RELATIONSHIP TO THE COMMUNITY

Institutional Resources and Support (1.7/3):

Student Concerns: Students felt strongly that, in the spirit of Brown’s mission of graduating socially responsible physicians, more institutional resources and administrative support should be provided in order to operationalize this goal. Specific suggestions included establishing an Office of Advocacy and Community Service, cataloging existing community service projects, creating a faculty fellow position in community service to mentor students, build in more time in the medical school schedule to allow students to participate in service activities, and to establish links with Brown alumni in other parts of the country who exemplify the socially responsive physician.

Response: The medical school administration endorses the students’ goals. An important part of the educational process is learning through experience in the community, and the development of communication and organizational skills that are useful in a variety of settings involving persons of different ages, as well as cultural and socioeconomic backgrounds. Community-based projects and service comprise an important aspect of achieving this mission.

Several programs and departments within the medical school and across the campus have important functions and resources relevant to community-based service and learning. The newly developed Program in Public Health and Public Policy led by Dean Terrie Wetle is working closely with the affinity group program, the community health clerkship, the Swearer Center, and other programs in developing a collaborative strategy for identifying information and providing resources to medical students and faculty interested in community service. One focus of this activity is identifying the many sources of information regarding community service opportunities and resources currently available across campus and to identify gaps in resources to be addressed. Catalogues of such activities are available through the affinity group program, the Howard Swearer Center for Public Service, and the community health clerkship.

The medical school also employs a service-learning coordinator, Bettye Williams, who works closely with student organizations that have a community-service focus. Ms. Williams works closely with the newly appointed health coordinator at the Swearer Center, Claudia Decesare. Together, Dean Wetle, Ms. Williams, and Ms. Decesare constitute a strong team to promote the medical school’s mission of graduating socially responsive physicians. Over the next six months, they will propose a targeted strategy for improved coordination, information sharing, and resource identification for community-based projects and service.

Advocacy and Activism (2.0/3)

Student Concerns: Students were moderately concerned that the medical school should take a more active role in supporting community advocacy and activism by students. Students recognized a need for the medical school to put more effort into establishing and maintaining relationships with community members and agencies in order to foster a climate of mutual respect and collaboration

Response: The medical school is committed to fully realizing our mission of educating socially responsive physicians. We believe this is the heart and soul of Brown Medical School and what makes us stand out among medical schools. The medical school administration will work closely with the Medical Student Senate to make us “the best” in turning out future leaders who will be the “movers and shakers” of health care reform.

Since the time the data for the report was gathered, much has happened in this area. The medical school received a $198,000 grant from the Arthur Vining Davis Foundations to support activism and advocacy, a new associate dean of medicine for public policy and public health was appointed (Terrie Wetle, Ph.D.), a student-run free clinic was started, the MOM program was initiated by students (Medical Students Outreaching to Mothers-to-Be) and will be integrated into the first-year curriculum, two retreats for Brown students were held on activism and advocacy and regional meetings on the same subject are planned by the AMA-MSS (February 2001) and the SNMA (November 2001). A patient advocacy component was pilot tested in the second-year curriculum this semester with the expectation that it will be expanded and continued in the future.

In a similar vein, the Medical Student Senate requested that the dean institute a broad review of how well the medical school promotes professionalism. In response, the dean has charged the M.D. Curriculum Committee with that responsibility and a task force has been formed this semester to do that. The task force - includes broad representation, not just from the medical school, but from other departments in the university and with the community.

A patient advocacy coordinating council has been formed consisting of leaders of all the medical student organizations and representatives from the administration and the Swearer Center for Public Service. The medical school has identified office space for all student organizations to share and has provided office equipment to support the student organizations. Grants for joint efforts by student organizations in the area of advocacy and activism are being provided through the Arthur Vining Davis Foundations grant and have so far been awarded for a spring health fair and a program on reproductive health advocacy and activism issues.

Faculty Involvement (2.5/3)

Student Concerns: Students asked that faculty should be more involved in student projects in the community. Students noted that this could be another way for students to identify clinical mentors early in their medical school careers.

Response: Brown Medical School faculty provide substantial community-based service both locally and regionally. They participate in a wide array of advocacy activities aimed at improving access and quality of services to selected populations, encouraging beneficial change in preventive care and health behaviors, and encouraging enactment of health policies that improve population health. Faculty also devote considerable time mentoring and providing other assistance to students involved in or planning community-based service. However, because there is not a systematic process for identifying and documenting this important community service, opportunities for collaboration with students and other faculty, or leveraging among service projects and activities are often missed. Moreover, competing demands and increased constraints may limit the capacity of interested faculty to provide as much assistance as they might want to.

Some progress had been made in identifying strategies for documenting and “crediting” relevant mentoring and service activities, and to provide administrative and academic support to students and faculty involved in such service. For example, the newly launched MPH program has targeted resources to a staff person responsible for serving as liaison between the university and the community internship placements (for example, with the Rhode Island Department of Health).

As effective models and strategies are developed for encouraging and supporting faculty for student mentoring and direct participation in community services, they will be promulgated throughout the medical school. Efforts will also be made to facilitate access to existing university resources, for example the new personnel in the Swearer center devoted to health-related projects. Discussions with external funding agencies are underway in an effort to identify resources for developing innovative programs to encourage community-based collaborations.