of health. The course includes three learning components: didactic teaching, experiential learning, and a community health improvement project. The impetus for the evaluation project was to assess the many changes to the curriculum and to assure that CHIC 2.0 is still impactful and relevant to the current medical students.
The CHIC course remains mandatory for fourth year students. The URMC curriculum committee reviews courses in the medical curriculum at least every three years for quality improvement. Changes to CHIC will be sustained if they are effective and relevant to the students. Evaluation is necessary to review how the course material is received and to provide evidence to support inclusion in the curriculum.
Reference:
[2] McIntosh S, Block R, Kapsak G, Pearson T. Training Medical Students in Community Health: A Novel Required Fourth-Year Clerkship at the University of Rochester. Academic Medicine, Vol. 83, No. 4 / April 2008.
The CHIC is a prevention education program focusing on primary prevention and the social and environmental determinants of health. The course includes three learning components: didactic teaching, experiential learning, and a community health improvement project. The impetus for the evaluation project was to assess the many changes to the curriculum and to assure that CHIC 2.0 is still impactful and relevant to the current medical students.
The CHIC course remains mandatory for fourth year students. The URMC curriculum committee reviews courses in the medical curriculum at least every three years for quality improvement. Changes to CHIC will be sustained if they are effective and relevant to the students. Evaluation is necessary to review how the course material is received and to provide evidence to support inclusion in the curriculum.
Reference:
[2] McIntosh S, Block R, Kapsak G, Pearson T. Training Medical Students in Community Health: A Novel Required Fourth-Year Clerkship at the University of Rochester. Academic Medicine, Vol. 83, No. 4 / April 2008.
EVALUATION PROJECT ADDRESSES:
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PROFESSIONS/DISCIPLINES/SCHOOLS INVOLVED:
Fourth year medical students at the University of Rochester, School of Medicine |
ACADEMIC LEVELS TARGETED:
Other: Undergraduate Medical Students |
COURSE DESCRIPTION:
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PLACEMENT SITES FOR ANY SERVICE-LEARNING COMPONENTS:
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EVALUATION METHODS USED FOR THE SUBGRANT PROJECT:
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LESSONS/RESULTS/OUTCOMES
Evaluation Results:
The evaluation of CHIC has led to several results tied to the original questions:
1. Is the course well received and delivered in a way that supports self-determination theory?
The CHIC course was redesigned to promote self-determination theory by supporting its underlying tenants of autonomy, competency and relatedness. All analysis results indicate that the students were supported in these components and agreed that the course was impactful and relevant. Supporting self-determination theory should lead to behavior change over time, and the behavior change that is desired is a movement of the students towards a more psycho-social approach to medicine. The Ashford Physician’s Believe Scale was given to all students during the 2015-16 academic year pre- and post- CHIC. Results of this analysis are being completed.
The evaluation of CHIC has led to several results tied to the original questions:
1. Is the course well received and delivered in a way that supports self-determination theory?
The CHIC course was redesigned to promote self-determination theory by supporting its underlying tenants of autonomy, competency and relatedness. All analysis results indicate that the students were supported in these components and agreed that the course was impactful and relevant. Supporting self-determination theory should lead to behavior change over time, and the behavior change that is desired is a movement of the students towards a more psycho-social approach to medicine. The Ashford Physician’s Believe Scale was given to all students during the 2015-16 academic year pre- and post- CHIC. Results of this analysis are being completed.
2. Does the course have a positive impact on the students’ career and appreciation for social determinants of health?
When students in CHIC were asked how likely it is that the information learned will impact their future career as a physician, a very large majority (88%) indicated at least “somewhat likely” in response. A qualitative evaluation has been conducted on the narrative responses of students in support of this question. Several quotes were collected as part of this process, including:“I will use what I learned during CHIC to be more aware of the impact that social determinants of health have on my population. I believe it has already made me think differently about the way I counsel patients” MS ID57
“Learning about community health interventions in CHIC has been one of the most informative experiences in my four years of medical school… it gave me significant insight into ‘the patient experience’.” MS ID13
When all students were asked to choose three words to describe their CHIC experience with community health improvement, the five most common words chosen were ‘enlightening’, ‘eye-opening’, ‘frustrating’, ‘informative’, and ‘rewarding’.
When students in CHIC were asked how likely it is that the information learned will impact their future career as a physician, a very large majority (88%) indicated at least “somewhat likely” in response. A qualitative evaluation has been conducted on the narrative responses of students in support of this question. Several quotes were collected as part of this process, including:“I will use what I learned during CHIC to be more aware of the impact that social determinants of health have on my population. I believe it has already made me think differently about the way I counsel patients” MS ID57
“Learning about community health interventions in CHIC has been one of the most informative experiences in my four years of medical school… it gave me significant insight into ‘the patient experience’.” MS ID13
When all students were asked to choose three words to describe their CHIC experience with community health improvement, the five most common words chosen were ‘enlightening’, ‘eye-opening’, ‘frustrating’, ‘informative’, and ‘rewarding’.
3. What impact does the students’ service learning have on the community health delivery system?
Each student is required during CHIC to complete at least 20-25 hours per week for four weeks with community partners in community health service learning. Community partnerships were formalized during the evaluation process. Individual meetings were conducted with community partner leadership and overwhelmingly community partners were extremely satisfied with the work and process of CHIC students with minimal additional time and effort needed. There are several examples of sustainable change and impact that were listed by community leaders in food delivery, Head Start, school recess observation, Boy Scout first aid training, homelessness, teen education and empowerment, cancer services outreach, etc. Quantifying this impact is a focus of the 2016-17 academic year.
Each student is required during CHIC to complete at least 20-25 hours per week for four weeks with community partners in community health service learning. Community partnerships were formalized during the evaluation process. Individual meetings were conducted with community partner leadership and overwhelmingly community partners were extremely satisfied with the work and process of CHIC students with minimal additional time and effort needed. There are several examples of sustainable change and impact that were listed by community leaders in food delivery, Head Start, school recess observation, Boy Scout first aid training, homelessness, teen education and empowerment, cancer services outreach, etc. Quantifying this impact is a focus of the 2016-17 academic year.