JeffSTARS:
One Student, One Resident,
One Step Toward Change
Columbia Physician Advocacy
Fellows Meeting
November 18-19, 2010
Esther K. Chung, MD, MPH
Associate Professor of Pediatrics
Jefferson Medical College, Thomas Jefferson
University
A.I. DuPont Hosp for Children/Nemours
JeffSTARS Overview
Req. Outpt Rotation
(Year-Round)
• Journal Club (monthly)
• Advocacy Café (weekly)
• Reflective writings
• Community Site visits and
reports
• Pre- and postassessments
Continuity Clinics (Yearly)
• JeffSTARS paper/talk
Intensive Elective
(1-3x/Year)
• Seminar series
• 50% time with a
community partner
• Mutually agreeable
project
• Legislative Advocacy Day
• Presentation
• Paper
• Cafés and Journal Club
Year 1 Progress: July ’09 – Sept ‘10
IMPACT
• 3rd year students: 138
• 4th year students: 15
• Pediatric residents: 52
• Family and community
medicine residents: 18
• Cafés: 58
• Community site visits:
approx. 90
• Community partners
• Advocacy
opportunities for
faculty
• Expansion to
Wilmington Clinic
• Website completion
• Community partners
• Campus partners
Community Site Visit - Examples
• WIC orientation and visit to neighborhood
offices
• Home visits with the MOMobile
• Trips to Harrisburg – Child Death Review
• EPA Hearing
• PSR Peaceful Posse groups
• PA AAP Advocacy Initiatives
• Child with Special Health Care Needs
workgroup
Mike Campbell, Esq., with two 3rd-year medical students in
front of Kendra Klein, MD’s poster on child abuse prevention
at the Community Partner’s Appreciation Lunch
Advocacy Cafés & Reflective Writings
Topics – examples
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Childhood obesity
Media violence
Child abuse
Teen pregnancy
Infant mortality
Access to care
Access to dental care
Car safety
Breastfeeding
Qualitative analysis of
writings
• Tone (detached,
engaged, passionate)
• Broadening perspective
(barriers, personal
experience, selfreflection)
• Empowerment
(passive/active;
generating
ideas/actions, attitudes)
Advocacy Café, Fridays, 1230 – 2 pm
Kurt Yusi, MS III, “Why don’t all clinical rotations have small
group discussions where we talk about advocacy?”
Language Barriers in Clinical Care:
Reflections from A.M., 3rd-Yr Pediatrics Resident
• “Advocating for ways to provide medical
care in a language the patient can
understand is important for all…involved:
patients, families, and physicians.”
• “The inefficiency that comes from
everyone hoping the patient speaks
English could be avoided. This is a
problem that needs to be dealt with headon, not when it’s just too obvious to
ignore.”
Refugee Clinic (Clinical Care) at Jeff. Peds –
Reflections from A.B., 3rd Yr Pediatrics Resident
• “The refugee clinic is…amazing…, and I’m
so proud that our residents will be a part
of it.”
• “I don’t know that I would have ever come
home from a regular clinic day and read
multiple articles about refugee camps and
international policy; the experience
undoubtedly leads to reflection.”
Community Site Visit to Harrisburg with PA
AAP – Resident Reflections
“This experience was significant in unveiling the
mystery of the legislative process.”
“I now realize how achievable it is to identify a
problem you feel passionate about, and work
towards a solution with the help of your state
legislators.”
“As a young resident, I feel energized and
empowered to work towards change for the
members of my community.”
Pre- and Post-Assessments
• Rise in subjective and mean objective knowledge scores
(17 vs. 23, p < 0.0001) for residents and medical
students, independent of anticipated specialty
• Rise in self-reported, comfort and ability to advocate for
children (mean score 24 vs. 28, p < 0.0001)
• Residents when compared to medical students were
more likely to vote in the past year (97% vs. 81%, p <
0.01)
• Higher advocacy activity scores were associated with
higher baseline mean objective knowledge scores (0-3:
15; 4-6: 17; 7+: 19, p < 0.01)
Elective Projects
• Launching a Refugee Clinic at Jeff Peds
• Developing a Toolkit for Teachers for Prevent
Child Abuse PA
• Developing Guidelines for the Transition of
Medically Complex Foster Care Children
• Developing Web Resources for Health
Professionals for Planned Parenthood
• Contributing to Reproductive Health Guidelines
with the Women’s Law Project
• JeffREP: Jefferson Refugee Education Partners
Recent meeting with Cheryl Bullock, Senior Advisor and
Southeast Regional Director for U.S. Senator Bob Casey
(Risa Yavorsky, MS III; Cheryl Bullock; Vicki Mui, MS III)
Goals for Year 2
• Expand community partners
• Delaware expansion
• Change to the JeffSTARS longitudinal
component
• Continue to take advantage of community
events
• Reassess volume of data collected
Thank you! Happy Thanksgiving!