Abstract:

The practice of caring for the pediatric patient is no longer limited to the clinic setting. The Flint water crisis, childhood obesity epidemic, and outbreaks of vaccine-preventable illnesses in the United States have illustrated the need for a physician-community partnership and physicians adept at working within the community, government, and media to affect change.

Pediatricians are called upon to navigate an increasingly complex health care system and the community in order to provide and promote culturally and evidence based patient-centered care. Despite the recognized need for physicians to possess the skills and interest in community pediatrics, fewer and fewer pediatricians actively participate in the community with less than 40% with any involvement in community projects in 2004.

The American College of Graduate Medical Education (ACGME) requires training programs to provide instruction in community pediatrics and advocacy but the specific format and content have been relatively undefined. A wide variation of educational formats can be found in the resident training programs from unstructured community visits to longitudinal resident projects usually over a 4 week period. It remains difficult to impart the amount of information over a discrete rotation timeframe needed to produce physicians with advanced training in community pediatrics and advocacy.

The creation of individualized training pathways (ITP) have provided an opportunity for programs to develop a longitudinal curriculum over a 2-3 year period to address the need for a skillset in advocacy training, community assessment and partnership building, cultural awareness in healthcare, and media training. There are no current ITP for advocacy in pediatric residency.

The University of Missouri program has developed a 2 year longitudinal curriculum for selected resident physicians incorporating 12 weeks of rotation-based training in addition to 4 hours of protected time per week. There are 2 faculty members who serve as mentors and facilitators for the track.

Curriculum content includes: social determinants of health, physical determinants of health, health care disparities, adverse childhood experiences, cultural self-awareness, cultural health practices, patient-centered communication skills, community assessment skills, community partnership creation, and role of physician-advocate in the community and government, legislative advocacy, media training and communication skills.

The educational sessions are multi-modal with interactive activities including community walking tours, food stamp challenges, PBS and Health People 2020 website and documentaries, cultural immersion and self-reflection, engagement with local media and the state and local government. The residents will also serve on the leadership teams for the planning and implementation of our state government advocacy day and our intra-agency community partnership dedicated to immigrant and refugee health developed by our pediatrics program.

Assessment types: performance on simulated cases, self-reflection narratives, development of teaching tools for peers, creation of written communication toolkit for state legislators and local media outlets.

We plan to perform a mixed methods study using periodic data sampling at 6 months, 12 months, 24 months, and 3 years to determine long and short term acquisition of skills and long term involvement in community pediatrics and advocacy.

Keywords:

Medical Education, Individual Training Pathway, Community Pediatrics, Advocacy.