Training a new generation of physicians in population health

By Dennis Archambault

It’s hard for a medical resident to have a sense of history after a long day of clinical training. But most of the primary care residents training in the Authority Health teaching health center program, sponsored by the Detroit Wayne County Health Center, experienced history on Oct. 30 as the University of Michigan School of Public Health initiated its first population health certificate program. A mandatory component of the Authority Health curriculum, the two-year course will enhance the residents’ understanding of the social determinants of health and the potential of community-centered practice.

While there are training programs in preventive medicine and residencies that have public health components, nowhere in Michigan, and probably few training programs anywhere integrate the principles of population health into the primary care experience. As Phyllis Meadows, PhD, RN, associate dean for practice at the University of Michigan School of Public Heath explained, “You’re launching launching something that has never been done before… you are pioneers in health equity.”

The administrative and clinical leadership of Authority Health underscored that in explaining the program to around 50 residents.

David Kindig, M.D., emeritus professor at the University of Wisconsin Institute for Population Health, who co-chairs an Institute of Medicine roundtable on population health (Dr. Meadows is also a member of the roundtable), greeted the residents through a pre-recorded statement. Credited with having defined population health practice in America, Dr. Kindig recalled his days as a medical resident specializing in social medicine and reiterated his observation that progress won’t be achieved until there is reform in the payment incentives for providers. Society, he said, needs to make “paying for health” a goal.

The residents will attend nine sessions annually, each with one hour of lecture and one hour of group interaction. Additionally, there will be selected readings and six hours of independent study in a small group project. While those are the minimum requirements, Dr. Meadows offered a wealth of additional experience for residents who wanted a deeper experience.

“This is wonderful moment for us,” noted Chris Allen, CEO of the Health Authority. He worked with Dr. Meadows for over a year to conceive the program and design it so it works for a school of public health as well as the Authority Health medical training program. He and John Sealey, D.O., director of Medical Education for Authority Health, will present the program to the American Association of Teaching Health Centers in November.

Residents will learn about population health through “contextual reality,” “race and ethnicity,” “personal influences,” and “evidenced-based strategies.” There will be an ongoing assessment of resident progress, on a spectrum from awareness to understanding and action. There also will be assessment of this pilot course, for refinement in subsequent offerings.

In closing the program, Dr. Meadows predicted that “at the end of this experience, you will be different. You will think differently. You will work differently.” He offered a final assignment in advance of the first formal session in November: She asked residents, when they go to their community health setting the next morning, to pay attention to their surroundings. “See what you see, and what you don’t see. It’s not what you see, but what you don’t see.”

Dennis Archambault is director of Public Affairs for Detroit Wayne County Health Authority.