Neighborhood HELP™ trains 21st century physicians at FIU

A physician can prescribe an antibiotic, but that does no good for a patient without money to get the prescription filled. Written self-care instructions do a Spanish-speaking patient no good if written in English. And worst of all, those too poor to afford any medical care get no help for their health problems at all – at least not before the problem escalates to an expensive emergency room visit.

Because such issues profoundly influence patients’ health but may not be obvious in the exam room, FIU’s startup Herbert Wertheim College of Medicine is educating medical students in a revolutionary new way: During three years of their education, it sends them out to visit patients in their homes in low-income communities of north Miami-Dade. The holistic educational approach is called Neighborhood HELP™, or Health Education Learning Program, and the curriculum integrates ethics, public health principles, cultural competency and interdisciplinary expertise.

“Future physicians must understand communities and understand the ethics and morality of medicine and the responsibility they have,” says FIU President Mark B. Rosenberg.

“The program is, in essence, the largest fundamental change in medical education in this country in a hundred years, since the Flexner report” of 1910 prescribed two years of basic sciences followed by two years of clinical studies, says Pedro “Joe” Greer, M.D., founding chair and professor of humanities, health and society at the medical school.

Ambassador Steven Green, chair of the Green Family Foundation that endowed the initiative at FIU with a $10 million gift, agreed, saying at the initiative’s launch, “This is a program that will become a model for medical schools across the nation and around the world.”

Because the problems affecting these patients’ health go way beyond medical issues, each Neighborhood HELP team includes not just medical and nursing students but those from other disciplines: law, social work and public health. Patients are referred to the school by community organizations.

“This gets help to the families who really need it and where we can really make a difference in their lives,” Greer says.

Adds medical school founding dean John Rock, M.D., “We want to be a partner with the community for as long as it takes. We have adopted these neighborhoods, and we won’t leave.”

A hallmark of Neighborhood HELP is a socio-economically and culturally diverse group of students and instructors that mirrors the diversity of the patients they visit, notes Cheryl Holder, associate professor in the Department of Humanities, Health and Society: “Our medical students come from every different ethnic group and socioeconomic background, so our physicians reflect the 21st century physician.”

Greer notes that diversity increases the chance of cultural common ground and understanding, making interactions with patients easier and more comfortable: “Families see a doctor or student who looks like them, talks with the same accent. We believe we have an influence on some of the younger family members who say, ‘Wow I can become a social worker,’ or ‘Wow I can become a doctor.’ ”

The forward-thinking curriculum has helped FIU compete for promising medical students, Greer says.

“Many of the students hope to be role models and say they selected FIU’s program over other schools precisely because of the social mission,” he notes.

That was true for medical resident Michael Hann: “There are probably some great programs out there, but there was nothing as comprehensive as FIU’s program to get into the community for three years.”

“In the majority of schools, you maybe do one or two home visits,” explains Iveris Martinez, assistant professor and director of the college’s Green Family Medicine and Society Program. “With Neighborhood HELP, we’re doing something more extensive. We’re taking a longitudinal history of all household members, and we’re working with families on a particular issue that they’ve identified as a priority with the idea of graduating both the students and those families to sustainable change.”

Neighborhood HELP fits the 2004 founding principle of the College of Medicine to fill a community need for access to medical education and to address a regional shortage of physicians.

“Miami-Dade County, Florida, has one of the highest rates of uninsured residents in America,” says Green Family Foundation President Kimberly Green, also founding chair of the Medicine and Society Community Advisory Board. “While this presents tremendous challenges, it also presents … a perfect laboratory to explore health care solutions. From this kind of alliance we can learn from each other and effect real change.”

Already there are signs that the innovative program has become the model its leaders envision. The medical school receives frequent inquiries from around the country and the globe. Recently, Greer says, 14 people from California’s Kaiser Permanente School of Allied Health Sciences visited FIU to see Neighborhood HELP in action.