Published in the June 2011 AAMC Reporter
By Whitney L.J. Howell
As she watched the teenagers discuss their new health information database, Tirza Cannon realized why getting communities engaged in their own health care is so important.
The teenagers were unveiling HealthShack.info, a Web site that gives marginalized and homeless young people a safe place to compile and access their medical information. For Cannon, a third-year student at the University of California Davis (UC Davis) School of Medicine, the Web site illustrated how to make the community a true partner in medical research.
“These young people talked eloquently to more than 100 people about how they helped design and implement a system to house medical information,” Cannon said. “That really drove home for me that physicians must be aware of the social, economic, political, and cultural factors influencing their patients.”
HealthShack is an example of a new kind of research that has gained ground over the past decade: community-based participatory research. This method unites investigators with communities to identify health problems, the best ways to study those issues, and how to design health behavior changes that the community is most likely to adopt.
Now, a growing number of medical schools like UC Davis are introducing this research method to their students. The National Institutes of Health and the Centers for Disease Control and Prevention sparked interest in this fledgling field in 2008 when they issued a call for grant proposals in community-based research. Since then, some schools have incorporated community-based research instruction into their curricula through individual studies or full classes.
Still, the method remains a relatively new concept, and finding the right way to teach it has been difficult. In fact, a 2009 study published in Academic Medicine reported that some medical schools and teaching hospitals may be reluctant to accept or encourage community-based research because their investigators have proven success with other methods.
Being familiar with this technique, however, will benefit students as medicine continues to shift its focus to prevention, said Elizabeth Miller, M.D., UC Davis assistant professor of pediatrics and adolescent medicine.
“The amount of didactic instruction that students have received on community-based participatory research has been variable at best,” said Miller, a faculty leader for the HealthShack project. “There’s been very little room in medical education to do this type of thing, but including it is vital because it teaches students early on how to really connect with the people they will serve.”
According to Miller, UC Davis will launch a community-based prevention program in July, in which first-year medical students spend a month tackling child and family wellness issues with community partners.
Jen Kauper-Brown, M.P.H., a director in Northwestern University’s Community-Engaged Research Center, echoed Miller, stressing that community-based research lectures alone are not as effective as real-world training.
“Community-based research is hard to learn in the classroom,” she said. “We have to provide experiential learning models that fuse faculty instruction with days spent working in the community.”
In 2012, Northwestern University Feinberg School of Medicine will introduce a community engagement course series that will place students in a research project, provide on-the-ground training for community-based research skills, and offer students ongoing feedback and support from faculty and peers.
Duke University School of Medicine teaches these concepts to incoming medical students through an interprofessional course in which they learn alongside physician assistant and physical and occupational therapy students, said Mary Anne McDonald, Dr.P.H., assistant professor at Duke’s Center for Community Research.
Students also work in prenatal health and telemedicine programs through the Arizona Cancer Center at the University of Arizona College of Medicine. To help students understand how community-based research is similar to clinical skills, Ana Maria Lopez, M.D., Arizona medicine and pathology professor and telemedicine director, often draws a parallel to a basic medical activity.
“I tell students that working with community partners is a lot like getting the vital signs for an individual patient,” Lopez said. “In order for this research method to work, we have to go talk to them, see what’s working, and change course if we need to based on what they tell us.”
With the growing popularity of community-based research, it is still challenging to ignite medical student interest and make participation feasible, said McDonald. The rigors of medical school and the short length of rotations make it difficult for students to cultivate the long-term relationships that are needed to succeed.
For now, that problem has no clear solution. Getting students excited about the idea that community-based research is the next wave of medical research will depend very much on the faculty role models involved in these projects, said Kauper-Brown.
Even though there is an ongoing debate about what types of research projects can correctly claim that they truly engage the community as partners, exposing medical students to research that immerses them in the community will only have a positive impact, said Doug Brugge, Ph.D., public health and community medicine professor at Tufts University School of Medicine.
“There is no substitute for real-world experience,” said Brugge, who also directs the Tufts Community Research Center and has conducted collaborations with several neighborhoods around Boston. “You can talk or read about working with communities, but you’ll never understand how complex some community’s issues are or how difficult implementing changes can be until you ask questions and listen. Some students are shocked to see that, and it’s an important thing for them to learn.”