Behind the White Coat: Residency Program-CBO Partnership Spotlights Social Determinants of Health

January 25, 2019

In ongoing support of our members’ efforts to incorporate population and community health into optimal health care delivery, GNYHA has increased its social determinants of health programming. One GNYHA project, Improving Collaboration Between Primary Care Residency Programs and CBOs, partnered primary care residency programs in 15 member hospitals and health systems with community-based organizations (CBOs) to train residents on how to address social needs of patients to achieve better health outcomes for the community.

Christina Guillén, MD, Assistant Professor of Pediatrics and Program Director for the Pediatric Residency Program at SUNY Downstate Medical Center, participated in that project, which was funded by the New York State Health Foundation. Dr. Guillén is also a graduate of the SUNY Downstate residency program. She spoke with Anu Ashok, GNYHA Associate Vice President, Graduate Medical Education and Physician Workforce Policy, on her experience with the project and her work to make social determinants of health a part of her residents’ training experience.

Anu Ashok: Why have you made social determinants of health such a big priority within your residency program?

Dr. Guillén: SUNY Downstate Medical Center is located in East Flatbush, Brooklyn, where our pediatric residents care for children and their families who struggle with consequences of health care disparities. Our patient population often faces obstacles, whether housing or education or poverty, and we have a responsibility to help them and to better understand their world with respect. That’s where the communication and dialogue began. I felt it was important that our residents appreciate the impact of social determinants on the health of children and their families.

AA: What have you observed outside the GME world on the hospital’s role in addressing social determinants of health?

CG: There is a unique community/academic/government partnership between SUNY Downstate’s Brooklyn Health Disparity Center, Arthur Ashe Institute for Urban Health, and the Office of the Brooklyn Borough President. The overall goal is to eliminate health disparities by bringing diverse partners to the table. SUNY has done a lot of work that resulted in community-based approaches to reducing health disparities, including promoting healthy lifestyles amongst the patient population in Brooklyn facilitating access to care and forums for the community to learn about social determinants and their impact on health disparities.

AA: How has the emphasis on the importance of community-based experiences evolved since you trained as a resident at SUNY Downstate?

CG: I didn’t get this kind of exposure while I was a resident. It definitely has grown as an area of importance for residency training. At the time, we had a Social Pediatrics elective and community-based Developmental-Behavior Pediatrics experiences but no formal Community Pediatrics or Pediatric Advocacy rotation, so I developed one to ensure that residents have the skill set to address social determinants of health. As faculty, with the encouragement and support of my institution, I participated in a mini-fellowship in Community Health and Advocacy. As a general pediatrician in primary care, you are a resource hub for everything, and you should be able to not only coordinate care, but also ensure that psycho-social needs are met. In my practice, I access community-based organizations a lot to help support my patients. Our residents must be capable of doing that as well.

AA: Can you describe the partnership that formed with the Young Adult Institute through SUNY’s participation in GNYHA’s Improving Collaborations between Primary Care Residency Programs and CBOs project?

CG: Young Adult Institute (YAI) is a CBO that works with patients with intellectual and developmental delays. Downstate residents had the opportunity to participate in the [GNYHA project with YAI] over three weeks in Spring 2018. I met with the residents beforehand and said, “You need to respect where you’re going and understand that you may know about medicine, but YAI knows everything about what is done there.” The first week was an introduction for the residents to understand the purpose of YAI. The second week the residents met members of “In My Shoes,” a group of men with intellectual and developmental disabilities, and discussed their experiences navigating the health care system. The residents toured YAI to see all their services, that include developing skills for traveling, public transportation, and engaging in the community. During the last week, the residents visited the medical and dental clinic.

Throughout the program the residents were asked to send me reflective narratives. It was very touching to see how they honestly said, “When I went there, this was not what I expected, but it was such a humbling experience. I learned so much, like how I have to change my behavior as a doctor and how to approach my patients that have developmental disabilities and their families.”

AA: What feedback have you received from the residents on these new experiences? Have you been able to observe any changes in outcomes?

CG: The feedback has been great. We had a Grand Rounds in the residency program last year that featured our participation in the GNYHA project. I wanted faculty to see what our residents are doing and where the residency program is going. The residents who participated in the GNYHA project talked about how they want it to be part of the curriculum. I could see them discussing with other residents how they were going to change their practice in specific ways [as a result of their experience with the GNYHA project]. That they want more of these opportunities speaks to their engagement and the fact that this is important to them, and it is important to me and our Department.

Since participating in the GNYHA project, things seem to have exploded in a positive way. I integrated electives on health disparities in the resident educational curriculum, we have a new elective for the LGBTQ community and a Community Pediatrics Advocacy elective. There is a heavy involvement in community-based initiatives.

AA: What advice would you give to a fellow program director who is interested in pursuing a CBO partnership for their residents?

CG: First, conduct a community needs assessment to identify the CBO that suits the population you serve and their concerns—because a lot of times we think we know what they need, but we don’t. When you choose a CBO, make sure that you discuss mutual goals and expectations. Get to know who they are and let them know who you are and about your institution, and why you want to partner with them. Educate residents before they start going to the CBO or doing any type of community advocacy because understanding social determinants of health or health disparities is essential to why they’re doing what they’re doing as residents.

Please click here to watch a short video on SUNY Downstate’s experience at YAI.