As part of its Population Health pillar, the CTSI is supporting a resident in the University of Rochester General Preventive Medicine and Public Health Residency program. The Preventive Medicine Residency, which is within the Department of Public Health Sciences, places an emphasis on epidemiology andpopulation health skills, as well as the skills needed to improvedelivery of preventive healthcare to individuals. The training program is at its core multi-disciplinary with residents itslearning by completing work central to the mission of numerousdepartments both inside and outside the Medical Center. These include the URMC Department of Patient Safety and Quality Improvement, the Center for Community Health, the National Center for Deaf Health, the Monroe County Department of Public Health and the American Cancer Society.
Elizabeth Helm, M.D., M.P.H., recently completed her Preventive Medicine residency, and spoke with CTSI Stories about her experiences.
Can you give a brief overview of the residency?
Part of the 2-year program is a Masters in Public Health, which definitely gave me a better appreciation of the health care system, epidemiology in general, and the changes from the Affordable Care Act.
Another core components of the residency are the practica rotations, including two required rotations. One is at the County Department of Health, which was a 3-4 month rotation, and that was incredibly useful. We learned about the resources available to the public in terms of immunization, tuberculosis, STD screening, treatment, and so on. It’s important as a physician to know what types of things are available to people, especially those without insurance, but I didn’t really know about all ofthose services from any previous curriculums.
The second required rotation is quality improvement, which lasted about 3 months. From that, I got a much better understanding of how quality improvement works within individual practices and a hospital system, as well as the governing bodies that require these quality improvements. We did this rotation on quality improvement with Dr. Panzer. It was eye opening to me because I didn’t realize that a lot of this stuff is mandated by CMS and Medicaid services. So if we want to remain accredited, these quality improvement projects aren’t optional. More importantly, quality improvement projects allow us to take better care of our patients and help others do so as well, potentially with less effort as system changes can make our jobs easier by providing automatic reminders or minimizing the likelihood that a human error gets through to a patient.
Aside from those two, the rest of the rotations are flexible?
Yes, and that ties into one of the most important things I want to share about this residency: The administration is incredibly supportive. Whatever you want to get out of this, they will help. For example, my co-resident really wanted to do occupational health and ended up focusing many of her elective rotation around this subject (which is a sister specialty to Preventive Medicine focusing on the different types of workers as individuals and populations) For me, that didn’t end up being as much of an interest, but I got to focus more on global health. In fact, I did my thesis on a global health issue, regarding the diet of pregnant women in Tibet, analyzing data collected by Tim Dye, Ann Dozier, Nancy Chin and others at the medical center and in Tibet.
So what other rotations did you end up selecting?
I did do one in occupational health, where we learned how people’s exposure at work can relate to their health, and how you can use the workplace as an opportunity to provide health care teaching and health screenings and things like that.
I did a rotation at Passport Health, a travel clinic run by the University of Rochester School of Nursing,which is where people go before they go abroad. When I came to URMC, I knew from the beginning that I wanted to live and work abroad,so that rotation helped me because it helped familiarize me with the health risks in various countries.
I also did a rotation at the American Cancer Society, which helped me understand nonprofits, how they function, and some of the extremely useful work that goes into it.
Another favorite rotation was at the Center for Community Health. I learned a lot about community engagement and enjoyed the opportunity to teach medical students about how to keep involved with community health improvement efforts throughout their careers. I also spent time at the Healthy Living Center learning how to apply Self-Determination Theory to help people quit smoking, lose weight and follow healthly lifestyle habits under the direction of Geoff Williams, M.D., Ph.D and his staff.
Finally, I also enjoyed my mini-rotation at the National Center for Deaf Health. I learned a ton about the barriers that the Deaf face in learning about healthy lifestyle habits let alone obtaining quality health care.
When you started, you already had a residency in family medicine. Why did you decide on a residency in preventive medicine as well?
When I finished my family medicine residency, I did kind of struggle with whether I should do this because I was already boarded in one thing. But, at that point, I was really burnt out clinically — I wasn’t loving the day-to-day work, because it seemed really constrained by the system. So I thought this would be a great opportunity for me to get more of a big-picture look, and that maybe a better understanding of the system would help me appreciate the day to day more. And I do think it really broadened my perspective on health care in general and what some of the problems were, and how we can work on solutions even in small units and in individual practices.
It really helped me renew my faith in the health care system, because I saw how big and complicated it is. Instead of being frustrated at how quickly I had to see patients, or how limited I was in addressing their issues, I saw that there’s a lot going on behind the scenes, and change is slow because the system is so big, so you can’t just get frustrated. You’ve got to work with what’s available instead of saying “The system doesn’t work.” Because it’s the system we live in, so we all have to make the best of it.
Who would you recommend this program to?
For medical students I would say that if you know you’re interested in a broad picture — in treating a population rather than an individual — this might be a good fit for you, especially if you’re finding the day-to-day clinical work frustrating. And for people who have done a clinical residency, like I did, then I’d recommend it for those who want to have a good understanding of clinical research and epidemiology and public health interventions, and how you can improve the health of a community, not just the health of your patients.