Community Medicine

• Rotation Information

• Goals and Objectives

Rotation Information (back to top)

Faculty:     Maureen Brown, M.D.

According to the Residency Review Committee (RRC) of the ACGME, community medicine curricula must teach residents to "assess and understand the important health needs of the community in which they work." The RRC requires instruction and clinical experiences in:

• Occupational medicine, including disability assessment, employee health, and job-related injury and illness
• Community health resources that may be utilized in the care of patients and their families, including school health services and public health (including environmental health) services
• Disease prevention/health promotion, including appropriate strategies and behaviors such as immunizations and healthful lifestyle changes that will protect children, adults, and families from illness or injury.

While the RRC defines community medicine only in terms of the public and preventive health skills outlined above, Swedish Family Medicine believes that it is important for family physicians to recognize the influential role they can and do play in their communities and therefore to develop the broader skills necessary for serving as effective leaders and advocates for the public health. This belief draws on the long tradition in family medicine of social activism and advocacy for our patients and communities. As we prepare physicians for the 21^st century, it is important to consider what are the appropriate and/or ideal roles of the family physician in our communities.

The Community Medicine rotation is an opportunity for residents to step outside the office setting and investigate what they can accomplish when applying principles of public health, population-based medicine, and advocacy to the broader health problems facing their patients. The curriculum is designed to empower residents to be agents for change in their communities, states, and the larger health care system. During their training, residents will cover the RRC requirements, and will also develop critical thinking and advocacy skills essential for serving as community leaders on issues of community health.

• Two full days in a busy occupational medicine clinic in Tacoma.  The resident should call Dr. Kirk Harmon as soon as possible to set up the two days.  Learning objectives include a better understanding of the L&I system and workman's  compensation (including paperwork), an introduction to the spectrum of occupational illnesses and injuries, a  better understanding of how to approach determining whether and when an injured or ill worker can return to work, as well as when a patient should be referred to an occupational medicine specialist for help in making these determinations.  Dr. Kirk Harmon can be contacted at: 253-274-5521.
• Half day spent with Heather Barr, a public health nurse from the Health Care of the Homeless project.  She will take you on a fascinating tour of notorious downtown service sites.  Heather Barr can be contacted at:  206-296-4656.
• A set of seven questions will be sent to the resident by e-mail on the first day of the rotation.  The questions will be covering a wide range of community medicine topics that can come up in your office practice on any given day.  You will need to research these and write up short answers. Some can be done by using internet resources.  Others may be best handled by talking to local public health department experts.  These should be completed by the end of the rotation.
• Attend the monthly Board of Health meeting in Seattle.  You can find out when and where this is happening on the website: http://www.metrokc.gov/health/boh/.  Typically, the meeting is the third Friday of each month.
• Attend a second meeting of your choice, where issues of some relevance to public health are being addressed.  These meetings can also serve as forums for addressing such issues in the future.  Examples include School Board, city council, local neighborhood council, etc.  
• Brief (5-10 minute) presentation,  to be given at the first community medicine didactic following completion of the community medicine block.  This should take the form of an argument or presentation designed to convince a designated agency or organization to change policy regarding a public health issue of your choosing.  Imagine, for example, that you are asking the Board of Health to allow private physician offices to prescribe methadone to heroin addicts, asking the school board to take pop machines out of the schools, or perhaps asking your community organization to try to keep a McDonald's from going up next door to the junior high school.  This exercise is designed to help you polish your skills at lobbying or advocating for issues that your believe are of public health significance.  The presentation to the group also gives you a chance to educate your colleagues about that issue.  Two websites that might be useful include:                                               http://ctb.lsi.ukans.edu/tools/EN/sub_section_main_1248.htm             http://www.ieeeusa.org/forum/guide/index.html
• Meet with the community medicine faculty chair weekly, in person or by phone, to discuss the questions you are working on or to talk about community medicine issues of current interest and importance.  Please set those meetings up at the beginning of the block.
• Please see the reading list for the community medicine resources.  Our expectation is that you check out each one and become familiar with them as possible resources to refer to later as needed.  The Public Heath Department's website has a lot of interesting and useful information: http://www.metrokc.gov/health/datawatch/index.htm

• Presentation skills training
• Media skills training
• Lobbying training
• Didactic lectures on various community medicine topics throughout the academic year
• Ongoing training at the resident’s continuity clinic in preventive medicine, health promotion, disability evaluation, and utilization of community resources

• Faculty review of case-based problems
• Report on public health or community meeting attendance
• Media presentation (article, press release, interview preparation, etc.)
• Report on advocacy activity (meeting or other communication with public official, testimony at a hearing, etc.)

Residents are required to contact the Community Medicine Faculty Advisor, Dr. Maureen Brown, at least two weeks in advance of starting their rotation. Dr. Brown will inform the resident about required meetings and scheduling of activities and tutorials, and will provide resident with a packet of materials for the rotation.

Please contact the curriculum faculty chair if you have any questions about this rotation, or if you are running into problems.  There is quite a lot of time that is unscheduled.  Please try to use this time to work on the questions and on your presentation.  Your feedback at the end of the month on what was worthwhile and what was not, will be much appreciated!

During the Community Medicine rotation (R2 year), residents will be in their continuity clinics a maximum of 4 half-days per week, and will attend didactics on Tuesday afternoons. Community Medicine activities will be scheduled with Dr. Brown in advance of and during the rotation

Goals and Objectives (back to top)

• To develop the skills necessary to conduct occupational, environmental, and population-based health assessments;
• To foster an awareness of and appreciation for the many local public and private organizations working toward a common goal of improving the health of the community;
• To broaden residents’ perspectives regarding the impact of public health, preventive health, and legislative measures on their patients’ health and well being;
• To develop the leadership skills, organizational abilities, and communication skills essential to serving as an effective voice for our communities outside the doctor-patient relationship.

• Identify, research and problem solve 10 issues related to public health, preventive health, and health advocacy;
• Identify and utilize key informational resources for public and community health;
• Define and identify the major components of public health (including occupational health, environmental health, school health, public safety, housing policy, transportation) and population health (including communicable diseases, prevention, and epidemiology);
• Conduct occupational medicine assessments, including disability, employee health, and job-related injury and illness evaluations;
• List community health resources that may be utilized in the care of patients and their families, including school health services and public health services;
• Discuss disease prevention/health promotion, including appropriate strategies and behaviors such as immunizations and healthful lifestyle changes that will protect children, adults, and families from illness or injury;
• Prepare and deliver an effective presentation for use in settings such as Board of Public Health meetings, legislative hearings, community meetings, and other public forums;
• Interface effectively with various types of media, including newspaper, radio and television;
• Serve on the board of a community organization.