JeffSTARS: JeffSTARS: One Student, One Resident, One Student, One Resident,

One Step Toward ChangeOne Step Toward Change

Columbia Physician Advocacy Fellows Meeting

November 18-19, 2010

Esther K. Chung, MD, MPHAssociate Professor of Pediatrics

Jefferson Medical College, Thomas Jefferson University

A.I. DuPont Hosp for Children/Nemours

JeffSTARS Overview

Req. Outpt Rotation (Year-Round)• Journal Club (monthly)• Advocacy Café (weekly)• Reflective writings• Community Site visits and

reports• Pre- and post-assessments

Intensive Elective (1-3x/Year)• Seminar series• 50% time with a

community partner• Mutually agreeable

project• Legislative Advocacy Day• Presentation • Paper• Cafés and Journal Club

Continuity Clinics (Yearly)• JeffSTARS paper/talk

Year 1 Progress: July ’09 – Sept ‘10

IMPACT• 3rd year students: 138• 4th year students: 15• Pediatric residents: 52 • Family and community

medicine residents: 18• Cafés: 58• Community site visits:

approx. 90

• Community partners• Advocacy

opportunities for faculty

• Expansion to Wilmington Clinic

• Website completion• Community partners• Campus partners

Community Site Visit - Examples

• WIC orientation and visit to neighborhood offices

• Home visits with the MOMobile• Trips to Harrisburg – Child Death Review• EPA Hearing • PSR Peaceful Posse groups• PA AAP Advocacy Initiatives• Child with Special Health Care Needs

workgroup

Mike Campbell, Esq., with two 3rd-year medical students in front of Kendra Klein, MD’s poster on child abuse

prevention at the Community Partner’s Appreciation Lunch

Advocacy Cafés & Reflective Writings

Topics – examples• Childhood obesity• Media violence• Child abuse• Teen pregnancy• Infant mortality• Access to care• Access to dental care• Car safety• Breastfeeding

Qualitative analysis of writings

• Tone (detached, engaged, passionate)

• Broadening perspective (barriers, personal experience, self-reflection)

• Empowerment (passive/active; generating ideas/actions, attitudes)

Advocacy Café, Fridays, 1230 – 2 pm

Kurt Yusi, MS III, “Why don’t all clinical rotations have small group discussions where we talk about advocacy?”

Language Barriers in Clinical Care: Reflections from A.M., 3rd-Yr Pediatrics Resident

• “Advocating for ways to provide medical care in a language the patient can understand is important for all…involved: patients, families, and physicians.”

• “The inefficiency that comes from everyone hoping the patient speaks English could be avoided. This is a problem that needs to be dealt with head-on, not when it’s just too obvious to ignore.”

Refugee Clinic (Clinical Care) at Jeff. Peds – Reflections from A.B., 3rd Yr Pediatrics Resident

• “The refugee clinic is…amazing…, and I’m so proud that our residents will be a part of it.”

• “I don’t know that I would have ever come home from a regular clinic day and read multiple articles about refugee camps and international policy; the experience undoubtedly leads to reflection.”

Community Site Visit to Harrisburg with PA AAP – Resident Reflections

“This experience was significant in unveiling the mystery of the legislative process.”

“I now realize how achievable it is to identify a problem you feel passionate about, and work towards a solution with the help of your state legislators.”

“As a young resident, I feel energized and empowered to work towards change for the members of my community.”

Pre- and Post-Assessments

• Rise in subjective and mean objective knowledge scores (17 vs. 23, p < 0.0001) for residents and medical students, independent of anticipated specialty

• Rise in self-reported, comfort and ability to advocate for children (mean score 24 vs. 28, p < 0.0001)

• Residents when compared to medical students were more likely to vote in the past year (97% vs. 81%, p < 0.01)

• Higher advocacy activity scores were associated with higher baseline mean objective knowledge scores (0-3: 15; 4-6: 17; 7+: 19, p < 0.01)

Elective Projects

• Launching a Refugee Clinic at Jeff Peds• Developing a Toolkit for Teachers for Prevent

Child Abuse PA• Developing Guidelines for the Transition of

Medically Complex Foster Care Children• Developing Web Resources for Health

Professionals for Planned Parenthood• Contributing to Reproductive Health Guidelines

with the Women’s Law Project• JeffREP: Jefferson Refugee Education Partners

Recent meeting with Cheryl Bullock, Senior Advisor and Southeast Regional Director for U.S. Senator Bob Casey (Risa Yavorsky, MS III; Cheryl Bullock; Vicki Mui, MS III)

Goals for Year 2

• Expand community partners • Delaware expansion• Change to the JeffSTARS longitudinal

component• Continue to take advantage of community

events• Reassess volume of data collected

Thank you! Happy Thanksgiving!