Virtual Mentor. August 2011, Volume 13, Number 8: 539-543.
The Underserved Pathway—Fostering Medical Student Interest in the Care of Vulnerable Populations
The Underserved Pathway at the University of Washington School of Medicine helps prepare future physicians to work with underserved populations by providing a foundation of practical knowledge and real-world experiences.
Shannon U. Waterman, MD, Amanda Kost, MD, Rachel Lazzar, MSW, and Sharon Dobie, MD, MCP
The University of Washington School of Medicine (UW SOM) is a regional primary care medical school serving five states in the Pacific Northwest United States. Washington, Wyoming, Alaska, Montana and Idaho (WWAMI) together constitute over 25 percent of the land area of the United States, with 35 percent of this region’s population living in rural areas. The mission of the school includes “meeting the health care needs of our region, especially by recognizing the importance of primary care and providing service to underserved populations.”
In “Who Is Caring for the Underserved?” Grumbach et al. state:
Fostering Student Interest in Underserved Care
Founded in 2006, the University of Washington School of Medicine Underserved Pathway (UP) provides curricular focus and support to students interested in the health and care of underserved populations. Between 2008 and 2009 the first 14 UP students graduated. Initially funded with Health Resources and Services Administration Title VII funds, Underserved Pathway faculty currently receive funding from the dean of the School of Medicine with staff support provided by the Department of Family Medicine.
The UP helps prepare future physicians to work with underserved populations by providing a foundation of practical knowledge and real-world experiences. As an elective, longitudinal, supplemental curriculum in the School of Medicine, the UP is open to all medical students. Students can complete the pathway or take advantage of the offerings without earning a certificate of completion .
UP goals are that students acquire a knowledge base about underserved communities and populations, have the opportunity to discuss issues affecting these communities with other students, and reflect on their role as future physicians. The hope is that students will ultimately practice in these areas. Longitudinal data regarding UP student residency choice and practice patterns is not yet available.
What is Meant by “Underserved”?
The UP defines “underserved” as individuals or populations who are disadvantaged because of inability to pay, lack of access to comprehensive health care, or other disparities for reasons of race, religion, language group, or social status.
Structure of the Underserved Pathway
UP staff and faculty assist each student to design a pathway tailored to his or her interests and career goals. Students may study broadly, focus on a specific populations or communities that interest them, or explore health policy and advocacy.
Several core elements characterize the UP (see fig. 1), providing pedagogic and practical grounding in the fundamentals of caring for the underserved.
Figure 1. Core elements of the Underserved Pathway.
Completion of the UP is based on fulfillment of the required elements. Students do not receive grades or credit; they receive a certificate of completion, and recognition is included in the medical student performance evaluation (dean’s letter) upon successful completion of pathway requirements.
The pathway conducts exit interviews with all graduating UP participants and with any student who leaves the pathway without completing it. These interviews gather feedback about student experiences and explore potential enhancements of the UP. All modules and coursework have built-in evaluation surveys which students are encouraged to complete.
Future activities of the Underserved Pathway include review of existing and development of new online modules, continued expansion of the mentorship network, and standardization of the program evaluation process. Since its inception, the UP has also worked close with the other School of Medicine pathways, including the Indian Health Pathway , the Global Health Pathway , and the Hispanic Health Pathway .
The Underserved Pathway is now a fundamental requirement of the curriculum for a new UW SOM program called TRUST. The Targeted Rural Underserved Track (TRUST) grants admission to a cohort of medical students through a secondary application and separate interview process. TRUST guides qualified, committed students through a special curriculum that connects underserved communities in Washington and Montana to the UW SOM and its network of affiliated residency programs to help meet the workforce needs of the region. As TRUST develops, it will expand to include Wyoming, Alaska, and Idaho .
Shannon U. Waterman, MD, is a clinical instructor at the University of Washington School of Medicine in Seattle. She is a faculty advisor for the Underserved Pathway and a faculty member at the Roosevelt Family Medicine site.
Amanda Kost, MD, is an assistant professor, a faculty advisor for the Underserved Pathway, lead advisor for family medicine, and a faculty member at the Harborview Medical Center site of the University of Washington School of Medicine in Seattle. She oversees the introductory preclinical family medicine preceptorship.
Rachel Lazzar, MSW, is the program coordinator for the Underserved Pathway and the Community Health Advancement Program (CHAP) service-learning project in the Medical Student Education Division of the University of Washington School of Medicine’s Department of Family Medicine in Seattle.
Sharon Dobie, MD, MCP, is a professor in the Department of Family Medicine at the University of Washington School of Medicine in Seattle, where she maintains a full-spectrum clinical practice and advises medical students and residents. She is the director of the Underserved Pathway and the 2010 recipient of the UW Sterling Munro Public Service Teaching Award.
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