William lives in a high-crime neighborhood. Julia doesn’t own a car and has few public transportation options. Michael lost his job two years ago and now is homeless. Ever since her husband died, Andrea, a retiree, has spent most of her time at home alone.
Are these health-related issues? While we think of crime, homelessness, housing, transportation, poverty, unemployment, and loneliness as social and economic issues, they all can affect your health. So much so that the UNLV School of Medicine is addressing these issues in its curriculum.
Dr. Ellen Cosgrove, vice dean for academic affairs and education, explained, “We want to educate physicians, and we want them to be well versed in the Las Vegas community. We want them to understand the people who live here, the hardships they face, and their social issues.
“Health care is not just about the body, it’s also about the social, economic, physical, and cultural environment of the person. We want our students to understand that when they see a patient to take these factors into consideration.”
The school’s approach also is aimed at turning the physicians into proud Nevadans. Currently, Nevada ranks 48th out of 50 states in doctor-to-patient ratio, with a lack of sufficient doctors in almost all medical specialties. Dr. Barbara Atkinson, founding dean, said, “We want our students to fall in love with our community so they will stay and complete their residency and eventually practice here.”
Immersions EMT/Population Health
Connecting the students with the community begins immediately with a six-week course called Immersions EMT/Population Health. All students are required to become certified by the end of the course as emergency medical technicians (EMTs). After certification, students will participate in EMT calls, gaining first-hand knowledge of the medical and social issues in Las Vegas.
The experience exposes students to the “downstream” and “upstream” aspects of medical emergencies. Downstream refers to medical emergencies that physicians encounter, such a vehicular trauma, and how to manage those situations. Upstream refers the conditions that can contribute to those emergencies, such as lack of crosswalks or inadequate street lighting. Students will work in small teams to talk to residents in Southern Nevada’s high-risk areas and assess risk factors.
Nevada Community Service
In the 18-month-long Nevada Community Service I course, students spend two hours each week learning about community health topics, such as homelessness, obesity, and addiction, from health experts and leaders in local service organizations. The students will reflect and discuss what they learned about the topic with mentors and a mixed team of medical, nursing, social work, and law students. Perhaps most important, students will get first-hand experience by volunteering in an organization of their choice four hours each month.
Phase 2 of Nevada Community Service course is a year long and runs parallel with their longitudinal integrated clerkship. The emphasis in this phase is on clinical management of special populations and their families. One week of every month, students learn from specialists and observe how medical care is provided in clinics for serving vulnerable populations — such as military veterans, prison inmates, the homeless, and children with developmental challenges.
Nevada Community Medicine
In their final year of training, students take a month-long course called Nevada Community Medicine. Each week is devoted to a different topic relevant to public health:
- Health in all Policies — Covers the policies, laws, systems, and agencies that affect medical care.
- Hot Topics in Public Health — Covers public health topics of current interest, such as the Zika virus, HIV, and genetic manipulation.
- Environment Health — Covers environmental issues that pertain to health, such as toxic chemicals, water and air pollution, and climate change.
- Health Care Systems — Covers health care systems around the world, including ours, and the future of public health.
Community service learning is also intensified during this period. For 14 hours each week, students are imbedded in an organization such as a hospice, a mental health clinic, or an agency that addresses homelessness.
All students will have 12 weeks during their training to complete and present a research project, which can be on a bench science or a community-based topic, such as factors contributing to obesity or the use of social media in health education. With assistance from Community Health faculty in developing the project and finding mentors, the students will be encouraged to propose a solution to specific problems.
Dr. Laura Culley, associate dean for health policy and community affairs, sees the need for students to connect with their communities as being increasingly important in the training of physicians. “We are entering a new phase of medicine, one in which we are taking medical care to communities that previously have not had it. Medicine more than ever will be a social responsibility and to be a good doctor in the coming decades you will need to be community-minded and community-focused.”