Medical training in school-based health centers: a collaboration among five medical schools.

School-based health centers (SBHCs) have tremendous untapped potential as models for learning about systems-based care of vulnerable children. SBHCs aim to provide comprehensive, community-based primary health care to primary and secondary schoolchildren who might not otherwise have ready access to that care. The staffing at SBHCs is multidisciplinary, including various combinations of nurse practitioners, physicians, dentists, nutritionists, and mental health providers. Although this unique environment provides obvious advantages to children and their families, medical students and residents receive little or no preparation for this type of practice. To address these deficiencies in medical education, five downstate New York state medical schools, funded by the New York State Department of Health, collaborated to define, develop, implement, and evaluate curricula that expose health professions students and residents to SBHCs. The schools identified core competencies and developed a comprehensive training model for the project, including clinical experiences, didactic sessions, and community service opportunities, and they developed goals, objectives, and learning materials for each competency for all types and levels of learners. Each school has implemented a wide range of learning activities based on the competencies. In this paper, the authors describe the development of the collaboration and illustrate the process undertaken to implement new curricula, including considerations made to address institutional needs, curricula development, and incorporation into existing curricula. In addition, they discuss the lessons learned from conducting this collaborative effort among medical schools, with the goal of providing guidance to establish effective cross-disciplinary curricula that address newly defined competencies.

Adolescent school-based health care: a description of two sites in their 20th year of service.

PURPOSE: While there are currently nearly 1,400 school-based health centers (SBHC) nationwide, only 20% have been in operation for more than 10 years. The Mount Sinai Adolescent SBHC Program is now in its 20th year of service. The purpose of this study is to: (a) present the demographic data for 2003 high school SBHC medical visits, including age, sex and insurance status; (b) describe the current prevalence of medical and psychosocial risk factors of the students seen for examination; and (c) present general distributions for psychosocial risk factors found in 1988 archival information and note differences from current risk factors. METHODS: A retrospective chart review was conducted in high school A, whose SBHC serves students mainly interested in going to college, and in high school B, whose SBHC has a heterogeneous population with a large proportion of recent immigrants. Data collected included demographic variables as well as reports of risk factors such as: considering oneself to be overweight, history of sexual activity, history of sexually transmitted diseases, same-sex attraction, use of alcohol, cigarette smoking, use of marijuana, suicidal ideation and exposure to violence. RESULTS: For those participating from high school A (n=231): 78% female, mean age 15.75; asthma (17%); think oneself overweight (30%); family member with HIV (11%); sexually active (35%); same-sex attraction (3%); cigarette use (14%); marijuana use (13%); alcohol use (38%); suicide ideation (14%); witnessed violence (37%); and overweight and obese (33%). For those participating from high school B (n=241): 64% female; mean age 16; asthma (16%); think oneself overweight (32%); family member with HIV (9%); sexually active (43%); same-sex attraction (7%); cigarette use (38%); marijuana use (24%); alcohol use (53%); suicide ideation (23%); witnessed violence (33%); and overweight and obese (31%). In 1988, students at these schools reported: sexually active status (41%); marijuana use (13%); cocaine use (12%); alcohol use (20%); and sadness/depression (43%). CONCLUSIONS: While a snapshot of the risk factors in 2003 might indicate that sexual activity has decreased somewhat, substance use, as well as eating-related and AIDS-related issues have come to the forefront. SBHCs continue to serve students with intense medical and psychological needs. It remains crucial that SBHCs provide comprehensive medical and mental health services.