Medical School Hotline

In the past century, medical educators have focused on the delivery of skilled practitioners that are trained to provide the highest quality of care possible.1 However a challenge for medical schools is not only to train skilled and competent practitioners, but to be socially responsible for the priorities and healthcare concerns of the communities in which they serve. This concept, known as “social accountability”, applies to both the medical school as an institution and the graduates that the school produces.¹

World Health Organization defines social accountability for medical schools as:

“…the obligation to direct their education, research and service activities towards addressing the priority health concerns of the community, region, and/or nation they have a mandate to serve.”²

Social accountability is not only a responsibility to the community, but also the act of being accountable. In the current healthcare system there are several growing healthcare concerns: (1) physician and healthcare professional shortage; (2) health professionals migrating to financially and socially attractive positions; (3) medically underserved populations; and (4) deficits in disease prevention and health promotion.³ To be accountable, medical schools need to fulfill their inherent obligation to alleviate these stresses in the healthcare system. This can be done by training a competent and socio-culturally aware health and biological science workforce, providing healthcare outreach and services to those in need, and conducting research to benefit health and well-being of the community.²

To demonstrate accountability, the University of Hawai‘i at Manoa John A. Burns School of Medicine (JABSOM) complied a report to the legislature exemplifying outreach programs, service projects, and research in which JABSOM faculty, staff and students have participated. The contents of this report are activities conducted during the 2011–2012 academic year at JABSOM. The report is categorized by senatorial district to show the impact of JABSOM on specific communities in Hawai‘i. The aim of the report is to show accountability and how JABSOM contributes directly to the community. The following are some of the activities highlighted in the report.

Education

The school's basic mission is not only to train high-quality physicians, but also to train biomedical scientists and allied health workers. Of the 469 registered students, 77% of whom are residents of Hawai‘i (fall 2012 enrollment), approximately 47% (220 students) are seeking (non-M.D.) degrees in other programs that include the following.

• Master of Public Health (MPH)

• Doctor of Public Health (DrPH)

• Doctor of Philosophy (PhD) in Epidemiology

• Master of Science (MS) or Doctor of Philosophy (PhD) in

  • Biomedical Sciences
  • Cell & Molecular Biology
  • Developmental & Reproductive Biology

• Master's Degree (MS) in Communication Sciences Disorders

• Bachelor of Science (BS) degree in Medical Technology

To address the needs of underserved populations, JABSOM's 30 year old ‘Imi Ho‘ola (“Those Who Seek to Heal”) Post-Baccalaureate Program provides educational opportunities for disadvantaged students who are selected on the basis of their commitment to serve in underserved areas in Hawai‘i and the Pacific. Many of these students are from these underserved communities. Of the 226 graduates (40% being Native Hawaiian ) 85% are practicing physicians in primary care, and 96% are currently working with underserved and/or disadvantaged populations.⁴

JABSOM's efforts to train a physician workforce addresses the growing healthcare workforce shortage in primary care medicine. Associate Professor Kelley Withy, MD has obtained funding from the State Loan Repayment Program, a grant funded under the Patient Protection and Affordable Care Act of 2010. The program extends a helping hand to assist physicians (allopathic/osteopathic), nurse practitioners, certified nurse-midwives, and physician's assistants who commit to serve for at least two years in public or non-profit private entities located in health professional shortage areas. The goal of this program is to improve the retention and number of primary care providers in medically underserved areas in Hawai‘i.⁵

A key step in the accountability for graduating medical students is to prepare graduates to work effectively with disparate populations and gain practical experience in community-centered models of healthcare delivery.⁶ One example is the training program of the Department of Family Medicine and Community Health. Its main ambulatory training site, the Physician Center at Mililani, is located in rural O‘ahu. It is the home-base for training JABSOM's Family Medicine students and residents. Students include medical residents, third and fourth year JABSOM students, UH Hilo College of Pharmacy students, and externs from various medical assistant training programs. The program is under the supervision of JABSOM faculty physicians and provides care to a diverse population. An objective of the program is to teach students to view patients in the context of their social, familial, and cultural backgrounds in making medical decisions. Education and hands-on experiences are provided on cross-cultural patient care, homelessness, and prison medicine.

Outreach

Underserved communities face many obstacles in the healthcare system that include problems with access to care and poor health outcomes.⁷ Medical outreach activities provide services to communities that might not otherwise have access to those services. JABSOM's chief outreach program is the Hawai‘i Homeless Outreach and Medical Education (H.O.M.E.) project. This project was established in 2005 and continues to provide medical service to the homeless at three homeless shelters on O‘ahu.⁸ In addition, the program conducts outreach services via a mobile van at O‘ahu beaches and parks. Medical services include care for acute and chronic illnesses, preventative health series, vaccinations, medical testing, and health education. The project has been integrated into the medical school curriculum as a year-long rotation for first year medical students. The students experience working in community organizations with homeless patients and have the option to serve as mentors for homeless teens, thus gaining knowledge and awareness in caring for the underserved.

As part of the excellence in training healthcare professionals, JABSOM's student groups provide voluntary outreach in the community. This includes students from the ‘Imi Ho‘ōla Post-Baccalaureate Program and JABSOM's Ka Lama Kukui (students who are interested in indigenous health). These student groups participate in outreach activities that include serving as mentors to disadvantaged high school students and conduct health screenings at community centers and health fairs. Hui Ola Pono, a Public Health Sciences student group, volunteers at Ho‘oulu ‘Aina, a place where community engages in the reforestation of Native Hawaiian species, restoration of ancient agricultural terraces, and development of a sustainable community food production system. Medical students also participant in the Healthy Keiki Can program that promotes the healthy development of Hawai‘i's youth by providing mentoring relationships that offer guidance, companionship, and support. Also in partnership with Big Brothers Big Sisters of Honolulu, medical students serve as mentors to elementary students who may be facing challenges in their lives.

Following are a few of the programs in which JABSOM Faculty, staff, and resident trainees participate.

• The Department of Psychiatry provides behavioral health geriatric care to nursing homes in Liliha, Kaimuki, and Nu‘uanu.

• The Department of Family Medicine and Community Health assists community leaders to promote aquaponics to families through education and workshops. A pamphlet on aquaponics was developed, which evolved into a newsletter called Ma Ka Hana Ka ‘Ike.

• Hui No Ke Ola Pono, the Department of Native Hawaiian Health Community Engagement Division conducted the Land, Food, and Health initiative program. This program combines diabetes self-management classes and activities that reconnect patients with Pacific concepts of land and health.

• JABSOM faculty and staff participant in Tar Wars, a tobacco-free education program for children; volunteers visit 4th-grade class-rooms in Hawai‘i to teach students how to avoid tobacco use through counseling and advising.

Service

A key component of social responsibility is service to promote better health for the community. The following are a few of the service projects and programs conducted by JABSOM in the 2011–2012 academic year.

• The Le‘ahi Clint Spencer Immunology Clinic, part of the Hawai‘i Center for AIDS, is the only specialized HIV/AIDS clinic in Hawai‘i, providing state of the art care to all HIV positive patients, regardless of their ability to pay. Approximately 5% to 10% of patients have no medical insurance, and are unable to pay for services. Regardless of their ability to pay, the clinic serves all HIV positive patients and does not turn away those in need.

• Volunteers from the Department of Surgery provided free plastic and reconstructive surgery to wounded and deformed American soldiers returning from the wars in Iraq and Afghanistan. Services are provided through the Iraq Star Foundation.

• The Department of Communication Sciences and Disorder's training clinic, in 2011–2012, provided free services to patients with speech, language, and hearing issues.

• The Perinatal Addictions Treatment Clinic, established by the legislature of the state of Hawai‘i, provides obstetric clinical services, addiction medicine services, social services, and counseling for pregnant women and new mothers who are struggling with substance abuse addictions. This year the clinic began offering education in early childhood development, which includes the particular harms that addictive substances can cause to children.

• Many JABSOM faculty members provide presentations and lectures to educate the community on healthcare issues, this includes topics of diabetic eye disease, diabetes management, nutritional promotion, and elderly care.

Research

It has been well documented that Native Hawaiian and Pacific Islanders have poor lifestyle behaviors and high prevalence of chronic conditions, compared to the overall population in the United States. This includes issues of obesity, smoking, and chronic conditions such as diabetes.⁹ It is apparent, the current state of healthcare in the United States is not fulfilling the needs of minority and underserved populations.⁷ Research, a critical component of a medical school's responsibility, must be conducted to find new more competent ways to treat patients, develop effective health interventions, as well as discover new knowledge in biological sciences.

JABSOM is the frontrunner in research on the health of Native Hawaiians, Pacific Islanders, and Asian Americans.

• The Pili ‘Ohana program, Department of Native Hawaiian Health, has been conducting community-based research to address obesity and related health disparities in Hawai‘i for over eight years. The aim of this program is to integrate community wisdom and scientific methods to combat obesity and reduce health disparities with Native Hawaiians and Pacific Peoples. Results of their program show a higher likeliness to maintain weight loss, compared to standard behavioral weight loss program.¹⁰

• The Fun 5 is a study that explored the implementation of a fruit and vegetable consumption and physical activity program. This study found that an afterschool program that emphasizes exercise and nutrition does have positive impacts on fruit and vegetable consumption and physical activity among elementary school children in Hawai‘i.¹¹

Additional studies conducted by JABSOM faculty include the following.

• Research on the effectiveness of palliative care approaches for underserved populations.¹²

• Understanding the needs of diabetes management in Native Hawaiian, Pacific Islanders, and Asian Americans.¹³

• Understanding ethnic disparities in smoking and smoking cessation.¹⁴

• Exploration of telepsychiatry for rural patients in Hawai‘i.¹⁵

Conclusion

This goal of this report is to exemplify JABSOM activities that demonstrate social accountability. It is well apparent that Hawai‘i has many healthcare challenges. Native Hawaiians, Asian Americans, and Pacific Islanders are disproportionately affected by chronic diseases such as diabetes, heart disease, and hypertension. Native Hawaiians have the highest percentage rate of obesity (42.8%) compared to any other racial/ethnic group in the United States.¹⁶ Native Hawaiians/Pacific Islanders are also disproportionally affected by infectious diseases, such as HIV/AIDS, at a rate of over two and half times that of White Americans.¹⁷ With the growing healthcare crisis and gap in health disparities, the contribution of a socially accountable medical school is critical in helping to close the gap. As such, social accountability cannot be accomplished alone. To be effective, collaborations with government and private sectors are a necessity. This is especially true since policy often dictates resources and economic allocation, ie, federal designations, appropriations, and grants.¹⁸ The Hawai‘i State Legislature and public and private institutions have supported and made possible many of the successful programs at JABSOM. Moving forward, there are many healthcare challenges ahead, JABSOM will continue efforts towards social accountability and its responsibility to the people of Hawai‘i.