Community Driven Approach

Health professionals education represents one of the South's major successes….. despite increases in the overall supply... serious problems of distribution of professionals to geographic, subspecialty, and public service areas of need continue, except for those situations in which carefully coordinated strategies have been directed to specific problems. - Southern Regional Education Board 1983             

Why is it 2002 and we have yet to fully implement these strategies? Why, when we have successfully implemented these strategies in a few select locations, blessed by leadership and vision and dedication, do we continue to ignore these successes and pass this on to the rest of the nation and the world?  - RCB

Rationale for an Integrated Approach by Carlton and Weston in Academic Medicine (2000) 75: 721-723.   http://www.academicmedicine.org/cgi/content/full/75/7/721

Community Driven Medical Education - article and description
Assessing Community Orientation of Medical Schools
The Evidence for Community Driven Approaches in construction
Community Driven Approach: The Rural Component
Centralization and Regionalization  state system obstacles
Community Friendly Aspects
Community Role in Rural Med Ed
Community Driven with links
Why a Preceptorship Is Better
Dispersed or Decentralized Training
Best Admissions, AHEC info, and Complete Rural Medical Schools
Nebraska's Rural Training Programs
WWAMI Model
The Case for Involvement in Rural Communities- Rural Faculty Development Through A Different Approach
Meeting the Needs of Underserved Rural and Inner City Areas with Accelerated Programs
McLennan County FP Residency, integrating procedures, public health, hands on, foundation, care for underserved
Reforming Medical Ed To Meet Rural Needs
What It Would Take To Have More Rural Physicians - Efforts at the Community Level
Ultimate Recruitment Experience
The Three R's Ripen, Recruit, Retain
CORE Program, Residents Serving Small Towns

More and more we are understanding that the solutions to complex health care situations involve working closely with clinicians, the community, and academics. The best solutions for minimizing the negative impact of substance and alcohol abuse involve this kind of approach.

"This community study lends support to the belief that the ability of a community to attract physicians is closely related to the ability of that community to confront problems and take necessary actions" Bruce and Norton, Improving Rural Health 1984 p 66

The Old Testament prophet Jeremiah said: " . . . seek the peace and prosperity of the city to which I have carried you into exile. Pray to the LORD for it, because if it prospers, you too will prosper."   Jeremiah 29:7       Indeed the rural physician's fortunes are tied to the community and vice versa, even when he or she has had no previous contact with it.

"Physicians occupy an unusual spot in the social structure of rural communities. From an economic standpoint, they are successful entrepreneurs, well-paid business people similar to bankers and lawyers. On the other hand, they are also social servants like policemen or teachers, just as essential to the welfare and functioning of the community but paid for through a fee-for-service mechanism outside of local community control. This anomalous status requires some fairly innovative interpersonal and structural relationships to strike a workable balance." Rosenblatt and Moscovice, 1982

Chronology of Community Driven from local schools to med school to practice to health policy

Community Oriented Primary care

http://www.familypractice.com/journal/abfpjournal_frame.htm?main=/journal/1998/v11.n01/1101.04/art-1101.04.htm

From Tom Rickets on page 32 at http://www.iom.edu/iom/iomhome.nsf/WFiles/Disparities-Ricketts/$file/Disparities-Ricketts.pdf   Thomas Mettee offers an approach to the development of a larger set of options for building  within the COPC structure when he integrates the idea of community diagnosis into planning for community health (Mettee 1987). He develops the ideas of Edward McGavran to view the "community as patient" ascribing a hierarchy of needs, like Maslow's, to the community. Maslow saw the individual's needs for nutrition, air and water as basic; followed by safety, then family and society through self-esteem to independence and finally growth. The community hierarchy of needs is depicted in Figure 3 and describes the most important needs of communities as, first, clean air and water and safe food; then safe housing, medical care and fire and police protection; moving up to growth and prosperity. Mettee, Thomas M. 1987. Community diagnosis: a tool for COPC. In Community Oriented Primary Care: From Principle to Practice , edited by P. A. Nutting. Albuquerque, NM: The University of New Mexico Press.