The STFM Group on Community
Medicine
Educating the Reflective
Community Oriented Practitioner
Group on Community Medicine
STFM Toronto, May 2004
Presenters: JL Benson, A
Perkins, M Stearns, L Michener
Agenda
 History lesson: COPC lit & group on
Comm Med activities
 Play with Allen’s website for curriculum
(Perkins/group)
 COPC & ACGME competencies (Stearns)
 Making trouble-are we really working with
community? (Michener)
 Future plans-web & beyond (group)
What Is COPC?
Four process steps
 Identify the community of interest
 Identify the health problem
 Develop and implement interventions
 Conduct ongoing evaluation
One Minute History
of COPC
 Will Pickles, MD kept diligent records of
patient information in 7 rural villages in
England “epidemiology in a country
practice” 1939.
One Minute History
of COPC
 Sidney Kark, MD given team & developed
“comprehensive, curative, and
preventive service” named community
oriented primary health care in South
Africa, then Israel
One Minute History
of COPC
 U.S. “Community responsive initiatives”
in 1950s and 60’s for Native Americans,
Kentucky rural areas
One Minute History
of COPC
 OEO mandates to eliminate poverty
created funding for neighborhood health
centers in 60’s. Geiger goes to
Mississippi Mound Bayou in Mississippi
delta, Gibson-Columbia point NHC
One Minute History
of COPC
 IOM 1982 study and 1987 Nutting book on
COPC
One Minute History
of COPC
 APHA 1998 book “COPC Health Care for
the 21st Century”
One Minute History
of COPC
 Pathman & colleagues describe doctor
training 1998
COPC Lit Review,
2001 on
 Read “community-oriented primary care….” 2
part, Longlett, Kruse, Wesley, JABFP 2001.
 Update search: pub med/medline for
“community oriented primary care, 2001-2004
English only
 200 found, only 169 unique and 79 not COPC
 90 total COPC or close enough
 Where and what is being written?
COPC Lit Review,
2001 on
 Where done or written?
• Brazil, Bolivia, Peru, Finland, Netherlands, UK, S
Africa, Russia, Saudi Arabia, Jerusalem, India,
Canada….. & DC to NC to CA to Dallas
 What is being described?
• 3 types: service/care, policy, education
 Service/care:
•
Comprehensive care, seniors, leprosy, school
based health, mental health, child health, oral care,
pharmacy, hypertension, diabetes
COPC Lit Review,
2001 on
 Policy, history, exhortations
COPC Lit Review,
2001 on
 “Vague processes of client
representation need to be replaced
by robust community based
participatory research
models”(Cawston 2003)
COPC Lit Review,
2001 on
 In 18 wealthy OEDC countries,
“strong primary care system and
practice characteristics such as
geographic regulation,
longitudinality, coordination, and
community orientation were
associated with improved population
health” (Macinko 2003)
COPC Lit Review,
2001 on
 Sustained community health
partnerships display 5 key qualities,
“outcomes-based advocacy, visionfocus balance, systems orientation,
infrastructural development and
community linkages” (Alexander JA
2003)
COPC Literature,
2001-4
Education and curriculum
 Medical students, nurses, docs,
community health workers, teams
 Longitudinal project work
 Short-term training, rotations
 In-service education
Group on Community
Medicine Activities
 STFM group since 1990
• HRSA funding preferences inspired
new FP curricula experiments
 Special session, STFM Chicago 1998
• Curriculum from 6 programs
Group on Community
Medicine Activities
 Pre-conference, STFM San Francisco,
2002
• “Art walk” of 18 programs
presentations on
• Field visit with community activists to
environmentally-challenged SF
community
 Plans for web-site to share curriculum
 Beginning electronic discussion forums
• Funding, working with community
So What to Do Next?
 Review Community Medicine
Competencies
• How do we make them real, sincere, notjust-a-checklist?
 Reconsider our community medicine
work
• What does it take to work sincerely with
community?
 Decide on future community
medicine activities, conversations