Thriving Urban Service Track Enters 2nd Decade at UConn Health

UConn Health's Urban Service Track has enrolled more than 500 trainees from across six health professions, serving the underserved while teaching a team-based approach to care, and becoming a national model.

Kara Anastasiou takes a patient’s blood pressure as part of a migrant farm worker clinic medical intake in 2007. At the time she was Kara O'Brien, graduate adult nurse practitioner trainee at the UConn School of Nursing. She and medical student Robin Deutsch (left) were part of the first cohort of Urban Health Scholars. (Photo by Petra Clark-Dufner)

As a UConn dental student, Nancy Wong envisioned herself providing care to underserved and low-income patients.

As a graduate student in the UConn School of Nursing, Kara Anastasiou had an eye on improving health care systems.

As a UConn medical student, Kate Anderson had aspirations to overcome health care disparities.

Their origins and destinations are different, but all three had a common path: UConn Health’s Urban Service Track, which starts its 11th year this fall.

“UST teaches all of us that you can be a health care professional and combat health care disparities in your daily work, across health care disciplines,” Anderson says.

From left: Urban Health Scholars John McCarthy (today a pharmacist), Kate Kubler, (today Dr. Kate Anderson, family medicine physician) and Katie Rose Crevier (today a nurse) were team leads for the 2010 Connecticut Mission of Mercy dental clinic in Middletown. (Photo by Petra Clark-Dufner)

Through its first decade, the Urban Service Track has enrolled nearly 550 students from the UConn Schools of Medicine, Dental Medicine, Nursing, Pharmacy, and Social Work, and from Quinnipiac University’s physician assistant program.

“I learned about different underserved populations and learned the value of collaborating with other health professionals in order to provide comprehensive care to these patients,” Wong says.

The trainees work together as they learn to overcome socioeconomic, cultural, and professional barriers to the delivery of care.

“There’s a tremendous interest in interprofessional collaborative practice, working with and learning from other health profession disciplines and faculty members, working with vulnerable underserved populations, and service,” says Petra Clark-Dufner, the program’s director.

“UST provides an amazing format for ideal collaborative, interdisciplinary service for the urban underserved, translates easily into any care environment, and the returns are exponential and long-lasting compared to the demands and efforts you put in,” Anastasiou says.

Roots in Primary Care

A translator and Urban Health Scholars from the UConn Schools of Medicine, Dental Medicine, and Pharamcy observe Dr. Bruce Gould performing an exam at a migrant farm worker clinic in 2010. (Photo by Petra Clark-Dufner)

UST is a program of the Connecticut Area Health Education Center (AHEC), born at UConn Health a decade earlier under the leadership of Dr. Bruce Gould, associate dean for primary care at the UConn School of Medicine and Connecticut AHEC director. The concept is to improve access to health care by connecting community groups with health professions training resources. Trainees, under the supervision of mentors, gain real-world experience caring for the underserved.

“AHEC has become the vehicle to promote primary care and service and underserved care at UConn,” Gould says. “It has, in that regard, been quite successful in changing culture and promoting primary care.”

For medical students in the program, an interest in primary care is preferred.

The Universal Health Care Foundation of Connecticut (known then as the Anthem Foundation) provided $50,000 in seed money for the Urban Service Track, originally conceived to have three or four students each from UConn’s medical, dental, nursing and pharmacy schools. Gould hired Clark-Dufner as the coordinator. A pilot in 2006 had some elements of what UST would become.

“It wasn’t until August 2007 that we actually admitted our first cohort, a total of 24 students, which was much greater than we expected,” Clark-Dufner says. “And that has been the story ever since.”

Urban Health Scholar Maggie Stevenson educates children about the importance of oral health at the Greater Hartford NAACP Family Celebration in 2013. Stevenson currently is an internal medicine resident at Deaconess Medical Center.  (Photo by Petra Clark-Dufner)

Today up to 60 students are selected from across the professions to join UST each fall, and between 160 and 170 students are involved in the program at any given time. Their participation ranges from two to five years and varies by discipline.

“I think it’s especially important to try to have a diverse workforce with the training we give, which is viewed through the lenses of vulnerable populations,” Gould says. “The whole curriculum is taught by saying, ‘Here are veterans, here’s addiction, here are the homeless,’ and these different populations, which is not the same way they learn in mainstream health professions training programs. They are aware of those populations but I think the experience they get through the Urban Service Track is more robust and real.”

Wong recalls, “My UST mentors challenged me and pushed me beyond my comfort zones, which has allowed me to grow personally and professionally.”

The curriculum was built on results of surveys of federally qualified health centers (FQHCs), asking, When a new hire crashes and burns in six months, what was missing from their undergraduate and graduate education?” The surveys were asking about all health care disciplines, not just physicians, at a time before interprofessionalism was a widely accepted concept.

The program expanded in 2011 to include UConn social work students and P.A. students from Quinnipiac.

“The Urban Service Track brings together students of different schools to foster primary care education and commitment in a concerted interprofessional manner,” says Dr. Bruce Liang, dean of the UConn School of Medicine. “Its emphasis on dedication to the underserved is a model for our medical students.”

The Changing World of Health Care Delivery

Urban Health Scholars provide oral screening and education at a 2008 migrant farm worker clinic in Windsor under the guidance of Dr. Ruth Goldblatt. (Photo by Petra Clark-Dufner)

The Urban Service Track embraces the vision of a team-based, patient-centered medical home. Clinical training opportunities—such as those at FQHCs, primary care facilities in underserved areas, community health fairs, homeless shelters and migrant farm worker clinics—reinforce this.

“We have been preparing our students to deal with the reality of their future,” Clark-Dufner says. “A physician who’s been an Urban Health Scholar doesn’t hesitate to pull that nurse in, to pull in that pharmacist. Our students literally are committed advocates for team-based care. They’ve experienced it. They’re comfortable working with other disciplines and professions, and they bring a mindset of advocacy and seamless teamwork.”

Gould believes the team-based approach is more efficient, costs less, and provides better outcomes than what the current American health care system offers.

“Students will benefit from what they’re going through, understanding complex care and social determinants of health and how to deal with diversity, as well as how to function as a team,” Gould says. “What we’re hoping to do is create a cadre of practitioners that will be the providers, the leaders, and the policymakers going forward.”

And the Connecticut AHEC has become a national model for experiential learning for interprofessional groups of students focused on care for the underserved, Clark-Dufner says.

Where Are They Now?

From left: Urban Health Scholars Michaela Morse, Nancy Wong, and Lanting Fuh went to Washington, D.C., in 2013 for the National Association of Community Health Center Policy and Issues Forum, which engages more than 2,000 clinicians, policy makers and health advocates for the underserved. Today, Morris is a nurse at Hartford Hospital and is pursuing a master’s in nursing at UConn, Wong is a dentist at a community clinic in Torrington, and Fuh is a pharmacist at an academic health center in Colorado. (Photo by Petra Clark-Dufner)

Anastasiou was part of the first Urban Service Track cohort in 2007, and was an Urban Health Scholar the entire time she was studying for her master’s in nursing. She says she chose to study at UConn because of the UST.

Graduating as an adult nurse practitioner, Anastasiou went on to work at two federally qualified health centers. Today she is an adult nurse practitioner at Trinity College Student Health Services.

“Trinity has an amazing health center that keeps holistic patient-centered care at its core,” Anastasiou says. “It is expected and regularly encouraged that providers seek out interdisciplinary collaboration. I have been impressed with the diversity of the student body and regularly call upon my UST education during care. I also discuss UST with interested students, highlighting the importance of open-mindedness, communication, advocacy, and policy formation, with consistently enthusiastic reception.”

Wong graduated from the UConn School of Dental Medicine in 2015 and was in the fifth UST cohort. Today she practices general dentistry at the Community Health and Wellness Center of Greater Torrington.

“One of the most valuable lessons that I have learned from UST is that in order for patients to receive comprehensive care, collaboration among the different health professions must occur,” Wong says. “I think that every day of my dental practice is essentially the Urban Service Track in action because I provide care to the underserved on a daily basis. I treat a lot of medically compromised patients with various social issues and I feel like my UST experience has adequately prepared me to manage this patient population.”

Anderson was an Urban Health Scholar from 2008 to 2013, which included a research year looking at interprofessional mentoring in addition to her four years of medical school. She went to rural Maine for a family medicine residency, and remains there today as an attending physician.

“I continue to have the opportunity of working intimately with social workers, physician assistants, nurses, pharmacists and dentists, throughout a given week of medical practice,” Anderson says. “I didn’t want to work anywhere that didn’t respect how vital interprofessional collaborative practice is to patient wellness and best outcomes.”

And for students considering the Urban Service Track?

“The knowledge, skills and attitudes that UST will endow you with will make you an exceptional health care professional,” Anderson says. “Soak it up!”

The Connecticut AHEC is holding a dual anniversary celebration Sept. 15 at the Pond House at Elizabeth Park in West Hartford—20 years of AHEC and 10 years of UST.

“Everybody told us we couldn’t do this.” Clark-Dufner says. “Fast forward, we’ve just admitted Cohort 11. Not only did we do it, but we did it well!”