Clerkship Program - Meeting the Challenges of Caring for the Underserved

This curriculum is designed to help third year medical students explore issues involved in securing access to medical care and community resources for families in medically underserved communities. We hope students who complete this mini curriculum will better appreciate some of the economic and cultural barriers which exist for underserved families and develop a broader view of families and their connections to resources in the community. We also hope to give students more training and practice working with a medical interpreter and a greater understanding of the federal WIC program and Wisconsin's Badger Care Program.

This curriculum consists of some short readings, video case presentations and a sample interview, as well as an independent project by each student with an underserved family. The project is designed to foster the use of interviewing skills and to learn to access community resources to achieve one mutually agreed upon health care goal for the underserved family.

We hope you will find the information and experiences in this curriculum make an impact on the care you provide and the relationships you foster with your patients.

Learning Objectives

This project is a required part of your pediatrics rotation.
It is highly recommended that the entire web curriculum be completed in the first two weeks of your rotation, so that sufficient time remains for your project.
The curriculum is designed to be completed in order. The lessons are presented in sequence and all activities should be done before moving on to the next lesson.

Curriculum Overview
Lesson	Learning Objectives	Activity
Introduction	Understand the purpose of the unit Become familiar with the case study used in the unit	Required Viewing Introduction to Curriculum Introduction to the Gonzales Family Meet the family that you will follow throughout the unit.
Understanding what it means to be "underserved"	Define what it means to be underserved. Describe the importance of access as a determinant of health. Identify common barriers to health for underserved families.	Required Reading Population Statistics to learn about the impact of lack of insurance on health care for children Andrulis D. Access to Care is the Centerpiece in the Elimination of Socioeconomic Disparities in Health. Ann Int Med. 1998; 129:412-6. Optional Reading Aronson R. Transforming MCH to Enhance the Health and Safety of Children, Families, and Communities in Wisconsin. WMJ. 2000:18-24
Underserved status and health outcomes	Identify common barriers to health for underserved families. Describe the role and responsibility of physicians in linking children and families with community resources.	Required Reading Evans Model to learn about the many factors that influence health For a viewpoint on what the physician's role should be, read: Morris S. Who Will Care for the Uninsured in a Managed Care World? Arch Otolaryn-Head and Neck Surgery. 2000; 126:290-2. Complete Activity on Factors of Underserved to check your understanding
Screening for underserved status	List I CARE	Required Reading I CARE handout to find out how to screen for underserved status. Required Viewing Gonzales Family Interview See how I CARE questions are used with a family.
Use interpreter services	Describe how to utilize interpreter services effectively.	Required Reading Working Effectively with an Interpreter for some additional guidance Required Viewing Working with Interpreters Guidelines on how to effectively employ their services. Gonzales Family with the Interpreter See how the guidelines might be applied. Optional Reading Flores G. Laws MB. Mayo SJ. Zuckerman B. Abreu M. Medina L. Hardt EJ. Errors in Medical Interpretation and Their Potential Clinical Consequences in Pediatric Encounters [Journal Article] Pediatrics. 111(1):6-14, 2003 Jan.
Set mutual goals	Identify and prioritize through interview, obstacles that may be overcome through community resources.	Required Viewing Setting Goals See how to handle families with multiple underserved issues. Gonzales Family Setting Goals See an example of prioritization.
Link with community resources	Identify potential resources for underserved patients and the services provided by those resources. Describe the eligibility criteria and services offered by WIC and BadgerCare. Facilitate the child/family's access to appropriate services.	Required Reading WIC BadgerCare Medicaid Covering Kids Required Viewing Gonzales Family Resources See what resources are used to address their needs. Complete Activity on Identifying Resources to gain practice on matching resources with needs
Follow up with the family	Describe strategies for following-up with underserved families	Required Reading Overcoming Obstacles to Follow-up for some creative strategies for maintaining contact with underserved families Required Viewing Gonzales Family Follow-up See an illustration of a follow-up strategy.
The Project	Apply the concepts you have learned to an actual case	Required Reading Safety and Ethics Required Viewing Project Instructions Student Projects Hear students talk about their projects. Student Project Advice Complete Review Past Student Projects to see examples of project write-ups. I CARE Formatted Examples I - Bike Helmets ARE - Employment E - Parental Stress Unformatted Student Projects Shelter, Food, Medical Care, and Transportation Swimming Lessons Community Project Worksheet Part 1 Worksheet Part 2
Conclusion and Unit Evaluation		Required Viewing Instructor Conclusion Complete Feedback on Curriculum to give us your opinion of this unit

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Clerkship Program - Meeting the Challenges of Caring for the Underserved

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