Training Residents to Address Cancer Health Disparities
Abstract
Introduction
Cancer is the source of significant morbidity and mortality in the United States, and eliminating cancer-related racial and ethnic disparities has become an ever-increasing focus of public health efforts. Increasing workforce diversity plays a major role in the reduction of health disparities, and a well-trained professional workforce is essential for the prevention, control, and ultimate elimination of this disease.
Methods
To help address this need, the Public Health/General Preventive Medicine residency program at Morehouse School of Medicine (MSM) developed an innovative Cancer Prevention and Control Track (CPCT). We describe the structure of the track, funding, examples of resident activities, and program successes.
Results
Since the development of the track in 2007, there have been 3 graduates, and 2 residents are currently enrolled. Residents have conducted research projects and have engaged in longitudinal community-based activities, cancer-focused academic experiences, and practicum rotations. There have been 3 presentations at national meetings, 1 research grant submitted, and 1 research award.
Conclusion
The CPCT provides residents with comprehensive cancer prevention and control training with emphasis in community engagement, service, and research. It builds on the strengths of the diversity training already offered at MSM and combines resources from academia, the private sector, and the community at large.
Introduction
Cancer is the second greatest cause of death in men and women in the United States,1 causing 23% of deaths annually.2 The clinical and economic burdens of cancer are severe, with an estimated 1 479 350 new cases diagnosed in 2009 and over $228 billion spent on cancer-related medical care in 2008.3 Racial and ethnic minorities often have higher incidence and mortality rates as well as poorer survival rates from cancer than their non-Hispanic white counterparts.3 Increasing workforce diversity is important to reducing health disparities as it contributes to minority patient satisfaction and access to and quality of care, all of which may affect the development of these disparities.4 Workforce development initiatives designed to mitigate cancer health disparities focus primarily on oncologists5,6 rather than medical professionals trained in cancer prevention to address this issue at the community level.
We describe the design and implementation of the Cancer Prevention and Control Track (CPCT) in the Public Health/General Preventive Medicine residency program at Morehouse School of Medicine (MSM), a historically African American medical school whose mission focuses on training physicians to address the primary health care needs of underserved populations through programs in education, research, and service. Both MSM and the residency program have affiliations with governmental agencies, academic partners, nonprofit organizations, and community-based groups.
Curriculum Design
The CPCT is designed to follow the pattern of the existing preventive medicine residency program structure, with specific emphasis on cancer prevention and control in each phase. The program is composed of an academic phase and a practicum phase.
Academic Phase
Residents choose a track in the Master of Public Health (MPH) program as their area of focus. A specific cancer prevention and control focus is incorporated into the academic phase through 2 study courses: Cancer Epidemiology and Clinical Preventive Services. The cancer epidemiology course was developed to provide an overview of epidemiologic approaches to the most prevalent cancers. box 1 lists cancer epidemiology lectures and the faculty presenters. The Clinical Preventive Services course provides an overview of the specific screening guidelines for preventable cancers and is taught during the regularly scheduled educational seminars provided by the program. Seminar topics on cancer prevention and control are also incorporated in the program's weekly didactic sessions. This enhances the learning experience of all residents in the program and allows CPCT residents to share their knowledge with residents who are not in the track. Additionally, CPCT residents choose articles relevant to cancer-related research and policy for journal club presentations. This allows additional focus on cancer risk factors, policies, and health disparities.
Practicum Phase
Residents complete competency-based objectives designed for the preventive medicine residency program that reflect the cancer prevention and control focus. Residents complete 9 rotations during the practicum phase at the program's affiliated sites (box 2). For example, at the Georgia Division of Public Health, residents work with cancer prevention and control programs directed by the state of Georgia and its affiliated local health districts. Residents also rotate through the national American Cancer Society office where they assist in program planning, review, and implementation.
Additional activities include an experience in community-based participatory research (CBPR) at the MSM Prevention Research Center, which focuses on risk reduction and early detection in African American and other minority communities. This experience consists of didactic sessions covering topics such as principles of CBPR, community engagement, health communications, and program evaluation. The sessions culminate with resident participation in a local radio program in which they present a cancer prevention and control topic and respond to questions from the call-in audience. Residents can participate in community board meetings and assessment, intervention, and evaluation components of ongoing projects. Through the center's Cancer Prevention and Control Research Network, residents participate in cancer prevention and control projects in colorectal, tobacco-related, and prostate cancer.
Residents have a “research home” in the Cancer Prevention Network of the MSM Prevention Research Center. CPCT residents identify a cancer-related research project by the end of their first year and pursue it as the topic of their master's degree thesis in the MPH program.
Residents are required to submit at least one abstract of their cancer research to a national meeting each year. In addition to the CBPR experience, all residents receive a longitudinal assignment to a church in an underserved community. Residents receive the longitudinal community assignment shortly after entering the residency program and spend at least 30 hours per semester at the sites for continuity activities and serve as public health consultants to the church. They design, implement, and evaluate health promotion activities related to cancer disparities, prevention, and control. Churches initially became used as community assignment sites in an effort to assist the local American Cancer Society (ACS) unit in meeting its community outreach goals.
Results
Since receiving the grant in 2007, the program has successfully recruited 5 residents for the CPCT. Three residents have completed the program, and 2 residents are currently enrolled. Their experiences reflect a multidimensional training experience to prepare them to address racial and ethnic cancer disparities.
The 3 program graduates are African American women in their mid-30s, who have completed master's thesis projects with a cancer focus, and who have presented at the annual meeting of the American College of Preventive Medicine. One graduate was awarded “Best Cancer Prevention and Control Poster” at the 2010 national meeting. All program graduates have accepted employment opportunities that reflect the aim of the grant. Two graduates are developing careers in teaching and cancer research at academic medical institutions, and another graduate has entered the Epidemic Intelligence Service at the Centers for Disease Control and Prevention.
Residents also integrated cancer prevention and control activities into their longitudinal community assignments at local churches. One resident assisted the church with writing a grant to support a cancer prevention and control program within the congregation. The resident also planned cancer education activities, participated in the Pennies for Leukemia Patients campaign, and wrote cancer prevention and control articles for distribution in the church's weekly bulletin. Three residents were trained as facilitators for the “Body and Soul” program, an evidence-based, faith-based cancer prevention initiative funded by the National Cancer Institute and ACS.
Finally, residents evaluate their experiences in the CPCT through 3 mechanisms: the program evaluation system, the ACS funding guidelines, and resident portfolios. All program residents complete a formal assessment of the content and supervision of each rotation. Additionally, residents provide feedback on their training experiences to the program administration during their semi-annual evaluations. In adherence to the grant requirement, residents in the CPCT submit a final report summarizing their academic and practicum activities in the track to the funding agency. Third, residents record their experiences quarterly in learning portfolios, which are reviewed by each resident's advisor as well as the residency program director and associate director and are discussed with the resident after each review.
Discussion
The MSM Public Health/General Preventive Medicine residency program has experienced early success with its CPCT. Residents have acquired comprehensive cancer prevention and control training with an emphasis in community engagement, service, and research.
The major limitation of the CPCT is the small number of residents in the track. This necessitates that the cancer prevention and control is often taught as directed study courses. This problem will be alleviated with the implementation of a newly funded cancer prevention and control focus within the MSM MPH program. This addition will enhance the potential for continuing the CPCT should ACS funding end.
CPCT resident experiences have been strengthened through a strong, longitudinal affiliation with the local ACS unit and national headquarters. It is expected that residents' experiences will translate into a life-long commitment to cancer prevention and control. This program serves as a model for other residency and fellowship programs that may have an interest in developing specialized training through cancer prevention and control tracks or rotations.
Author Notes
All authors are at the Morehouse School of Medicine. Beverly D. Taylor, MD, is Director of the Public Health and General Preventive Medicine Residency Program and Interim Chair of the Department of Community Health and Preventive Medicine; Ayanna V. Buckner, MD, MPH, is Associate Director of the Public Health and General Preventive Medicine Residency Program; Carla Durham Walker, MA, is Residency Program Manager of the Public Health and General Preventive Medicine Residency Program; and Ijeoma Azonobi, MD, MPH, is a graduate of the Public Health and General Preventive Medicine Residency Program.
Funding: The Morehouse School of Medicine Public Health/Preventive Medicine Residency Program receives funding from US Department of Health and Human Services Health Resources and Services Administration (grant D33HP19039), American Cancer Society (grant PTAPM-07-094-05), and Georgia Board for Physician Workforce.
The authors wish to thank Virginia Krawiec, Program Director of the Physician Training Awards in Cancer Control at the American Cancer Society. The authors also wish to thank the faculty and staff who participated in training residents in the Cancer Prevention and Control Track.
