The relevance of community-oriented primary care for training preventive medicine residents.

Abstract

The application of a community-oriented primary care (COPC) model that links an academic health center and a community health center (CHC) through a postgraduate training rotation offers many benefits to both the preventive medicine (PM) resident and the CHC. In order to have a meaningful and successful COPC rotation, we recommend that academic health center faculty select a primary care provider at a CHC as a preceptor for the PM resident. It is essential that the resident, under academic faculty supervision, define a COPC project with the preceptor, consult with an epidemiology professor in the design and execution of the project, identify and set priorities for the significant community health problems uncovered by the project, and present and discuss the findings and recommendations with the preceptor. Based on our experience with the COPC rotation, we recommend that several residents in sequence participate in a longitudinal COPC rotation. When the University of South Carolina School of Medicine and Palmetto Richland Memorial Hospital, in Columbia, South Carolina, developed a COPC rotation 1 for PM residents at a nearby CHC, we attempted to match residents' training with community needs. The resulting COPC rotation, begun in 1996, consisted of the residents' forming a partnership with a family medicine physician preceptor at the CHC and then designing and conducting an epidemiologic study that compared information from various community-based data sources. The PM residents developed policy recommendations that enhanced the mission of the CHC to provide preventive medicine services to the surrounding underserved community. The major benefits resulting from the affiliation between the CHC and the academic health center have been the enhancement of the service and education missions for the collaborating institutions. The CHC benefited from the expertise of PM residents in characterizing the clinic community and recommending community-based interventions at no financial cost to the CHC. The PM residents felt that they benefited from the exposure to a broad spectrum of diseases affecting the medically underserved population. Residents learned about applied prevention while identifying the health needs of a vulnerable population, enabling them to acquire many preventive medicine core competencies. Because of time constraints, the residents were unable to implement or evaluate any intervention program. We believe that a comprehensive COPC rotation requires several months to complete the epidemiologic studies. However, another COPC/PM residency program found that when the community was involved as a partner with the CHC and the PM residency program early in the COPC process, the time limits on the rotation could be removed. 2 A fifth step should be added to the four-step COPC process: organizing both community members and health professionals in a partnership. 3 Health professionals should work together with the surrounding medically underserved community to develop community-based intervention programs. Each step in the COPC process should be part of a feedback loop improving upon earlier efforts. 3 It is vital that PM residents wanting to expand their residency training experience to include COPC take the lead in developing a suitable affiliation with a CHC. The CHCs should increase their use of PM residents, who can develop programs necessary to improve the preventive care delivered to the surrounding community. Increasing these ties should help both the specialty of preventive medicine and CHCs better prepare themselves to address the future health needs of the medically underserved.