Center for the Advancement of Underserved Children

Research
Research project with mentors, Master’s degree program, fellowship seminars and thesis advisory committee

Education
Faculty development, fellowship seminars, precept residents and medical students, child health policy and advocacy, practice opportunities and presentations

Administration
MCW and department meetings and committees

Professional Academic Skills
Networking, grant proposal preparation, oral and poster presentations and preparing scientific manuscripts

Activities for Fellows with Clinical Degrees
Primary and/or inpatient care limited to 8 hours weekly by federal rules, clinical seminars and grand rounds and minimal call responsibilities

Earnestine Willis, MD, MBA, Pediatrics Fellowship Director
Effectiveness of community-based interventions, insuring the uninsured, racial/ethnic disparities, community health, health policy, medical education and poverty

John Meurer, MD, MBA, Pediatrics Fellowship Co-Director
Care coordination, education and case management for children with asthma, clinical quality improvement, asthma and medical injury epidemiology

Sharon Busey, MD
Preventive care

Lisa Zetley, MD
Foster care

Margaret Layde, MD
Lead poisoning

Community Pediatrics Educational Objectives

1. Assess and address the cultural and non-medical influences to improve health of children in their communities;
2. Provide culturally-competent, family-centered, coordinated and community-based care utilizing community strengths and assets;
3. Implement a collaborative community-based initiative with community-based organizations and other professionals, as a part of an interdisciplinary team;
4. Advocate for children with other professionals locally, regionally and nationally.

Community Pediatrics Key Components

1. Core Curriculum (Pediatric Level, PL 1-3)

• Expand knowledge and attitudes about social and cultural influences on health
• Develop skills in multi-dimensional team interactions
• Noon conferences
• Mandatory month-long block rotation

2. Community Experiences (PL-2)

• Expand ability to apply concepts and skills into community projects with the guidance of faculty and community mentors
• Completed during month long block rotation

3. Faculty Development

• Enhance interactive teaching techniques through quality improvement processes

4. Parent Development

• Enhance use of real life experiences to augment learning

Community Pediatric Staffing

Earnestine Willis, MD, MPH, Medical Director
Michael C. Weisgerber, MD, Residency Director
Elizabeth Nelson, Program Manager

Parents are an under-recognized resource in educating professionals. Low-income families experiencing barriers to healthcare offer a unique opportunity to teach residents about their real-life experiences. Since the inception of the Dyson Initiative (2000), parents have been incorporated into the community pediatrics rotation.

Parents are identified by partnering community-based organizations and are invited to participate in each 4-week community pediatrics rotation. These parents share their knowledge and insight of life experiences and are encouraged to attend core curriculum sessions. Prior to an orientation, parents fill out a Consumer Experience Survey to assess their level of participation in various social service agencies and partnering community-based organizations. Prior to attending the sessions, parents participate in a five-hour training including their roles and responsibilities and watch a 45-minute video on the life of a resident. Parents interact with residents on a daily basis as they work in teams to improve child health outcomes.

Definition: Parents are representatives of diverse communities that seek and benefit from the services offered by the community

Parent roles and responsibilities:

1. Combine talents with other members of the team

2. Share valuable life experiences about your life and the lives of your family that contribute to the expansion of residents' knowledge regarding living in the community

3. In sharing experiences and story telling consumers must:

• Relate to the topic being discussed
• Share only the experiences that feel "right" and are comfortable for them
• Speak sincerely and honestly about the situations that affect them and their concerns

4. Be willing to learn and teach others:

• Ask questions when they have doubts related to a topic
• Explore and share the things in common with other members

5. Listen with openness. Give attention to what others have to say

6. Be well prepared and willing to participate actively in discussions:

• Find out about the topic prior to the session to be able to actively engage yourself
• Keep account of your experiences brief

7. Be responsible and reliable:

• Be present and on time when you commit to a session or meeting

Since 2000, we have trained over 55 parents to assist in teaching residents since the initiation of this Training Initiative. On average, parents attended 2.3 sessions per month and have contact with the program for one year. Interviews with parents reveal that they perceive themselves as assisting residents in understanding real life and being a vital community resource. In addition, they also gained knowledge about how physicians think and respond. Written feedback from pediatric residents completing block rotation reported that parents offer a point of view that would normally go unheard.

Parents and pediatric residents find it mutually beneficial to incorporate parents into teaching residents. They provide a wealth of knowledge about community resources and real life experiences, adding depth to the curriculum topics. They also gain knowledge about the profession and how to interact. Parents who complete the orientation have a vested interest in the residents education. They are valuable resources to the education of medical professionals.

Generous financial support for parent participants has been awarded from the Milwaukee Area Health Education Center since 2006 and the Bob and Linda Davis Family Fund of the Greater Milwaukee Foundation.

To move beyond the traditional pediatric residents' community education paradigm, our specific mission incorporates community-based, collaborative interactions to enhance residents' effectiveness in providing family-centered, community-based, coordinated care to address health disparities with a culturally sensitive approach.

Pediatric residents participate in Community Pediatrics throughout their three years of residency training. Participating community-based agencies benefit from the residents' work on their selected community projects. The greater metropolitan community, itself, benefits from modest, but important, improvements in health disparities at the local level. And the residents benefit from ongoing personal and professional growth through self-awareness, reflection, and valuing the integrity and experience of other experts, including families.

Community Pediatrics serves both as a public health and as a community-based participatory research model for determining the most effective methods of training pediatricians to actively promote the health and well-being of all children in partnership with our community-based organizations.

This training program was designed with vital community input from our multi-faceted, community-focused partners. Our community partners have made significant commitments of their time and resources to the development, implementation and sustainability of this education program. Collectively, we have invested 10 years in the Community Pediatrics rotation to assure its educational success.

These modules are highly interactive, and are taught by a rich group of faculty teams. The faculty teams include professionals and consumers from a variety of dimensions.

The multi-educational core and elective curriculum modules (PDF) provide an overview of the elements of multi-dimensional, family-centered, community-based care. Through activities to expand their personal knowledge base, participants gain understanding of the factors that impact the development and health of children and families who have traditionally been underserved. These factors include poverty, culture, race, political and systems issues. They likewise gain greater insights into their individual beliefs and values.

Finally, participating individuals acquire an array of skills, including teamwork, communication, and advocacy skills.

Begun in 2000, our program in addition to nine other pediatric residency training programs is undergoing a national evaluation through the Dyson Initiative National Evaluation (DINE) of the Johns Hopkins University; Bloomberg School of Public Health, Women's and Children's Health Policy Center. The evaluation of the DINE is designed to describe its impact in comparison to the potential changing/growing focus on community pediatrics in U.S. pediatric residency training programs. This requires collecting information that assesses concurrent related changes among non-Dyson funded residency programs and among their residents/graduate pediatricians. National findings are summarized (PDF) from two surveys of a national sample of pediatric residents (2001 and 2006), surveys of pediatric residency program directors (2002 and 2006), and one national survey of practicing pediatricians (2004).

Locally, Community Pediatrics utilizes a competency and exposure evaluation tool to assess the core curriculum and the pediatric residents' increased understanding of its core competencies. Since 2000, for both exposure and competency, there was a significant difference pre- and post- for all 5 main groups. The pediatric residents’ (175) improved their level of exposure and competency (PDF) after their training. Baseline ratings in the domain of team-building were relatively high in the initial self-assessment, indicating that pediatric residents felt competent in this domain before the Community Pediatrics rotation began. Pediatric Residents perceived the greatest changes in their exposures and competencies related to system-based practice, child advocacy, poverty impact on children, and professionalism/diversity.