- Revolutionizing the Training of Clinicians for the Poor and Underserved
A few years ago, while driving through one of the poorer areas of Detroit's inner city, I read graffiti prominently written on the side of an abandoned building, Revolution is the Hope for the Hopeless, and my passion to care for the underserved flared up. I know that a career in public health and medicine was within my grasp and that soon I would be in communities where hopelessness might be rampant. Reflecting back on that moment, I wonder if my training has prepared me to be a part of the revolution. Has it provided me with the knowledge and skills to change things for the poor and underserved?
Fact: In 2004, 45.8 million people were without health insurance coverage, which is an increase of 800,000 since the previous year.1, 2
These facts, the depressing but painfully real context of delivering health care services to the population having the least, but needing the most, bring to mind a quote by Hilfiker, "[n] ot only poverty, but inequality decimates the health of the people." Although those who are underserved are not always poor, those who are poor are almost always underserved. The Association of Clinicians for the Underserved advocates care as the path towards providing complete high-quality care for those who need it most. Our hope is that future health care clinicians and providers, current ones, and even those who have left because of what is grippingly called "compassion fatigue" can assist in initiating a peaceful, nonviolent revolution.
Change, however, must be undertaken mindfully, after exploring the possible directions. How successful is continuing education in changing the knowledge and skill set of existing clinicians? And, are those individuals who have the iatrogenic [End Page 6] compassion fatigue wanting to re-enter a world that threatened personal wellness? All these questions merit research.
By starting at the campus level, we can lay the groundwork of cooperative and comprehensive care by helping to break down traditional roles, fostering appropriate cultural and linguistic skills, and eliminating dysfunctional, antiquated systems of care. Bringing together future health care professionals of different disciplines with the common goal of caring for the poor and underserved helps establish a more holistic approach to health care, that addresses the whole continuum of prevention, treatment, and recovery. In the transdisciplinary approach to health care, members of the team must offer unconditional respect not only to their colleagues but also to their patients for their life experiences and knowledge.
Why advocate for revolutionizing the training of future clinicians working with underserved communities?
For quite some time, effective teamwork has been considered the means to achieve better outcomes, measured in terms of patient satisfaction and cost effectiveness.3,4 In 2001, the Institute of Medicine (IOM) released a report titled Crossing the Quality Chasm that examined the provision of health care in the U.S. The IOM recognized that there is a gap between the care currently provided and the care that could be provided to patients. Major themes of the report included:
1. the shift from acute to chronic care,
2. the need to integrate an increasingly growing knowledge of evidenced-based medicine and new technological improvements,
3. the increased emphasis on working in teams,
4. the complexity of the health care delivery system, and
5. the ever-evolving patient-clinician relationship.
Included within these major themes is the preparation of the workforce and the required skills that clinicians need to function most effectively. Again, there is an emphasis on interdisciplinary teams that will allow for better coordination, communication and standardization of care systems in order to have more patient-centered, continuous, and reliable care.5
The IOM further advocates the continual teaching of team practices. The Institute acknowledges that, while team practice is commonplace, opportunities for learning and training are few and the training of individual health professionals is often an isolated process.5 "People should be trained in the kinds of teams in which they will provide care, starting with initial professional training and continuing through graduate training and ongoing professional development [p. 210]."6
Training future clinicians in team care...