Socially Accountable Medical Education: An Innovative Approach at Florida International University Herbert Wertheim College of Medicine

Abstract

Problem: Despite medical advances, health disparities persist, resulting in medicine's renewed emphasis on the social determinants of health and calls for reform in medical education.

Approach: The Green Family Foundation Neighborhood Health Education Learning Program (NeighborhoodHELP) at Herbert Wertheim College of Medicine provides a platform for the school's community-focused mission. NeighborhoodHELP emphasizes social accountability and interprofessional education while providing evidence-based, patient- and household-centered care. NeighborhoodHELP is a required, longitudinal service-learning outreach program in which each medical student is assigned a household in a medically underserved community. Students, teamed with learners from other professional schools, provide social and clinical services to their household for three years. Here the authors describe the program's engagement approach, logistics, and educational goals and structure.

Outcomes: During the first six years of NeighborhoodHELP (September 2010-August 2016), 1,470 interprofessional students conducted 7,452 visits to 848 households with, collectively, 2,252 members. From August 2012, when mobile health centers were added to the program, through August 2016, students saw a total of 1,021 household members through 7,207 mobile health center visits. Throughout this time, households received a variety of free health and social services (e.g., legal aid, tutoring). Compared with peers from other schools, graduating medical students reported more experience with clinical interprofessional education and health disparities. Surveyed residency program directors rated graduates highly for their cultural sensitivity, teamwork, and accountability.

Next steps: Faculty and administrators are focusing on social accountability curriculum integration, systems for assessing and tracking relevant educational and household outcomes, and policy analysis.

Figure 1

The Green Family Foundation Neighborhood Health Education Learning Program (NeighborhoodHELP) at Herbert Wertheim College of Medicine (HWCOM) at Florida International University (FIU). To facilitate a meaningful service–learning experience, classroom activities align with service to households and community partners, periodic reflection, assessment of impact, and the development of a service–learning portfolio. The figure reflects the longitudinal coordination of classroom learning, rounds, and reflection activities (top row) with iterative student household visitation activities (bottom row), across the four periods (loosely aligned with traditional academic years) of the medical school curriculum (columns). NeighborhoodHELP is integrated with the Medicine and Society curricular strand which comprises the following courses: Ethical Foundations of Medicine and Socio-economic and Cultural Aspects of Health (Period 1), the Community Engaged Physician I–III course series (Periods 2–4), and the Community Practicum (integrated through all periods). Student household visits, represented by the house, begin in Period 2 and initially focus on assessing health needs in the context of the social determinants of health and on developing a holistic care plan to address identified needs. Subsequently, student teams provide direct services to household members and assist them in navigating the health and social services systems, including services provided by the NeighborhoodHELP network of university and community partners. This process of assessment and service provision occurs iteratively.