The University of Tennessee Health Science Center (UTHSC) sits in the heart of Memphis, one of the poorest major cities in the country. Yet medical students at UTHSC rarely engage in things that directly affect their patients’ health. Issues like chronic stress, inadequate transportation, food deserts, or lack of health care coverage often take a back seat to the more traditional topics in medical education. Additionally, students have few opportunities to discuss why they went to medical school in the first place, or how their education relates to larger policy debates about health insurance and access. Kelly Jeu, a local Memphis doctor, says, “As a pediatric resident, we often know what is wrong with the child and the indicated treatment. However, we can’t always get the child what they need because of insurance approval or coverage, access to transportation, etc. Consequently, many children cannot be discharged safely or get lost to follow up.”
To address these inadequacies, local healthcare organizations offer a free certificate course called “Serving the Underserved.” Drawing on theories from narrative medicine, public health and urban studies, Serving the Underserved (STU) grew from a small handful of students in 2010 to over 400 graduates over the last seven years.
The course occurs yearly over six weeks for two hours in the evening. The curriculum includes readings and speakers from across the community on themes like “Understanding Social Determinants of Health” and “Treating our Patients, Treating Ourselves.” Everyone from patients to activists to professors to the mayor have joined the students for box meals provided by the organizers, and conversations about acute community health challenges.
The course was founded by leaders at Church Health, a faith-based ministry that provides healthcare for the working uninsured and promotes healthy bodies and spirits for all. It expanded to include support from Methodist Le Bonheur Healthcare, the largest health care system in Memphis. In recent years, the course has been coordinated by Dr. Susan Nelson, medical director at the Church Health clinic; Dr. Nia Zalamea, a general surgeon with an interest in international mission; and Rev. Jonathan Lewis, a hospital chaplain and campus minister for United Methodist students at UTHSC. Rev. Lewis says, “The response to the course has been tremendous.
To meet enrollment demands, we often have to create a waiting list for the next course offering. I think the students are eager to engage about these issues, and it also seems that this course meets a need not filled by anything else in their standard curricula.” While the course is not faith-based, many students enroll because they believe their faith compels them to provide healthcare to this particularly vulnerable population. Others cite the opportunity to connect with like-minded students, or a desire to better understand the state of their community’s health, as their reason for enrolling.
Interest in the course has remained high over the last seven years, with an average graduating class of 60 students. The course initially focused on M3 and M4 students, but has expanded to include students of all levels from all the schools at UTHSC including dentistry, pharmacy, nursing, and occupational therapy. After the first few years, it became clear that some students were retaking the class every time it was offered. Course organizers then changed up the speakers to ensure that students heard from a variety of perspectives. The focus, however, remained the same: introducing students to the effects of poverty on health, highlighting examples of how they could make a difference, and creating camaraderie among students to help them avoid the stress and burnout that often accompanies this work.
Molly McEwen, a M4 who is currently applying for a residency in pediatrics, completed STU in 2016. She says, “In STU, one particular activity stuck with me. We were given a certain number of Smarties candies to allocate to different resources for our ‘family’ (home, transportation, insurance, food, laundry, etc.). Then, the announcer would call out an event, like a big utility bill or repairing a car, that might cost two Smarties, and we had to decide what resource category to remove them from. Health insurance was often the first thing to go when our Smarties were running short. In pediatrics, you have many families who have multiple small children, or have a child with a chronic disease. This STU activity helped me to appreciate the tough decisions families in poverty face when there just isn’t enough money to feed the kids, clothe the kids, send the kids to school, and then throw in a hospital bill or expensive medications.”
The course also emphasizes the network of health professionals that are needed to meet the demands of underserved patients. Chaplains, social workers, case managers, and home health workers have contributed to a regular panel for STU students, the goal of which is to introduce students to assets they may not always know of or trust. Alex Galloway, also a 2016 graduate, highlighted the import of those connections and assets: “On my rotation at LeBonheur [Children’s Hospital], I saw firsthand the importance of team-coordinated care as social workers and case managers were part of rounds each day. Serving the Underserved helped me recognize family needs and the challenges they would face once they left the hospital. I hope I was a better listener and more empathetic to these families, but I know I was more understanding of the vital role that team members like social workers do for the overall care and well-being of children and families.”
STU has been so successful that national groups have looked to replicate its model. In 2016, the Institute for Healthcare Improvement (IHI)’s Open School launched an online course created by STU presenters and organizers. Dr. Zalamea; Dr. Kendra Hotz, professor at Rhodes College; and Mary Smith, a Memphis pastor, created “Introduction to Patient-Centered Care” for the IHI. Since its launch, 36,000 students have completed the IHI course. The course draws on years of lessons from Serving the Underserved, making what has worked in Memphis available to an international audience.