Community Health Track

Mission

Hope for improving health in our community and around the world requires preparing the next generation of physicians to understand non-medical determinants of health and to act as partners for improved living conditions, health literacy, and widening portals to services. Our track is grounded in a commitment to prepare residents in this shared effort. Residents will practice and learn how to improve health outcomes by improving access to health care, to demonstrate empathic understanding and cultural humility, and to effectively advocate for community health in our local and broader community.

Our mission is to promote community health by empowering residents with the clinical competencies, advocacy skills, and community partnerships needed to identify and overcome adverse outcomes due to non-medical determinants of health.

Why Community Health?

The practice of medicine is beset with many challenges, among them a sense of inadequacy and frustration when facing adverse health outcomes that are preventable. As clinicians, we can become keenly aware of the sociocultural, geographical and economic challenges many of our patients face. Our patients live with barriers to safe living conditions, clean water, reliable sources of food, adequate housing or transportation, and/or education. They face a multitude of complex social and geographical issues, including generational poverty and a lack of healthcare coverage, or if they do have coverage, lack of accessible venues for care, all of which can reduce quality of life, longevity, and the opportunity to reach their fullest potential as citizens of Texas. For everyone to have an opportunity to live well and be as healthy as possible, and for society to thrive, these obstacles to healthcare must be eliminated.

Physicians are uniquely positioned to be effective partners for identifying and addressing the non-medical determinants of health for the patient, both at the healthcare system and community levels. It is our belief that all physicians-in-training have the personal experiences, curiosity, compassion, talent, and professional commitment it takes to recognize and tackle adverse  health outcomes due to disparities in access.

This track is intended to support and inspire those residents who seek to hone their clinical and advocacy skills while examining the non-medical sources of poor health they will encounter throughout their careers.

Learning Objectives

The Community Health Track offers a supportive learning environment for residents. The track complements the Internal Medicine Residency Program in developing the core ACGME competencies, including Interpersonal and Communication Skills (IC), Professionalism (P), Systems-Based Practice (SBP), Medical Knowledge (MK), Patient Care (PC), and Practice-Based Learning Environment (PBLE). By the end of this track program, residents will be able to:

  • Identify non-medical factors leading to adverse health outcomes among individuals and communities in San Antonio and our partner sites (MK)
  • Recognize and build relationships with local stakeholders and partners in promoting community health (PBLE, IC, P)
  • Define key public health principles related to non-medical determinants of health and community health and illustrate how they can effectively shape clinical decision-making, resource allocation, program development, policy formulation and governance, and other forms of practice (SBP, MK)
  • Analyze the relationships between health insurance coverage, access to services, quality of services, and health outcomes (MK, SBP)
  • Understand the nature and purpose of US health care safety-net programs including Medicare, Medicaid, and the Patient Protection and Affordable Care Act and how to promote patient access to those programs (MK, SBP)
  • Develop skills related to empathic communication, cultural humility, and trauma informed care in the context of caring for underserved populations (P, IC, PC)
  • Assess patients for preventable adverse health outcomes during clinical encounters and construct a plan to mitigate these outcomes for similarly situated patients (SBP, PC, PBLE)
    Engage in activities that promote community health through research, teaching, advocacy, and volunteerism (PC, PBLE)
  • Develop, complete, and present a capstone project offering a scholarly examination of changes in practices, environments, policies, laws, and systems to improve community health and therefore outcomes of the patient populations we serve (SBP)

Track Outline and Requirements

The Co-Directors for the Community Health Track intend to draw on our residents’ passion for service and change while helping to ensure a work-life balance. The structure of the track will balance residents’ other personal, educational, clinical, and research interests. Residents are asked to regularly and pro-actively communicate their interests and needs with the Internal Medicine Residency Program Director, Associate Program Director, and Chiefs, along with the Community Health Track Co-Directors.

Applicants who enroll in this 24-month program will begin at the start of their PGY2 year. The track includes (1) a core didactic curriculum, (2) experiential learning and service opportunities, including required activities during plus-one weeks and elective rotations, and (3) a capstone project.

Successful completion of the track requires:

  • ≥ 80% participation in the didactic curriculum, including Interest Wednesdays, dedicated Community Health Track sessions, and asynchronous online modules
  • Full and accountable participation in experiential learning and service opportunities, including a minimum of two half-day activities during plus-one weeks and a minimum of one elective during PGY2 and one elective during PGY3
  • Successful completion of a capstone project presented to peers by the end of PGY3

Each resident will meet with a track Co-Director every 6-months to ensure they are progressing within their program goals. Continued participation in the track is subject to good standing within the Internal Medicine Residency Program and among institutional partners within UT Health San Antonio. Learning and service sites may have specific requirements of participation that residents will be expected to honor. Residents are strongly encouraged to communicate clearly and promptly any concerns related to safety and security or their ability to participate in scheduled activities.

Core Curriculum

A curriculum with didactic teaching and asynchronous, self-guided learning assignments (e.g., assigned readings and online modules) will serve to advance fundamental clinical and system concepts relevant to social determinants of health, community health, and health policy. The curriculum, maintained in the Community Health site on Microsoft Teams, will focus on underserved populations in addition to specific community health topics. A monthly speaker series and small group learning sessions (e.g., case-based learning and journal club) will take place on Interest Wednesdays (noon conferences).

Core topics and associated readings and modules include:

  • Non-medical determinants of health
  • Physician advocacy
  • Cultural understanding
  • Poverty and its relationship to health outcomes
  • Violence and trauma-informed care of victims
  • Community resources
  • Research methods
  • Health literacy
  • Medical ethics
  • Health policy
  • Systems of care
  • Rural and urban health
  • Incarceration and homelessness
  • Mental illness and substance use disorders
  • Interprofessional teamwork

Experiential Learning and Service

Non-Medical Determinants Experiences

Every fifth or plus-one week, residents will participate in at least two half-day activities such as the following (note: location and time will vary for these clinical experiences and may include evenings):

  • Touring zip codes of San Antonio with an online community health atlas
  • Exploring important community resources throughout San Antonio
  • Accompanying patients or families through the CareLink enrollment process for uninsured patients
  • Partnering with community health workers for home visits
  • Collaborating with City of San Antonio and Bexar County advocates and programs
  • Promoting health literacy, e.g., at local schools or the Battered Women and Children’s Shelter
  • Engaging with University Health’s Patient Family Advisory Council
  • Providing clinical service in WellMed clinics and supportive care programs
  • Providing clinical care and education at UT Health San Antonio’s Student Faculty Collaborative Practices, including:
    • Alpha Home Clinic
    • Haven for Hope/Restorative Center Clinic
    • San Antonio Refugee Health Clinic
    • SAMM Transitional Living and Learning Center Clinic
    • Travis Park Dermatology Clinic
    • Pride Community Clinic

Advocacy/Policy Experiences

During their plus-one weeks, residents will have the opportunity to develop real-world advocacy skills, including:

  • Engaging with legislative stakeholders in Texas
  • Communicating professional and community priorities related to community health in various ways:
    • Opinion pieces
    • Congressional testimony
    • Legislative and policy memos

Elective Rotations

Residents will participate in at least one community health rotation of their choice during both PGY2 and PGY3 (total of two minimum electives) including, but not limited to:

  • Chinle Comprehensive Health Care Facility in Chinle, Arizona
  • Scottish Livingstone Hospital in Molepolole, Botswana
  • Health Systems Improvement rotation in the UT Primary Care Center

Housing will be available at various sites and some financial support for travel will be provided. There will also be opportunities to create specific community health rotations in a given field (e.g., incarceration medicine, immigrant care, etc.) upon request. Novel rotations can be developed in collaboration with the track Co-Directors. Schedules will be personalized for each resident and requested rotations will be accommodated as much as possible. All rotation offerings are dependent on clinical space and faculty availability.

Capstone Scholarly Project

Residents will complete a longitudinal scholarly project related to community health, non-medical determinants of health, underserved populations, global health, or health policy under the mentorship of UTHealth SA faculty (for global health projects, mentors must be local). Projects can include research, quality improvement, or meaningful contributions to ongoing community work. Residents will present a summary of their projects to their peers by the end of PGY3.

Pathways

The Community Health Track offers a diverse and broad experience for residents who will likely go on to focus their practices on specific populations and issues. Residents are invited to consider an informal and personalized pathway during PGY3 where they can begin to deepen their understanding of a population or access issue, and they may tailor their scholarly project and their experiential learning and service accordingly. Pathways to understanding and achieving community health include:

  • Global health
  • Mental health and substance use disorders
  • Disability and health
  • Incarceration medicine
  • Rural health
  • Homelessness and health
  • Other underserved populations

What roles will residents take on after graduation?

The purpose of this track is to train leaders in promoting community health. Typical career paths of graduates will include clinician-educators at academic institutions, primary care physicians in underserved settings, clinician-researchers with a focus on community health and public health, and leadership roles in policy, advocacy, or service-oriented local and global health organizations.