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Vulnerable Populations

Although the health of all American has improved over more than two decades since the Task Force Report on Black and Minority Health (Heckler, 1985) was issued, racial and ethnic health disparities persist and, in some cases, have actually increased. The persistence of such disparities suggests that current approaches and strategies are not producing the kinds of results needed to ensure that all Americans are able to achieve the same quality and years of healthy life, regardless of race/ethnicity, gender and other variables (Graham, 2008). Dr. Frances Collins (2004), past-director of the Human Genome Project reached a similar conclusion and recommended that new research approaches were needed to reduce health disparities. In response to these findings the National Center for Medical Education, Development and Research (NCMEDR) aims to address the needs of various vulnerable populations, including: homeless personsLGBTq, and migrant worker populations and translate research findings into primary care training and practice guidelines.

Vulnerable Populations – Who Are They?

Vulnerable populations include the economically disadvantaged, racial and ethnic minorities, the uninsured, low-income children, the elderly, the homeless, those with human immunodeficiency virus (HIV), and those with other chronic health conditions, including severe mental illness.[1]. The vulnerability of these populations are enhanced by various factors such as, race, age, sex, socioeconomic status, and health conditions. These populations are at risk of poor physical, psychological, and/or social health. For the purpose of this project, Health Resources and Services Administration (HRSA) has defined vulnerable populations as Lesbian, Gays, Bisexuals, Transgender, and Questioning (LGBTq), homeless persons, and migrant farm workers.

Overview

Meharry Medical College was recently funded by the Health Resources and Services Administration (HRSA) to establish a new academic administrative unit under grant number UH1HP30348. The new center is an academic unit (AU) housed in the Department of Family and Community Medicine at Meharry Medical College through a cooperative agreement with HRSA to evaluate the evidence-base for primary care interventions targeting vulnerable populations to transform primary care training in medical education and clinical practice in Tennessee and within the United States. The goal of the center is to transform primary care training and clinical practice in the United States through curriculum transformation in primary care.  

The National Center for Medical Education, Development and Research (NCMEDR) goals are to 1) conduct systems-level research of evidence-based interventions for vulnerable populations to inform primary care training; 2) disseminate best practices and resources to primary care providers and trainees across the mid-South to improve clinical outcomes among vulnerable populations; and 3) establish a community of practice (CoP) that will promote the widespread enhancement and development of a diverse primary care workforce that will produce better health outcomes for LGBT, homeless and migrant worker populations. In addition, this new community of practice will assist the Center in identifying and providing curriculum transformation and innovation. It is anticipated that the CoP will give relevant and timely feedback on the development of toolkits including case studies for simulation, and provide educational models and coaching to primary care faculty to train residents and health professions students to deliver high quality, cost-effective, patient-centered care to vulnerable populations in underserved communities.

The Center anticipates by linking clinical knowledge with the expertise of basic, clinical, and social science faculty and community partners in this new Center that we will strengthen capacity for engaging in multi-level, transdisciplinary and inter-professional primary care research and training.  It is expected this engagement will assist other medical schools as they develop new curriculum to examine health disparities, health services, health equity, and primary care training from a systems framework using a life course model.

Therefore, the charge of the CoP for Vulnerable Populations is to assist us in the development, identification, research, and feedback on the application of new tools in medical education that will enhance teaching and modeling of the provision of health care services to vulnerable populations through feedback and dissemination of ideas on medical education to primary care departments across the United States.

The topics for our first year were to:

  • Identify how medical schools are teaching students to address implicit physician bias towards vulnerable populations; and
  • Find out how they are preparing students to introduce preventive measures such as Pre-Exposure Prophylaxis (PrEP) to vulnerable patients in order to prevent HIV.

Our second year topics will include how medical schools are teaching students to address:

  • Interpersonal violence across the lifespan; and
  • The effects of adverse childhood experiences in these three vulnerable populations.

Partnership

The Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services awarded Meharry Medical College an Academic Unit for Primary Care Training and Enhancement (AU-PCTE) grant to transform primary care training and clinical practice to improve the quality of health for vulnerable populations. Vulnerable populations are defined as lesbian, gay, bisexual, and transgender (LGBT), homeless persons, and migrant populations.

Mission

To use a systems-level research framework to identify and evaluate primary care interventions targeting vulnerable populations in order to be effective in transforming primary care training and clinical practice to enhance models of care for vulnerable populations.

Vision

To enhance primary care training for health care professionals in improving the quality of health for vulnerable populations.

About Meharry

Meharry Medical College is an academic health sciences center that exists to improve the health and health care of minority and undeserved communities by offering excellent education and training programs in the health sciences. True to its heritage, Meharry places special emphasis on providing opportunities for people of color, individuals from disadvantaged backgrounds, and others regardless of race or ethnicity; delivering high quality health services; and conducting research that fosters the elimination of health disparities. More...