UNMSOM

University of New Mexico School of Medicine
Poverty & Health Curriculum
Content Manager: Brenda Proffitt, MHA

CURRICULUM PLAN

CURRICULUM DEVELOPMENT: GENERAL PRINCIPLES & RESOURCES

University of New Mexico School of Medicine Teacher & Educational Development

University of New Mexico School of Medicine

Cynthia Arndell, MD, Core Design Team Leader

The University of New Mexico School of Medicine poverty and health curriculum is based on Curriculum Development Guidelines from Creating Significant Learning Experiences: An Integrated Approach to Designing College Courses by L. Dee Fink (San Francisco, CA: Jossey-Bass, 2003). In addition, Curriculum Development Resources developed by the University of New Mexico School of Medicine were employed during the curriculum development.

CURRICULUM DESIGN TEAM
Cynthia Arndell, MD; Julie Sierra, MD; Matias Vega, MD; Mary Ellen Gonzalez, MSW; Tina Carlson, APRN, BC; Deana Richter, MA; and medical students Andrea King and Katherine Flynn-O'Brien

OVERARCHING GOAL OF UNM's POVERTY & HEALTH
CURRICULUM DEVELOPMENT PROJECT
To design, integrate and implement a four-year poverty and health curriculum that will prepare tomorrow’s clinicians to effectively address the profound impact of poverty on individual and population health, resulting in advocacy for patients and system change, skills working in transdisciplinary care teams, and enhanced sensitivity to and care of patients experiencing poverty.

STATEMENT OF NEED FOR A POVERTY & HEALTH CURRICULUM
Poverty and social inequity may be the most important determinants of ill health worldwide.[1,2] Over 37 million people in the United States live below the federal poverty level.[3] We as healthcare providers have a social responsibility to address poverty and its deleterious effects on individual and population health. Physicians and other healthcare providers can be a strong influence in reducing healthcare disparities as a result of poverty through our roles as clinicians, educators, researchers, and participants in policymaking.

Unfortunately, there exists a shortage of primary care physicians in underserved communities in the United States.[4] Exposing physicians early in their medical school training to the complex healthcare needs of the underserved has been found to positively impact their attitudes and abilities toward addressing these inequities.[5] Furthermore, long-term education programs designed to train medical students in meeting the needs of the impoverished have been found to influence their intentions to practice in underserved communities.[4,6]

Few programs exist in academic institutions across the nation to enable medical students to study, develop and implement solutions to the healthcare barriers that many of our indigent patients encounter.[7] The Poverty and Health Curriculum being developed and integrated at the University of New Mexico School of Medicine is intended to provide the education that will prepare future clinicians to address these needs. The curriculum is designed to be a four-year, integrated program that has a longitudinal progression such that learning outcomes build upon each other as students progress from one year to the next.

REFERENCES

Phipps, Shelly. The impact of Poverty on Health: A Scan of Research Literature. Canadian Institute for Health Information.
McCally, M., Haines, A., et al. (1998). Poverty and Ill Health: Physicians Can, and Should, Make a Difference. Annals of Internal Medicine 129: 726-733.
U.S. Census Bureau. Income, Poverty, and Health Insurance Coverage in the United States.
Ko, M., et al. (2005). Impact of the University of California, Los Angeles/Charles R. Drew University Medical Education Program on Medical Students’ Intentions to Practice in Underserved areas. Academic Medicine 80(9): 803-808.
Furin, J., et al. (2006). A Novel Training Model to Address Health Problems in Poor and Underserved Populations. Journal of Health Care for the Poor and Underserved 17(1): 17-24.
McDougle, L. (2006). Matching Community Need with Physician Training: The OSU Urban Family Medicine Program. Journal of the National Medical Association 98(5): 687-689.
Doran, K.M., Kirley, K., Barnosky, A.R., et al. Developing a Novel Poverty in Healthcare Curriculum for Medical Students at the University of Michigan Medical School. Academic Medicine: Journal of the Association of American Medical Colleges; 2008 January; vol 83 (issue 1): pp 5-13

ACKNOWLEDGMENTS
It took a village to develop this curriculum, and it would not have been possible without the support, participation, collaboration, and generosity of many people. With special thanks to the Health Care for the Homeless Clinicians’ Network Poverty & Health Advisory Committee members for their enthusiasm and thoughtful, generous feedback, and for bringing their years of experience in caring for impoverished people to the review process:

Jan Caughlan, LCSW-C; Wayne Centrone, NMD, MPH; Bernie Creaven, MN, RN;
Joseph Kiesler, MD; Ken Kraybill, MSW; Elizabeth Ryan, EdD;
Pia Valvassori, PhD, ARNP; Barbara Wismer, MD, MPH
And to Brenda Proffitt, MHA, for her unflagging support championing our curriculum.

We particularly want to acknowledge the inspiration and support of these vital University of New Mexico School of Medicine colleagues during the development of this curriculum:

Teresa Anderson, MD, Assistant Professor, Department of Pediatrics; George Comerci, MD, Associate Professor, Internal Medicine; Ellen Cosgrove, MD, FACP, Senior Associate Dean of Medical Education; Craig Timm, MD, Associate Dean, Undergraduate Medical Education; William Wiese, MD, MPH, Director, Institute for Public Health; and Arthur Kaufman, MD, Vice President, Community Health, and Chair, Department of Family & Community Medicine.
There are no words to adequately thank them.

Special thanks go to Ellen Beck, MD, Associate Physician, Family & Preventive Medicine, University of California at San Diego School of Medicine, who shares our common vision. Dr. Beck co-founded three UCSD Student-Run Free Clinics in the San Diego community that provide services to homeless and indigent people, and created a fellowship in Underserved Medicine at UCSD.

Finally, to our colleague, Robert Leverence, MD, Chief, Division of General Internal Medicine, we owe a debt of gratitude for allowing us the time needed to bring the curriculum to fruition. Dr. Leverence has been integral to the success of this project, and this curriculum is a tribute to him.

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