Community partnered projects: residents engaging with community health centers to improve care

Important residency curricular elements, including scholarship, quality improvement (QI), and community health, often exist as independent components. We developed a curriculum to train residents to become community-responsive physicians that included longitudinal care at a community health center (CHC) with a unique community-partnered project (CPP). We evaluated outcomes of one CPP and delineated challenges in implementing the curriculum.

After performing a needs assessment, the resident-CHC team designed a QI intervention to improve documentation of smoking status and cessation counseling. A chart review of 100 random patients assessed pre- and post-intervention documentation. Patient focus groups were held to guide the development of the final intervention, which included medical assistant (MA) education, appropriate patient education materials, and a visual communication system for MAs and providers. Curriculum evaluation via interviews with residency and community partners was done periodically throughout the 2-year process.

Focus group participants saw clinicians as a resource for quitting but did not want to talk about quitting at every visit. We reviewed 317 patient visits pre-QI intervention and 191 post-QI intervention. There were no significant changes in the percent of visits where smoking status was documented (82% versus 79%); however, smoking cessation counseling during office visits increased significantly (19% to 54%). Key challenges included academic-community communication and resident scheduling and availability.

In this CPP curriculum, residents made a difference in practice outcomes, and ongoing attention to challenges assisted with the project's success, possibly enhancing residents' likelihood of incorporating QI and principles of community health into their future careers.