The Medical College of Wisconsin Senior Mentor Program: experience of a lifetime.

The Medical College of Wisconsin (MCW) Senior Mentor Program (SMP) has been offered to a small group of first and second year medical students as a course alternative to the traditional physician mentor program. The program links students with healthy older adult mentors and includes mentor/student visits, didactic sessions, written assignments, and shadowing experiences. The goals of the course are to increase positive attitudes about aging and geriatrics and to teach basic assessment and interviewing skills in geriatric content areas. A course evaluation including questionnaires, focus groups, and content analysis found that students experienced positive attitude change about geriatric patient care, increased knowledge about geriatrics, and satisfaction with the mentor/student relationship. Students have reported gains in their knowledge of geriatric and gait assessment, ADL evaluation, and mental health screening, among other issues. Further, students report being excited, more comfortable, and less fearful caring for and interacting professionally with older adults as a result of the SMP. The SMP is an effective and meaningful method of geriatric education for preclinical students. It may be an alternative at medical schools that cannot support a large-scale multi-year senior mentor program.

Development, Implementation and Evaluation of an M3 Community Health Curriculum.

OBJECTIVES: This paper describes the development, implementation and evaluation of an M3 community health curriculum that responds to recent changes within the health care finance and delivery system. METHODS: The new curriculum was developed based on AAMC recommendations, LCME requirements, a national review of undergraduate community health curricula, and an internal review of the integration of community health concepts in M3 clerkships. RESULTS: The M3 curriculum teaches: 1) the importance of being a community responsive physician; 2) SES factors that influence health; 3) cultural competency; and 4) the role of physicians as health educators. Student evaluations for the first twelve months of implementation indicate that students are most satisfied with presentations and less satisfied with required readings and a patient interview project. DISCUSSION: Most students agree that at the completion of the course they understand what it means to be a community-responsive physician, and they have developed skills to help them become more community responsive. Evaluation tools need to be developed to assess if students' behavior has changed due to course participation.

Cancer prevention in underserved African American communities: barriers and effective strategies--a review of the literature.

African Americans suffer significantly more cancer morbidity and mortality than the white population. In order to decrease this differential, it is critical to understand the particular barriers to health and health care that underserved African Americans face. It is also important to identify the critical components of effective cancer prevention programs for this population. The barriers that impede care for underserved African Americans have been identified as: 1) inadequate access to and availability of health care services; 2) competing priorities; 3) lack of knowledge of cancer prevention and screening recommendations; 4) culturally inappropriate or insensitive cancer control materials; 5) low literacy; 6) mistrust of the health care system; and 7) fear and fatalism. Effective programs must incorporate community participation, innovative outreach, use of social networks and trusted social institutions, cultural competence, and a sustained approach. Programs that include these strategies are much more likely to be effective in reducing cancer incidence. Cancer ranks second only to cardiovascular disease as the leading cause of death in the United States. For the majority population, cancer incidence and prevalence have declined in recent years and cure rates for certain cancer diagnoses have improved. This can be attributed to progress in the development and implementation of prevention, early detection, and treatment strategies. However, despite these gains, medically underserved African American populations have not fared as well. When African American-white mortality rates are compared, African Americans are 1.3 times more likely to die of cancer than the general population. Data from the Bureau of Health Information, Wisconsin Department of Health and Family Services indicate that from 1996 to 2000, cancer accounted for 33% of deaths in African Americans aged 45-64 and 34% of deaths for those aged 65-74. To decrease the disparities in cancer morbidity and mortality between the African American and white population, it is critical to understand the particular barriers to health and health care that African Americans face. This paper is a literature review of the barriers that low-income African American populations confront in obtaining needed cancer prevention and detection and the characteristics of programs that have been effective in reaching these populations.

The Medical College of Wisconsin's program to strengthen geriatrics education.

Medical care for geriatric patients requires physician training that promotes the acquisition of attitudes, knowledge and skills that will permit future practitioners to meet the health needs of increasing numbers of aged patients. MCW has strengthened its traditional curriculum by focusing on student attitudes in the early pre-clinical years through outreach and interest groups programs. Knowledge is integrated throughout the 4-year curriculum using our aging virtual patients. These patients are a teaching resource to the entire faculty. Attitudes, knowledge, and skills in geriatrics are further developed through an M3 geriatrics medicine option and the M4 Integrated Selective. Geriatric-specific skills are emphasized through the use of standardized patients and objective structured clinical examinations in the M4 Selective. It is anticipated that these students efforts will create interest in a novel residency experience (Med-Ger) that will ensure that upon successful completion of the program, residents are expert in geriatric medicine practice and meet criteria for board certification in geriatric medicine.

Service-learning in healthy aging for medical students and family medicine residents.

INTRODUCTION: Community-based educational opportunities can diversify and strengthen traditional clinical education. With growing diversity of patient populations and increasing life expectancy, it is imperative that medical students and residents prepare for practice within this context. The Center for Healthy Communities in the Department of Family and Community Medicine at the Medical College of Wisconsin, USA developed a community-based, service-learning program in healthy aging to address this need. OBJECTIVES: The goals of the Chat and Chew program are to: generate medical student/ resident awareness of community health, aging, and diversity; train medical students/ residents to present health information to older, minority community members; encourage medical students/residents to view community members as "teachers" as well as patients; and provide needed health information and socialization opportunities to elderly public housing tenants. IMPLICATIONS: Medical students and residents gain the opportunity to interact with community members about the health issues that concern them. They also benefit from seeing community members in their real life context and learning about their health-related experiences. The housing tenants help shape how future patients will be understood and treated by the physicians who participated in the service-learning program. The purpose of this article is to: (1) provide an overview of service-learning and the Chat and Chew program, including reflection components; and (2) discuss how this program has become an integral part of the family medicine residency curriculum.