Academic medicine : journal of the Association of American Medical Colleges
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The community health center (CHC), or neighborhood health center as it was originally known, was an innovation developed under President Lyndon Johnson's War on Poverty to address the needs of poor urban and rural Americans. The ranks of CHCs have grown from 8 pilot health centers in 1965 to more than 1,100 health centers serving over 19 million Americans in 2012. The capacity of CHCs is limited by the availability of primary care clinicians (physicians, nurse practitioners, and physician assistants) who are trained to work in these settings. ⋯ This new federal initiative aligns the graduate medical education (GME) mission of preparing competent professionals with the CHC mission of providing quality and comprehensive care; it also helps address health care reform and the need for more primary care clinicians. Of the first 21 THCGME grants, 15 (71%) were awarded for family medicine residency training. As Chen and colleagues suggest in this issue of Academic Medicine, the THCGME program is an important step in reform of GME financing and training.
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The primary-care-oriented Teaching Health Center Graduate Medical Education (THCGME) program funded by the Patient Protection and Affordable Care Act of 2010 offers opportunities to explore alternative solutions to such graduate medical education (GME) policy issues as institutional indirect educational costs, variations in trainee-related productivity gains, and the program costs of GME innovations. THCGME reporting requirements may also provide data on the impact of various educational innovations on career choice and clinical care as well as other information that could be useful in devising a more transparent and equitable system of support for GME. THCGME program advocates should, however, be cautious in applying any lessons learned to broader GME policy reform. ⋯ Furthermore, the organizational infrastructures established, program leaders developed, data collected, and lessons learned from the program can inform more fundamental change in U. S. GME payment policy.
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Recent research indicates that the cultural competence training students receive during medical school might not adequately address the issues that arise when caring for patients of different cultures. Because of their unique communication, linguistic, and cultural issues, incorporating deaf people who use sign language into cultural competence education at medical schools might help to bridge this gap in cross-cultural education. ⋯ Because medical students better acquire cross-cultural competence through hands-on experience rather than through lectures, the DSH program, which includes a role-reversal exercise in which medical students play the role of the patients, provides such a model for other medical schools and health care training centers to use in teaching future health care providers how to address the relevant cultural, linguistic, and communication needs of both their deaf patients and their non-English-speaking patients. This article describes the DSH program curriculum, shares findings from both medical students' short-term and long-term postprogram evaluations, and provides a framework for the implementation of a broader cultural and linguistic sensitivity training program specific to working with and improving the quality of health care among deaf people.