Johns Hopkins Develops Curriculum for General Internal Medicine Residents that Focuses on Health Problems of Underserved Communities

Implementing and evaluating a population/community-oriented primary care curriculum for internal medicine residents

From 1999 to 2001, researchers at the Johns Hopkins Medical Institutions/Johns Hopkins Bayview Medical Center, Baltimore, implemented and evaluated a curriculum it had developed for population/community-oriented primary care.

Many people in underserved communities do not seek health care. Johns Hopkins' purpose in creating the curriculum was to provide primary care services to these people, while at the same time making systematic efforts to identify and address their communities' health problems, using methods of clinical medicine, epidemiology, social sciences and health services research and evaluation.

This was the first published community-oriented primary care curriculum intended for general internal medicine residents (second and third year), rather than family medicine residents.

The curriculum encompassed eight sequential modules. In addition to a three-hour class, each module contained a three-hour work session devoted to specific project assignments to enable general internal medicine residents to develop key knowledge, attitudes and skills in community-oriented primary care by participating in real-life community projects.

Key Results

Among the initial projects were:

  • Improving pharmaceutical access: Residents developed a pocket reference to help patients learn how to obtain low-cost medications.
  • A heart-healthy diet: Using locally available and culturally acceptable foods, residents drafted a modified cardiac-patient diet for community residents.
  • Resources for addressing obesity: Residents obtained body-mass index (BMI) charts for exam rooms, and created patient information packets with BMI charts, exercise and dietary suggestions and maps of local walking trails.
  • Well-women health care: Residents surveyed to assess how medical staff provided regular gynecological and breast examinations, and patient experiences and preferences about their care.
  • Discontinuities of care upon hospital discharge: Residents investigated whether patients and caregivers understood discharge instructions and whether primary care physicians received timely information about their patients' hospitalization.
  • Project staff did an internal evaluation after the program's first year, and modified the curriculum accordingly to integrate the first two modules into the internship year; however, according to the project director, the project's one-year span was insufficient for a true evaluation of the service-learning component.
  • The project directors did poster presentations of the project at two national conferences including for the Society of General Internal Medicine. They also participated in a community-oriented primary care workshop at the annual meeting of the Society of General Internal Medicine. The Journal of General Internal Medicine published an abstract on the project. (See the Bibliography for details.)
  • Johns Hopkins Bayview Medical Center has incorporated a modified version of the curriculum with the first two modules starting in the internship year, and second- and third-year residents collaborating on a single group project.

Funding

The Robert Wood Johnson Foundation (RWJF) provided $24,104 in grant support for the project between December 1999 and July 2001.

Johns Hopkins Bayview Medical Center's division of general internal medicine provided in-kind support for the project.