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Community–Academic Partnerships

How Can Communities Benefit?

      Abstract

      In answer to the question of how academic institutions will meet medical education needs and public health challenges of the 21st century, a strong, vibrant, and sustained community partnership has been developed to teach public health, address community public health needs, and develop health policy to sustain these improvements, all with a practical approach. In this paper, the partnership between the University of Vermont College of Medicine and various community agencies is described from the perspective of how the community can benefit from educational efforts in public health. Particular focus is given to the community–academic partnership model in public health, a strong and sustained partnership between the University of Vermont College of Medicine and the United Way of Chittenden County Volunteer Center that began in 2004. Public health projects are designed, through partnerships with community nonprofit agencies, to be effective in addressing community issues while helping prepare students to become problem-solvers in population health. Examples of benefits seen by the community are used to illustrate the success of this approach. Project examples and a brief case study illustrate how community–academic partnerships in medical education can serve as a “catalyst” to improving community health.

      Introduction

      The importance of population health in medical education and the leadership role of academic medical centers has been recognized by the IOM,
      IOM
      The future of the public's health in the 21st century.
      • Woollard R.F.
      Caring for a common future: medical schools' social accountability.
      • Gebbie K.R.L.
      • Hernandez L.M.
      Who will keep the public healthy? Educating health professionals for the 21st century.
      the Josiah Macy, Jr., Foundation,
      Education for More Synergistic Practice of Medicine and Public Health.
      and others in recent articles calling for social accountability and recommendations for public health content in medical curricula.
      • Woollard R.F.
      Caring for a common future: medical schools' social accountability.
      • Maeshiro R.
      Responding to the challenge: population health education for physicians.
      • Maeshiro R.
      • Johnson I.
      • Koo D.
      • et al.
      Medical education for a healthier population: reflections on the Flexner Report from a public health perspective.
      Recent recommendations also highlight the importance of developing community-based initiatives as part of undergraduate medical education, and such initiatives are described at institutions like Duke University, the University of Vermont, the University of Utah, the University of Rochester, and Stanford
      • Michener J.L.
      • Yaggy S.
      • Lyn M.
      • et al.
      Improving the health of the community: Duke's experience with community engagement.
      • Carney J.K.
      • Hackett R.
      Community–academic partnerships: a “community-first” model to teach public health.
      • Magill M.K.
      • Quinn R.
      • Babitz M.
      • Saffel-Shrier S.
      • Shomaker S.
      Integrating public health into medical education: community health projects in a primary care preceptorship.
      • McIntosh S.
      • Block R.C.
      • Kapsak G.
      • Pearson T.A.
      Training medical students in community health: a novel required fourth-year clerkship at the University of Rochester.
      • Chamberlain L.J.
      • Wang N.E.
      • Ho E.T.
      • Banchoff A.W.
      • Braddock 3rd, C.H.
      • Gesundheit N.
      Integrating collaborative population health projects into a medical student curriculum at Stanford.
      in the U.S., and Ege University
      • Ocek Z.A.
      • Ciceklioglu M.
      • Gursoy S.T.
      • et al.
      Public health education in Ege University Medical Faculty: developing a community-oriented model.
      in Turkey.
      There is substantial literature related to community–academic partnerships in community-based participatory research (CBPR) settings,
      • Seifer S.D.
      • Sisco S.
      Mining the challenges of CBPR for improvements in urban health.
      • Shalowitz M.U.
      • Isacco A.
      • Barquin N.
      • et al.
      Community-based participatory research: a review of the literature with strategies for community engagement.
      • Israel B.A.
      • Schulz A.J.
      • Parker E.A.
      • Becker A.B.
      Community-based participatory research: policy recommendations for promoting a partnership approach in health research.
      • Israel B.A.
      • Schulz A.J.
      • Parker E.A.
      • Becker A.B.
      Review of community-based research: assessing partnership approaches to improve public health.
      • Ahmed S.M.
      • Palermo A.-G.S.
      Community engagement in research: frameworks for education and peer review.
      • Baum F.
      • MacDougall C.
      • Smith D.
      Participatory action research.
      • Burdine J.N.
      • McLeroy K.
      • Blakely C.
      • Wendel M.L.
      • Felix M.R.
      Community-based participatory research and community health development.
      • Culhane-Pera K.A.
      • Allen M.
      • Pergament S.L.
      • et al.
      Improving health through community-based participatory action research Giving immigrants and refugees a voice.
      • Viswanathan M.
      • Ammerman A.
      • Eng E.
      • et al.
      Community-based participatory research: assessing the evidence.
      • Portillo C.J.
      • Waters C.
      Community partnerships: the cornerstone of community health research.
      policy setting,
      • Israel B.A.
      • Coombe C.M.
      • Cheezum R.R.
      • et al.
      Community-based participatory research: a capacity-building approach for policy advocacy aimed at eliminating health disparities.
      public health practice,
      • Rutkow L.
      • Levin M.B.
      • Burke T.A.
      Meeting local needs while developing public health practice skills: a model community–academic partnership.
      • Cheadle A.
      • Hsu C.
      • Schwartz P.M.
      • et al.
      Involving local health departments in community health partnerships: evaluation results from the partnership for the public's health initiative.
      • Cheadle A.
      • Sullivan M.
      • Krieger J.
      • et al.
      Using a participatory approach to provide assistance to community-based organizations: the Seattle Partners Community Research Center.
      • Krieger J.
      • Allen C.
      • Cheadle A.
      • et al.
      Using community-based participatory research to address social determinants of health: lessons learned from Seattle Partners for Healthy Communities.
      undergraduate public health education,
      • Cashman S.B.
      • Seifer S.D.
      Service-learning: an integral part of undergraduate public health.
      graduate schools of public health,
      • Brown N.A.
      • Hulsey E.G.
      • Wing Y.M.
      • et al.
      Perspectives on a community-based course for public health students.
      nursing practice,
      • Bellack J.P.
      • O'Neil E.H.
      Recreating nursing practice for a new century Recommendations and implications of the Pew Health Professions Commission's final report.
      health professional education,
      • Seifer S.D.
      Service-learning: community-campus partnerships for health professions education.
      • Cauley K.
      • Canfield A.
      • Clasen C.
      • et al.
      Service learning: integrating student learning and community service.
      • Brush D.R.
      • Markert R.J.
      • Lazarus C.J.
      The relationship between service learning and medical student academic and professional outcomes.
      and healthcare delivery.
      • Miller A.L.
      • Lopez L.
      • Gonzalez J.M.
      • Dassori A.
      • Bond G.
      • Velligan D.
      Public–academic partnerships: research in community mental health settings: a practicum experience for researchers.
      • Maurana C.A.
      • Goldenberg K.
      A successful academic–community partnership to improve the public's health.
      The CDC
      CDC
      Principles of Community Engagement.
      CDC
      Community Engagement: Definitions and Organizing Concepts From the Literature.
      and others
      • Shalowitz M.U.
      • Isacco A.
      • Barquin N.
      • et al.
      Community-based participatory research: a review of the literature with strategies for community engagement.
      • Campbell-Voytal K.
      Phases of ”pre-engagement” capacity building: discovery, exploration, and trial alliance.
      recommend approaches for building capacity and skills for community engagement, but there is sparse literature related to sustained community–academic partnerships used to teach public health in medical education. Although principles developed to create partnerships for CBPR may also be useful in educational settings, there is currently little evidence.
      New approaches are likely to emerge as more medical schools prepare to develop educational programs in local communities in response to recent recommendations
      • Maeshiro R.
      Responding to the challenge: population health education for physicians.
      • Maeshiro R.
      • Johnson I.
      • Koo D.
      • et al.
      Medical education for a healthier population: reflections on the Flexner Report from a public health perspective.
      and changes in Liaison Committee on Medical Education (LCME) requirements.
      Liaison Committee on Medical Education
      Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the M.D. Program.
      Current research and literature specifically emphasizes the academic benefits of partnerships, with little or no focus on specific types of community benefits. Better understanding and documentation of how communities can actually benefit from community–academic partnerships is critical to understanding how to create and sustain these partnerships. This, in turn, will help medical schools as they develop new educational programs in their local communities.
      A “community-first” approach to teach public health in medical education has been described previously.
      • Carney J.K.
      • Hackett R.
      Community–academic partnerships: a “community-first” model to teach public health.
      The purpose of this paper is to highlight examples of the types of benefits experienced by communities. The sustained community–academic partnership used to teach public health to medical students at the University of Vermont College of Medicine is described. Project examples and a brief case study illustrate how community–academic partnerships in medical education can serve as a “catalyst” to improving community health.

      Vermont's Community–Academic Partnership

      Since 2004, public health projects
      • Carney J.K.
      • Hackett R.
      Community–academic partnerships: a “community-first” model to teach public health.
      have been a required part of the second-year medical curriculum at the University of Vermont College of Medicine (UVCOM). These are developed in partnership with the United Way of Chittenden County Vermont Volunteer Center, which has a large network of many nonprofit organizations. Projects link to Healthy People priorities, and more than 100 community-based public health projects lasting a semester have been completed or are in progress. A wide variety of agencies have participated, and public health issues have included many Healthy People focus areas (Table 1).
      Table 1Public health projects: focus areas of Healthy People 2010
      Access to quality health servicesMental health
      CancerNutrition and overweight
      DiabetesOccupational health
      Educational and community-based programsOral health
      Environmental healthPhysical activity and fitness
      Health communicationPublic health infrastructure
      Immunizations and infectious diseasesRespiratory diseases
      Injury and violence preventionSubstance abuse
      Maternal, infant, and child healthTobacco

      Value to Community Partners

      Community agencies are equal partners in the development, design, implementation, evaluation, and presentation of results in every project. Projects are initiated by the community agencies themselves, in contrast to projects being developed from available health status data about the community or based on academic interests of students.
      • Carney J.K.
      • Hackett R.
      Community–academic partnerships: a “community-first” model to teach public health.
      Medical student groups rank available projects and computer match to them, after a lunchtime speed networking session, where agencies have an opportunity to briefly pitch their projects.
      The course includes a community agency orientation, where student groups visit their project agency to see and understand the mission of the agency, population served, most pressing health issues, and barriers to improving health, and to discuss most efficient ways to communicate. Projects last about a semester (about 19–20 weeks), beginning in late August and culminating in a poster session and community celebration each January. Each student project group has six to eight second-year students and two mentors, one a university faculty member and the other a mentor from the community agency. Mentors jointly provide guidance during regular meetings with student groups to ensure projects meet community needs and maintain an academic focus. Students have one afternoon per week of protected time, in the fall of their second year, devoted to project-related work.
      At the conclusion of each project, both university and community mentors provide student evaluations of the group. Community agencies are asked to answer a brief survey regarding their reasons for participation and their impression of the impact of the projects. The process and results of evaluations have been previously summarized,
      • Carney J.K.
      • Hackett R.
      Community–academic partnerships: a “community-first” model to teach public health.
      with nearly all community agencies agreeing or strongly agreeing that projects benefited the populations served. In addition, community agencies value their relationship with the university; want to be involved in the education of medical students; report prior positive experience with students; and need additional help.
      • Carney J.K.
      • Hackett R.
      Community–academic partnerships: a “community-first” model to teach public health.
      Learner evaluation is conducted by project group and has more recently, in 2010, included Likert-scale questions about student learning in the community, for example, asking agreement with the statement, “I am confident that my experiences in our community will help me in my role as a physician.”

      Benefits to Communities

      Community agencies also report needing additional resources as one reason for participation
      • Carney J.K.
      • Hackett R.
      Community–academic partnerships: a “community-first” model to teach public health.
      and report public health needs consistent with many Healthy People 2010 areas, although projects have not yet been linked to specific objectives. Project benefits for community agencies generally fall into such categories as: (1) identifying needs for public health education; (2) advocacy for resources to improve public health; (3) problem solving to help community agencies; (4) advocacy for policy change; (5) public health program development, implementation, or evaluation; (6) community needs assessment and planning; or (7) documenting the extent of a public health issue to serve as a catalyst for community action in public health. Examples of projects illustrating specific categories of benefits to communities are described below, with additional examples presented in Table 2.
      Table 2How can communities benefit from public health projects in medical education?
      Community benefit categoryProject titleCommunity partner (Healthy People areas)Brief description
      1. Identify needs for public health educationWarming Climate Changes Vermont DiseaseVermont Department of Health (Environmental Health; Immunizations and Infectious Diseases)Students modeled temperature projections to generate predictions of Vermont's future climate to 2020; vector habitats and disease lifecycles were analyzed to determine disease threats. Human cases of WNV, RMSF, hantavirus, encephalitis, and possibly malaria were expected to emerge. Students developed professional educational strategies for emerging infectious diseases.
      Are We Getting the Message About Mercury? A Survey to Assess Public Awareness of Mercury in FishVermont Department of Health (Environmental Health; Health Communication)Students surveyed members of the public in Vermont's largest county regarding fish consumption practices and knowledge of consumption advice. Vulnerable populations were specifically targeted. Based on results, students recommended expanding public health education efforts, including more emphasis on canned tuna.
      2. Advocacy for resourcesImplementing a Physical Exercise Curriculum for Residents of Woodside Juvenile Rehabilitation CenterWoodside Juvenile Rehabilitation Center (Physical Activity and Fitness)Woodside Juvenile Rehabilitation Center, a detention and treatment facility for delinquent adolescents, identified health needs in residents. Students designed a holistic physical activity curriculum, including evaluation tools. The facility's clinical director used project results to successfully advocate for funds from the Vermont legislature to purchase exercise equipment to implement the program.
      How Can I Help You? Eligibility Worker: Navigating Patients Through the Social Services MazeCommunity Health Center of Burlington (Access to Quality Health Services; Health Communication)See description in text.
      3. Problem solving to help community agenciesFood Shelf Friendly: Increasing the Nutritional Quality of Food Shelf DonationsChittenden Emergency Food Shelf (Nutrition and Overweight)See description in text.
      4. Advocacy for policy changeImpact of Paid Sick Days on Public Health in an Elementary School PopulationPeace and Justice Center of Vermont (Access to Quality Health Services; Immunizations and Infectious Diseases)Students evaluated the impact of parental-paid sick days on children's health, with a survey distributed to parents of 1135 students in nine Vermont elementary schools. Findings that adults with fewer paid sick days were more likely to send a child with symptoms of illness to school was used in testimony to the Vermont legislature on An Act Relating to Absence from Work for Health Care and Safety.
      Assessing Health Concerns and Obstacles to Diesel Exposure Reduction in Vermont Diesel Vehicle OperatorsAmerican Lung Association of Vermont (Occupational Health; Environmental Health)See description in text.
      5. Public health program development, implementation, or evaluationAssessing the Current State and Potential Needs of the Community for Autism Spectrum Awareness in the ClassroomPuppets in Education (Maternal Infant and Child Health; Health Communication; Educational and Community-Based Programs)Students determined what information would be useful to include in a puppet program addressing Autism Spectrum Disorders. Surveys were developed and administered to parents with and without children on the autism spectrum, and to educators across the state of Vermont. Findings suggested that a puppet program addressing autism spectrum disorders was needed within the surrounding community and Vermont as a whole.
      6. Community needs assessment and planningPromoting Healthy and Active Communities: Medical Students and the Built EnvironmentVermont Department of Health (Physical Activity and Fitness; Environmental Health)Students developed a questionnaire of community factors that promote physical activity, interviewed town staff and/or local government officials in interested towns, identified and shared best practices.
      Seniors Aging Safely at Home: Identifying Risk Factors of Seniors Living IndependentlyCathedral Square Corporation (Access to Quality Health Services)See description in text.
      7. Catalyst for community action in public healthSuburban Satellite Health Care Facilities Limit Access for Low-Income PatientsCommittee on Temporary Shelter and Safe Harbor Clinic (Access to Quality Health Services)See description in text.
      WNV, West Nile virus; RMSF, Rocky Mountain spotted fever

      Identifying Needs for Public Health Education

      The Vermont Department of Health has participated in the UVCOM public health projects since 2004 when the projects began. Medical students have helped the department better understand the educational needs of practicing clinicians and the general population with regard to specific public health topics. Climate change and its impact on infectious diseases
      • Baker E M.M.
      • Mu'Min A.
      • Oliver L.
      • et al.
      Warming Climate Changes Vermont Disease.
      was one topic of study that resulted in a publication in the Vermont Medical Society newsletter.
      UVM Med Students Analyze Effect of Climate Change on Disease in Vermont 2010 [cited 2010 October 1, 2010]; The Green Mountain Physician, a publication of the Vermont Medical Society].

      Advocacy for Resources to Improve Public Health

      The Community Health Center of Burlington (CHCB), a Federally Qualified Health Center, is a nonprofit medical and dental practice serving the greater Burlington area in Vermont. CHCB cares for about 13,000 patients; about 26% are uninsured or homeless; and about 6% of primary care visits each year require interpreter assistance.
      Student projects over several years studied issues of eligibility and navigation,
      • Bailey C G.L.
      • Guignon M.H.
      • Helminski A.S.
      • et al.
      Healthy Coverage History of Local Uninsured Patients: Assessing the Need for an Eligibility Specialist.
      • Ankuda C K.B.
      • Lam P.
      • Odelfey A.
      • et al.
      How Can I Help You? Eligbility Worker: Navigating Patients Through the Social Services Maze.
      trying to understand and have an impact on the healthcare needs of patient populations served by the CHCB. In one project, students described the insurance history of uninsured populations and found the vast majority had been previously insured, some of whom might now be eligible for public programs but were unaware of the application process, suggesting the need for an “eligibility specialist.”
      • Bailey C G.L.
      • Guignon M.H.
      • Helminski A.S.
      • et al.
      Healthy Coverage History of Local Uninsured Patients: Assessing the Need for an Eligibility Specialist.
      A subsequent project better defined the role of this specialist who could inform and help clients enroll in social service programs. The CHCB subsequently used project results to successfully advocate for, and hire, a “Patient Assistance Specialist” who helps clients access needed services. This advocacy was unique as through collaboration with the University of Vermont College of Nursing and Health Sciences, both medical and nursing student public health projects contributed to this successful outcome that demonstrated advocacy for resources to improve public health.

      Problem-Solving to Help Community Agencies

      A project with the Chittenden (Vermont) Emergency Food Shelf tested whether practical ways to improve the quantity and nutritional quality of donated foods could be achieved by working with local grocery stores. The stresses of a poor economy resulted in increased local demand for food at the emergency food shelf. Students worked with seven local grocery stores that had food collection bins to see if educating consumers with such methods as using posters and tear-off lists at entrances to grocery store or labels at the point of purchase could influence what foods were donated. At the end of 4 weeks, they found a significant increase in the proportion of nutritious donations, and concluded such steps could be easily taken in other communities.

      Advocacy for Policy Change

      Some student groups tried to understand and influence policy in Vermont (Table 2). A project completed in partnership with the American Lung Association of New England (Vermont), “Assessing Health Concerns and Obstacles to Diesel Exposure Reduction in Vermont Diesel Vehicle Operators,” was used to provide testimony to the Vermont Legislature regarding legislation entitled “An Act Relating to the Idling of Motor Vehicles.”
      Vermont Legislative Bill Tracking System
      H97 An Act Relating to the Idling of Motor Vehicles 2009–2010.
      Students had surveyed diesel truck operators before their morning delivery routes in two Vermont counties and found that 75% of the drivers had not been informed about health effects of diesel exhaust. Students presented data to the legislature detailing occupational health concerns about diesel exhaust among the vehicle operators and how truck drivers would respond to policies that limit diesel idling. Although the legislation was not enacted during that legislative session, the level of interest in this issue remains high. Students also presented their project findings at an American Public Health Association (APHA)
      • Marotta M.F.M.
      • Greenberg R.
      • Huang Q.
      • et al.
      Assessing Health Concerns and Obstacles to Diesel Exposure Reduction in Vermont Diesel Vehicle Operators.
      annual meeting.

      Public Health Program Development, Implementation, or Evaluation

      A Vermont nonprofit organization using a troupe of puppets to teach children about disabilities, children's mental health, social and safety issues, substance abuse, and AIDs, requested a project to assess community needs for classroom education related to autism spectrum disorders, described in Table 2.

      Community Needs Assessment and Planning

      Cathedral Square Corporation is a nonprofit organization that owns and/or manages senior housing communities in four Vermont counties. In response to needs of the aging population, the organization, along with stakeholders from government, academia, health care, nonprofits, and advocacy organizations, created Vermont's Seniors Aging Safely at Home program to better integrate health, long-term care, and support services for seniors, to ensure that they could remain in their own homes as long as possible. Medical students have completed projects with Cathedral Square Corporation to assess needs and determine priorities in development of Seniors Aging Safely at Home initiatives. In one project, students identified risk factors of seniors living independently and found less than half passed a cognitive screen, more than a third had a history of falls, and nearly 20% related a history of inadequate nutrition, factors requiring attention in the development of Seniors Aging Safely at Home programs.
      The executive director of Cathedral Square Corporation (N. Eldridge, Cathedral Square Corporation, personal communication, 2009) wrote about the student's project:
      From the Governor of Vermont to the Episcopal Bishop of Vermont, I use the data collected and convincingly presented by the medical students in their poster to draw a picture of the depth and scope of the problem, a problem that will have increasingly disturbing ramifications on our state's financial health and on the ethics of how we treat the most frail in our society.
      A subsequent project assessed nutrition and social eating habits among seniors living independently and made practical recommendations, such as vitamin supplementation, individual education, and social eating opportunities, to enable seniors to live independently at home in the community. Representatives from each of these projects presented their project at the APHA 2009 and 2010 annual meeting.
      • Bell R.
      • Coutou F.H.
      • Johnson R.C.
      • et al.
      Seniors Aging Safely at Home: Identifying Risk Factors of Seniors Living Independently Presented at the American Public Health Association 137th Annual Meeting, Philadelphia PA.
      • Stump M.
      • Cappelletti C.
      • Sorse L.
      • et al.
      Nutrition and Social Eating Habits Among Seniors Living Independently.

      Catalyst for Community Action in Public Health—a Brief Case Study

      The Committee on Temporary Shelter and the Safe Harbor Clinic, part of the CHCB, submitted a project proposal for a Fall 2008 project about transportation as a barrier to health. The project was designed to study the impact on homeless and low-income populations of relocating specific specialty healthcare services to a suburban location, not yet located on a city bus route. Project data supported the perception that lack of transportation was a barrier to health care for some community populations. Project results were presented as a poster entitled “Suburban Satellite Health Care Facilities Limit Access for Low-Income Patients” at the College of Medicine Poster Session and Community Celebration in January 2009 and at the APHA annual meeting.
      • Beal A.
      • Caulfield H.
      • Cipolla E.
      • et al.
      Suburban Satellite Health Care Facilities Limit Access for Low-Income Patients.
      This information was subsequently used in research by the Vermont Interfaith Action (VIA) committee, part of PICO (People Improving Communities through Organizing), a national network of nonpartisan and multicultural, faith-based community organizations.
      In June 2009, the VIA held an action,
      Vermont Interfaith Action News
      VIA Holds Tilley Dr Medical Facilities Action.
      covered by local news and cable TV, where more than 100 people met at a local cathedral to discuss the transportation issue in a public setting. Members of the academic medical center, county transportation authority, and city manager met with VIA leaders and heard testimony from members of the refugee community, senior citizens, local churches, and VIA leaders, about difficulty accessing needed healthcare services because of lack of transportation. There were articles in the local newspaper and TV interviews. Subsequently, VIA met with involved parties in September 2009
      Vermont Interfaith Action News
      Tilley Drive Update.
      to continue progress toward improving the issue. In November, VIA spoke out on cable TV
      Center for Media and Democracy
      Burlington Livable Community Project. [Cable TV Recording].
      and reported on progress.
      Vermont Interfaith Action News
      VIA in the News: Tilley Drive Update.
      Finally, in January 2010, leaders from all local organizations announced that a shuttle service, jointly funded by involved organizations, would provide transportation to low-income residents needing specialty care at the suburban location.
      Vermont Interfaith Action News
      New Shuttle Service for Tilley Drive.
      Project results were a catalyst used by a local faith-based community organization to organize community members and involved agencies to facilitate a workable solution to the problem.

      Discussion

      Community-driven public health projects have been implemented as a required part of the medical curriculum at UVCOM, since 2004. Educational goals associated with the projects are to: learn public health through actions in the community to improve health; understand and apply basic public health research methods; and put science into practice to improve health in the community. Public health needs have been identified by local community agencies, and projects are designed as community first to meet these health needs.
      • Carney J.K.
      • Hackett R.
      Community–academic partnerships: a “community-first” model to teach public health.
      There is growing evidence that project findings are resulting in tangible benefits for participating community agencies (Table 2).
      Academic credibility is important and brings strength to the partnership. Many of the projects listed in Table 2 were also presented by students at APHA meetings.
      • Baker E M.M.
      • Mu'Min A.
      • Oliver L.
      • et al.
      Warming Climate Changes Vermont Disease.
      • Ankuda C K.B.
      • Lam P.
      • Odelfey A.
      • et al.
      How Can I Help You? Eligbility Worker: Navigating Patients Through the Social Services Maze.
      • Marotta M.F.M.
      • Greenberg R.
      • Huang Q.
      • et al.
      Assessing Health Concerns and Obstacles to Diesel Exposure Reduction in Vermont Diesel Vehicle Operators.
      • Bell R.
      • Coutou F.H.
      • Johnson R.C.
      • et al.
      Seniors Aging Safely at Home: Identifying Risk Factors of Seniors Living Independently Presented at the American Public Health Association 137th Annual Meeting, Philadelphia PA.
      • Beal A.
      • Caulfield H.
      • Cipolla E.
      • et al.
      Suburban Satellite Health Care Facilities Limit Access for Low-Income Patients.
      • Damsky Jr, W.E.
      • Duncan E.
      • Flanagan N.
      • et al.
      Public awareness of mercury in fish: analysis of public awareness and assessment of fish consumption in Vermont.
      • Beville T.
      • Bramley A.
      • Costello K.
      • et al.
      Implementing a Physical Exercise Curriculum for Residents of Woodside Juvenile Rehabilitation Facitity 2007.
      • Carney J.K.
      • Barhoum D.M.
      • Conant J.
      • et al.
      Impact of Paid Sick Days on Public Health in an Elementary School Population.
      • Carney J.K.
      • Blevins L.Z.
      • Huynh K.
      Promoting healthy and active communities: Medical students and the built environment.
      Students find, summarize, and present the public health science and literature behind public health issues facing the community. In so doing, students develop skills in critical thinking, caring, and communication to support teamwork, collegiality, and problem solving. Building relationships with a wide range of community agencies is possible and feasible, but achieving consistency, sustainability, and results that benefit the community takes time.
      Principles from the CBPR literature may apply to educational endeavors in medical education. The CDC
      CDC
      Community Engagement: Definitions and Organizing Concepts From the Literature.
      provides guidance for community engagement, and other authors provide advice related to the challenges of CBPR, including dissemination of results.

      Chen PG, Diaz N, Lucas G, Rosenthal MS. Dissemination of results in community-based participatory research. Am J Prev Med; 39(4):372–8.

      Israel and her colleagues
      • Israel B.A.
      • Coombe C.M.
      • Cheezum R.R.
      • et al.
      Community-based participatory research: a capacity-building approach for policy advocacy aimed at eliminating health disparities.
      emphasize capacity building to promote policy advocacy; Ahmed
      • Ahmed S.M.
      • Palermo A.-G.S.
      Community engagement in research: frameworks for education and peer review.
      cites models for community engagement in research
      • Faridi Z.
      • Grunbaum J.A.
      • Gray B.S.
      • Franks A.
      • Simoes E.
      Community-based participatory research: necessary next steps.
      • Cornwall A.
      • Jewkes R.
      What is participatory research?.
      • Cawston P.G.
      • Mercer S.W.
      • Barbour R.S.
      Involving deprived communities in improving the quality of primary care services: does participatory action research work?.
      • Rifkin S.B.
      Paradigms lost: toward a new understanding of community participation in health programmes.
      and details a framework to educate researchers that includes values, strategies, and outcomes of community engagement in research
      • Ahmed S.M.
      • Palermo A.-G.S.
      Community engagement in research: frameworks for education and peer review.
      that may be applicable to educational partnerships as well. Other authors
      • Shalowitz M.U.
      • Isacco A.
      • Barquin N.
      • et al.
      Community-based participatory research: a review of the literature with strategies for community engagement.
      • Israel B.A.
      • Schulz A.J.
      • Parker E.A.
      • Becker A.B.
      Community-based participatory research: policy recommendations for promoting a partnership approach in health research.
      • Israel B.A.
      • Schulz A.J.
      • Parker E.A.
      • Becker A.B.
      Review of community-based research: assessing partnership approaches to improve public health.
      • Metzler M.M.
      • Higgins D.L.
      • Beeker C.G.
      • et al.
      Addressing urban health in Detroit, New York City, and Seattle through community-based participatory research partnerships.
      discuss “core principles and values,” and 12 common characteristics of successful partnerships,
      Building and sustaining community-institutional partnerships for prevention research: findings from a national collaborative.
      and Shalowitz
      • Shalowitz M.U.
      • Isacco A.
      • Barquin N.
      • et al.
      Community-based participatory research: a review of the literature with strategies for community engagement.
      shows how these characteristics can been applied to a successful community partnership for asthma.
      Although there may be similarities with CBPR principles in the area of community partnerships, there may also be differences. For example, most educational initiatives in medical schools last several months, the time of a semester, rather than years. In our experience, although some longitudinal projects with agencies span several years, in most cases, community agencies have specific and timely needs that can be addressed in one semester-long project.

      Conclusion

      Successful community engagement resulting in a strong and sustained community–academic partnership must be based on the premise that the community is an equal partner and that, while there are clear educational goals and competencies for students, the needs of the community must be put first. It is essential for medical schools developing such programs to understand that reasons community agencies participate may be very different from the missions of the academic medical center. Community agencies may be affected by economic factors, with increased demand for services requiring more resources, and not have the person-power or expertise to look at a problem from a broader perspective. However, the missions of community nonprofit organizations involved in health intersect with those of the academic medical center and can complement meeting the medical, social, and overall health needs of individuals and populations. Understanding where missions intersect and reasons for participation are important to ensure the highest level of collaboration and successful outcomes.
      Ensuring that educational endeavors result in tangible products that benefit the community is essential to nurturing and sustaining such partnerships. Educational projects must be conducted in a timely manner, and easily understandable results must be clearly developed and presented. Mentoring from both an academic and community perspective is important to keep projects on task, and to maintain the balance between academic and community needs. It is important also to celebrate success. In a busy and demanding environment seen in both community and academic settings, celebrating progress and small successes that over time translate to benefits to community health enhances the efforts of all participants. As more medical schools work to achieve both recommended competencies
      • Maeshiro R.
      • Johnson I.
      • Koo D.
      • et al.
      Medical education for a healthier population: reflections on the Flexner Report from a public health perspective.
      and required standards,
      Liaison Committee on Medical Education
      Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the M.D. Program.
      the development of educational initiatives in public health, in partnership with communities, will be more common. Both communities and academic institutions can benefit from such endeavors.
      Authors from the University of Vermont College of Medicine would like to acknowledge statistical consultation from Thomas V. Delaney, PhD, on some projects described in the manuscript.
      Funding for this project was provided in part by a Regional Medicine–Public Health Education (RMPHEC) grant through the cooperative agreement between the CDC and the Association of American Medical Colleges (AAMC), a partnership to “strengthen collaboration between the disciplines of academic medicine and public health,” grant number 5U36CD319276 .
      The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the AAMC or CDC.
      JKC receives royalties from Jones and Bartlett Publishers for publishing a 2006 textbook: Carney JK. Public Health in Action: Practicing in the Real World.
      Publication of this article was supported by the CDC-AAMC Cooperative Agreement number 5U36CD319276 .
      No other financial disclosures were reported by the authors of this paper.

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