Portal de Periódicos da CAPES

University of California, San Francisco, Fresno Latino Center for Medical Education and Research Health Professions Pipeline Program

2006; Lippincott Williams & Wilkins; Volume: 81; Issue: Supplement Linguagem: Inglês

10.1097/01.acm.0000225236.71811.1d

1938-808X

Katherine A. Flores, Bertha Dominguez,

Global Health Workforce Issues

The University of California, San Francisco, (UCSF) School of Medicine Fresno Latino Center for Medical Education and Research (LaCMER) began the development of its pipeline Health Professions Partnership Initiative (HPPI) in 1996. It was the culmination of much reflection on how to meet the health care needs of an increasingly diverse and underserved community in the Central Valley of California. Recognizing that a “home grown” health care workforce would assure cultural competence, we began to identify, motivate, and academically enrich the communities' disadvantaged youth. The UCSF Fresno Medical Education Program (MEP) is located in Fresno and is the School of Medicine's largest community campus residency program. LaCMER is a unit of the MEP. The targeted region is rural, and by all accounts the residents are among the poorest and most medically underserved of any in the state. Forty-four percent of the population is Latino, 6% is African American, and a significant percentage is from Southeast Asia. In contrast, less than 7% of the region's physicians are from these groups. Students enrolled in Fresno Unified Schools speak more than 120 languages and dialects in their homes. Poverty, especially among children, is a major barrier to health care and to scholastic performance. In the Central Valley, one child in four lives in poverty, and in Fresno County, the per capita income is slightly above $15,500 (32% below the state's per capita income average). At least 92% of students enrolled in the four feeder middle schools, which serve as the entry point into our educational pipeline, qualify for free or reduced lunch programs. The UCSF School of Medicine established the LaCMER to address the persistent gaps in access to health care among the underserved residents in the Central San Joaquin Valley and to diversify the health care workforce to reflect the characteristics of the population. A partnership with the community was created to create and sustain an educational pipeline in schools with many students from disadvantaged backgrounds. Building a Pipeline The pipeline's governance structure reflects a true collaboration formed by assuring a strong sense of community ownership among institutional partners. Our partnership council meets on a biannual basis, but communication amongst the partners occurs continuously. The council members are: UCSF School of Medicine; UCSF-Fresno Medical Education Program; University of California Office of the President; University of California, Merced; California State University, Fresno; State Center Community College District; Superintendent of Schools - Fresno County Office of Education; Superintendent of Schools—Fresno Unified School District; Community Hospitals of Central California; Sequoia Community Health Centers and the San Joaquin Valley Health Consortium, Inc., which is the local Area Health Education Center. In selecting target schools, we intended to work with a student population that mirrored the general community. We selected sites because of their demographics and their high economic need. Although our initial focus was at the university level, it was apparent that a strong academic math and science foundation in high school was needed. We began the Health Professions Preparatory Academy, or the Doctors Academy as it more generally became known. The “school within a school” design was endorsed because we wanted our kids to have access to a “full” high school experience. Students who attend the Doctors Academy are also involved in music, drama, leadership, and athletics. After the first year of the Doctors Academy, it became evident that many of our students were not academically prepared for the rigors of an accelerated high school program. Thus, in 2000, the Junior Doctors Academy was developed, which essentially mirrors the Doctors Academy program at the seventh and eighth grade levels. In this case study, we focus our description on Junior Doctors Academy activities. Partnership Programs Our pipeline begins with approximately 120 Junior Doctors Academy students from four middle schools, where educational enrichment and motivational activities are provided by the LaCMER and school staff. Partnership activities are detailed in Table 1. Drawing upon the pool of feeder middle schools, including selected county schools, recruitment and selection into the Sunnyside Doctors Academy generates a cohort of 50 high school freshmen each year. Math, science, and English comprise the core curricular focus of the Junior Doctors Academy and the Doctors Academy programs, where tutorials, mentoring, and counseling are offered to further help students excel in their studies. Saturday Academies, field trips, and summer internships serve to augment the challenging coursework. The strong partner relationship with the school administration and with school district leaders augments LaCMER's efforts with the Junior Doctors Academy and Doctors Academy students.Table 1: Programs and Activities of the University of California, San Francisco, Fresno Latino Center for Medical Education and Research’s Health Professions Partnership InitiativeTable 1: (Continued)Summer enrichment programs The LaCMER offers summer enrichment programs for Academy students consisting of a series of three six-week summer programs for the Doctors Academy and a one-week summer enrichment program for the Junior Doctors Academy. The planning and administration of these summer activities require considerable labor-intensive coordination. The LaCMER staff work closely with educational partner institutions, parents, students, and numerous health care providers and health care institutions. The one-week Junior Doctors Academy summer enrichment program is held at California State University, Fresno. The program emphasizes math, writing, reading, communication skills, leadership skills, goal setting, and an introduction to medical science. It includes a “Medical Mystery Festival” facilitated by University of California, Berkeley Lawrence Hall of Science and a “Science Mania” workshop provided by a California State University, Fresno, faculty. During this week, students receive a tour of the Downey Planetarium and visit the local Children's Hospital of Central California. For the ninth-grade students, the summer experience is a six-week prematriculation program focusing on developing health career awareness, good study habits, note-taking skills, group learning, interpersonal development, leadership skills, assertiveness for asking questions, introduction to research, and development of oral and written presentation skills. Included is a study trip to University of California, Davis and its School of Medicine. Students also receive a two-day blood pressure training workshop to prepare them for upcoming service-learning events where they participate in health fairs and other community fairs under the supervision of the school nurse. Parent empowerment workshops Parental empowerment is an important facet of our program. Increasing active participation in their child's education has been supported by the LaCMER and school sites. In the exit interview administered to the graduating Doctors Academy seniors, students reported that parents were the greatest source of encouragement for their achievement in school. Recognizing the importance of family and parental support, the LaCMER provides parents with workshops and parent meetings that offer them effective tools for advocacy and communication with school personnel, skills to enhance communication with their children, scholarship and financial aid workshops, and understanding the transition of parent and child roles as their children become adults and matriculate into college. Parents are provided with bilingual interpreters (Spanish and Hmong) and translated materials as needed. Through the evaluation process, parents provide feedback about the Academy programs and request topics for future parent meetings. The parent workshops are interactive and parents, at times, play a key role in co-facilitating small working groups. The purpose of these activities is to empower and assist parents so they may better support their children in their studies and preparation for college. Another purpose is the broadening of parents' roles to assist and encourage their children to take advantage of all opportunities offered by the program, including study trips to university campuses and health care settings. Parents are invited and often participate in study trips to universities and schools of medicine. Additionally, the LaCMER includes parents in key events such as the Medical Mania Conference and Junior Doctors Academy Award Ceremony. Junior Doctors Academy and Doctors Academy newsletters are sent to parents at the end of each school semester informing them of past and future events and activities of the Academy program. Service learning Our program requires all Academy students to participate in multiple service-learning experiences. The objective of these experiences is to instill altruistic values in each student. Under the supervision of the teachers and academic program coordinators, students become actively involved in community service events and health fairs where they interact with community residents. Students also participate in the Peer Smoking Cessation Program, the Health Occupations Student Association (HOSA), University Medical Center Children's Clinic Reach Out and Read Program, American Cancer Society “Buddy Check” Breast Cancer Awareness Program, Barrios Unidos Peer Health Educators, American Heart Association, Muscular Dystrophy Summer Camp, Make-A-Wish Foundation Toy Drive and Wrap-a-Wish Program; and Kaiser Permanente's Annual “Neighbors in Health” Clinic. Financial aid and scholarship workshops The Junior Doctors Academy has integrated the College Board CollegeEd curriculum that includes parents as key participants in helping their children plan and prepare for college. The curriculum includes 12 lessons that help students and parents identify the path to college, including how to foresee and overcome obstacles and develop a strategic plan in creating a college-going atmosphere. Included in CollegeEd is a section on demystifying financial aid and helping students and parents understand the process. Lessons Learned We have learned many lessons in developing our middle school and high school health professions pipeline. The most significant lesson is one that we understood when we started: that disadvantaged underrepresented minority students can be highly successful if offered an academically rigorous school curriculum and appropriate support. We also learned that parents and families will be highly supportive of their children's academic progression if offered information in a linguistically and culturally understandable manner. We learned that service learning is intriguing to youth, and that they are as eager as adults to “give back” to their communities. We learned that given the opportunity, our partners were willing to support many of our programmatic activities either in dollars or in in-kind support. We are clear that our partners value the outcomes of this program and are committed to working together with us to sustain as much as is fiscally possible. We have seen a cultural shift in the teachers' and parents' higher expectations of students, and we all recognize that we need to provide the support required to help students achieve at a higher level academically. Institutionalizing the Project Have we been successful? We have no doubts. The results of these partnership endeavors have been highly positive. Since 1999, 255 students have enrolled in the Sunnyside High School Doctors Academy, 655 students have received services in our middle school Junior Doctors Academy, and 1,274 college students have benefited from our HCOP program at California State University, Fresno. Our intent was to not only expose students to what they could be, but to also prepare them academically to be highly competitive to enter any institution of higher learning of their choice. From our first two cohorts of high school graduates, we have a 100% graduation rate and 100% acceptance into four-year academic institutions. These results have occurred in an environment where the high school dropout rate for Fresno County is 50% and the acceptance rate into four-year University of California schools and California State University schools is only 12% for the Central Valley. Another measure of success is the request from other school districts in the state to aid in the establishment of similar academies for their students. Although eager to be of assistance, funding sources limit how much we can offer. A significant measure of our success is the recognition on the part of our school district that they would like to institutionalize as much of the program as they can afford to. Should external funding cease for the Junior Doctors Academy and Doctors Academy, there will be key components of the programs that will remain intact due to the buy-in from the host institutions that recognize the importance of “growing our own” health professionals in order to meet the long-term needs of the community. Fiscal constraints continue to limit the amount of academic enrichment and support students and parents will receive, but with modification the sites will be equipped to maintain and institutionalize the following: Junior Doctors Academy AVID (Advancement Via Individual Determination) class with a focus on science and health CollegeEd curriculum. Without external funding it will be difficult to maintain will be the tutorials, study trips to universities, colleges, museums and health institutions, the summer program, parent workshops, writing workshops, and our focused academic intervention program for individual students. With the state's budget crisis, it will be very difficult for the district to offer more than the traditional basic-education program.