Care of the Underserved Pathway

There is a need for competent physicians who are able to offer compassionate and culturally sensitive care to the diverse and growing population of patients in underserved settings.*

In 2005, it is estimated that 46.6 million Americans lacked health insurance with a resultant poor access to health care.** In Houston alone, it is estimated that over 800,000 people lack health insurance and face difficulty in accessing needed health care.*** In caring for this population, it is important for physicians to have a particular set of knowledge, skills and attitudes since one study found that inner-city patients had more chronic medical conditions, more emotional issues, a greater number of problems evaluated per visit, higher rates of health habit counseling and longer, more frequent office visits.****

In addition, other studies have revealed that uninsured patients have poorer clinical outcomes for a variety of chronic illnesses such as diabetes, cardiovascular disease and mental illness and receive standard preventive services (immunizations, cancer screening) less often.*****

The four-year Care of the Underserved Pathway coordinates current offerings on underserved care and present them to students in a more formal and organized fashion across the four years. This pathway provides them with the specific knowledge, skills and attitudes they need to provide care to underserved patients in the future, recognize them for their accomplishments while here at Baylor and encourage them to seek future residency and practice positions that will enable them to continue caring for underserved patients.

In addition, the faculty involved in this pathway strive to supplement the curriculum by serving as positive role models of physicians providing care to underserved patients.

Overall Goals of the Care of the Underserved Pathway

• Provide students with high quality, hands-on clinical and service-based learning experiences at a variety of underserved sites, both ambulatory and in-patient
• Encourage students to develop a scholarly interest in underserved care by conducting a research project
• Encourage students to obtain residency training in a program which emphasizes care of the underserved
• Encourage students to care for underserved patients in their future practice

Requirements for Completing the Pathway and Recognition of Students

The steering committee has set the following requirements for students wishing to be recognized as pathway completers.

Foundational Sciences Electives

Complete one Foundational Sciences elective from the following list:

• MEFAM-407: Introduction to the Care of the Underserved 
• MEFAM-409: Longitudinal Community Medicine & Primary Care 
• MEOSA-441: Communicating Scientific & Clinical Research to Patients 
• MEFAM-447: Refugee and Immigrant Medicine 
• MEFAM-530: Underserved Care Clinics (Volunteering) 
• MEPED-562: It Takes a Village: Foundations of Pediatric Advocacy
• MEPED-565: Hiding in Plain Sight: Identify/Understand Victims of Violence
• MEOSA-501: Deconstructing Race in Medicine and Health 
• MEMED-583: A Readings in HIV-AIDS Epidemiology 
• MEMED-593: Beyond the Exam Room: Physician as Advocate

Community Project Electives

Complete one of the following:

• MEFAM-535: Community Project in Underserved Care

Advanced Electives

Complete two advanced electives: 2-4 weeks (two of the following advanced clinical elective).

Inpatient

• MESUR-501: Sub-Internship Surgery
• MEPSY-503: Emergency Psychiatry elective (4 week)
• MEPSY-504: Sub Internship Psychiatry
• MEFAM-515: Family Medicine Sub-Internship (Ben Taub Hospital)
• MEMED-503: General Medicine Sub-Internship (Ben Taub Hospital)
• MEPED-547: Pediatric Sub-Internship (Texas Children’s Hospital) – please ask to be placed on the PHM service
• MENEU-503: Neurology Sub-Internship (Ben Taub Hospital)
• MEOBG-503: Obstetrics and Gynecology Sub-Internship - please ask to be assigned to Ben Taub Hospital
• MEPSY-545: Inpatient Psychiatry (Ben Taub Hospital)

Ambulatory

• MEOBG 201: HIV in Ob/Gyn elective (2 week)
• MEPSY 200: Introduction to Emergency Psychiatry (2 week)
• MEFAM 201: Addiction Medicine (2 week)  
• MEPED 206: Complex Care in Pediatrics (2 week)  
• MEPED 207: Foster Care Pediatrics (2 week)  
• MEFAM-511: Care of the Underserved (Northwest Health Center)
• MEPED-506: Developmental Pediatrics
• MEPED-549: Emergency Pediatrics
• MEMED-202: Comprehensive HIV Care for the Underserved (2 week)
• MEMED-587: Medicine/Pediatrics Primary Care
• MEMED-579: Palliative Care for the Indigent
• MEMED-630: Life with Intellectual & Developmental Disability
• MEERM-504: Emergency Medicine 

Recognition of the completion of the above requirements will appear on the student's official transcript and will also be noted in the commencement program.

End of Pathway Reflection Paper

Students entering Baylor College of Medicine in July 2013 or afterwards will be required to submit an end of pathway reflection paper in April prior to their graduation from Baylor College of Medicine. In this paper, students are asked to describe key experiences that have contributed to their learning about underserved care in medical school. Students are asked to explain how these key experiences have contributed to their learning in at least three of the following competency areas:

• Medical knowledge
• Patient care
• Interpersonal communication
• Professionalism
• Systems-based practice
• Practice-based learning
• Leadership

Extracurricular Activities

In addition to the above curriculum, extracurricular workshops will be held periodically for students in the pathway for all four years and any other interested students. Activities for those workshops will include:

• Discussion of current community projects being conducted by either students or faculty
• Discussion of pertinent underserved care topics
• Presentation by a physician who practices underserved care on what he/she actually does
• Reflection on what they are learning from their underserved care experiences
• Students will also be encouraged to volunteer in the community in activities such as the HOMES clinic

For more information or to express interest in participating in this pathway, please contact Anjali Aggarwal, M.D., of the Department of Family and Community Medicine by phone at (713) 798-8741 or by email at aaggarwa@bcm.edu.

Footnotes

*Fernandez E, Foss F, Mouton C, South-Paul J. Introduction to the dedicated issue on minority health. Family Medicine 1998;30:158-159.

**DeNavas-Walt, Carmen, Proctor, Bernadette D. and Lee, Cheryl Hill, U.S. Census Bureau, Current Population Reports, P60-231, Income, Poverty and Health Insurance Coverage in the United States: 2005, U. S. Government Printing Office, Washington, D.C., 2006.

*** Gateway to Care web site. Accessed on April 1, 2004.

**** Blankfield RP, Goodwin M, Jaen CR, Stange KC. Addressing the unique challenges of inner-city practice: a direct observation study of inner-city, rural, and suburban family practices. Journal of Urban Health: Bulletin of the New York Academy of Medicine 2002;79:173-185.

***** Institute of Medicine, Committee on the Consequences of Uninsurance. Care without coverage: too little, too late. Washington, D.C.: National Academy Press; 2002.

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