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Item |
Community-Aware |
Community- Responsive |
Community-Driven |
| Mission | None or low priority | Included in mission | Top priority mission. In small schools this might need to be only mission, larger may have other missions such as research |
| Admissions
Ad + mission
Key Flexner concept was academic preparation of students which also worked to raise educational standards in high school and college. Unfortunately Flexner's concepts have been ignored and 4th report, a small portion of his life's work, was taken literally. |
Little impact of underserved needs on admissions policy and procedures. | Aware of need to select for certain student characteristics. Admissions at times willing to take academic risk for students with right characteristics. | Notes primary importance of finding candidates who actively desire to return to underserved communities (statements, interview, CV). Admissions Package Admissions personnel trained to discern those who desire to get in from those who desire to serve. Actively seeks candidates with rural background, underrepresented minority backgrounds, maturity, service orientation, from lower socioeconomic situations. School even establishes preadmission feeders when supply is less than adequate. Includes community input during admissions (some even have a process where academic faculty prepare the final group, with final selections by rural or underserved committee), small college advisors, early admission of those with right characteristics. Willing to take some academic risk for students with right characteristics and back this up with support for such students. Willing to deal with legal issues involved. Willing to track students and revise selection process based on outcomes |
| Infrastructure - Faculty, coordinators, FTE, positioning in relation to dean and power structure | None | Faculty with part time roles for underserved | Faculty with significant time for underserved mission (Medical Schools and Rural Graduation Rates), coordinators to support faculty (Rural Coordinators), Active visits and communication with underserved sites (Hobbs - Invisible Faculty), integration of underserved preceptors with academic faculty (Hobbs - Network). Rural or underserved faculty pursue health systems improvements for communities (working with community boards - Amundsen Implementing a Community Based Approach, helping rural doctors to integrate care with each other and the hospital - Verby, asset-based resource development - McKnight, Allen) Also see Facilitating Rural Health with Rural Faculty |
| Medical School Curriculum
Flexner included quality of labs and training of instructors |
Few months of primary care, little service learning or community projects | 3 - 4 months of primary care ) just enough to be overwhelmed according to Verby | 6 months or more of primary care, specific underserved requirements in M-1, M-2, and M-3 years, longitudinal underserved experience |
| Medical School Environment
Key Flexner concept was relationship of school to hospitals |
Intolerant of primary care, academic faculty dissuade students from careers in primary care, those with poor attitudes toward local medical doctors are tolerated instead of being disciplined | Some student support groups. Supported mainly by interested faculty and sometimes by the institution when they become aware of such efforts. | Schools have consistent relationship with practitioners and clinics serving the underserved. Student interest groups for underserved active and medical school facilitates their efforts (AMSA, international, rural). Students, being service motivated, also create new efforts on a regular basis. |
| Relationship to Underserved Communities, Outreach Activities | Are you kidding? Marketing only if anything at all
See America Bracho for usual relationship |
Some outreach activities but their recommendations go unheeded and faculty or deans rarely follow up requests of needs in a timely fashion | Outreach personnel follow up and their requests for assistance are backed up by the dean. Good communications between underserved and academic faculty. Student and resident efforts are "Community Friendly" so as to prioritize needs underserved communities. |
| Primary Care Departments
Flexner included size and training of faculty |
Little clout if they exist | Active primary care departments but constant struggle for funding, little recognition of value of primary care | Active primary care departments with research, teaching, and service for underserved, cooperation between those involved in primary care across department lines, key efforts in preadmissions, admissions, M-1, M-2, and M-3 years |
| Relationships with various departments, nursing schools, allied health | Little | Some but competitive | Cooperative regarding underserved and some other areas. Realization of great needs of shortage areas overcome competitiveness |
| Relationship to State | Little | Some funding for efforts for the underserved | Active cooperation with state departments involved with the underserved in preadmissions, education, research, and service - Office of Rural Health, Minority Affairs, state and federal community health centers, public health departments |
| Financing
Key Flexner concept was sum available from endowment, fees, and budget |
Funding from sources other than primary care to underserved | Funding includes services to underserved | School embraces services to the underserved and makes state and federal government aware of importance of adequate funding to be able to deliver the quality and quantity necessary to enable underserved areas to move forward. |
| Integration of health, education, economics, and leadership | Medical school realizes that Flexner and other past medical leaders were able to change education at many levels through school policies, mission, and programs. Realizes potential for impacting underserved areas as evidenced by Howard Rabinowitz, Jack Verby, Robert Waldman, Tom Bruce, Doeksen, and others. School takes leadership role in stimulating improvements in small colleges, minority colleges, and other schools that traditionally have graduated students that tend to go back to underserved areas. School realizes that young professionals are the lifeblood of rural communities and small rural colleges are the breeding grounds. Medical school takes leadership role in assisting underserved communities to improve local education and works to hire employees from underserved communities or populations. School realizes the important impact of health professionals to provide health care, reduce costs of public health and other care by prevention and early treatment and improved access, also realizes that young professionals are a key sources of jobs for underserved communities as well as a stimulus for better education and a focus of leadership. Health, education, economics, and leadership are all necessary for underserved communities to emerge from dependency and hopelessness. | ||
Community Driven Approach: Linking Resources with True Needs
Community-Driven Med Ed: The Rural Component
Community Driven Approach: The Rural Component
Hope: Students From the Underserved, For the Underserved