Community Medicine
Developing an in-depth understanding of community health and the care of vulnerable and underserved populations is at the heart of our residency training philosophy.
We understand that healthy communities are the key to reducing health care disparities and that working upstream, before a risk factor has the chance to cause disease, often yields the greatest impact. Our community-oriented approach recognized the role of social determinants of health, adverse childhood experiences (ACEs), and the role the environment plays in supporting or preventing wellness.
This philosophy, along side the desire to graduate top-notch family doctors who are prepared to serve in any practice setting, underpins the Community Medicine curriculum.
Our residents are integrated into community clinics and the community at large. Rotations and continuity experiences provide our residents with skills unique to practicing in under-resourced environments and public health while developing connections with community partners. Through a partnership with the Vallejo City Unified School District’s (VCUSD) “Full-Service Community Schools,” our residents gain experience leading stakeholder discussions with community organizations to facilitate opportunities to improve the health and wellbeing of students, teachers, and parents. Additional experiences can include school-based health clinics, mentoring, and teaching. Through teaching sessions, we explore topics related to healthcare disparities, social determinants of health, culturally competent care, domestic violence, and more. We also integrate hands-on didactics including workshops, community mapping exercises, and service-based group activities.
Read more about our current community outreach activities here:
Required Community Medicine
In addition to elective time, there is required curriculum in each year of training supported by several dedicated faculty members and our own Community Medicine Global Health fellows.
PGY-1 residents rotate at La Clinica de la Raza, a local Federally Qualified Health Center (FQHC) in place of their own continuity clinic for an afternoon every 6 weeks. Residents also spend a two week dedicated community medicine rotation in several different community-based sites.
PGY-2 residents continue to rotate at La Clinica de la Raza in place of their own continuity clinic for an afternoon every six weeks. Residents on the outpatient surgery rotation spend Wednesday afternoons in a procedure clinic at La Clinica de la Raza supervised by our own faculty.
PGY-3 residents continue to rotate at La Clinica de la Raza in place of their own continuity clinic for an afternoon every 6 weeks. Residents spend two weeks at a single site as an immersion experience either locally or abroad. Examples include La Clinica de la Raza, a Global Health site, Indian Health Services, or working with migrant farm workers. Sites are selected in consultation with mentor/advisors and subject to approval.
Research Project: Over the course of the 3 years of residency training, each class collaborates with our Research Project Manager and Division of Research to design and conduct an IRB-approved retrospective cohort study using the Kaiser Permanente Northern California data set to investigate a research question identified by community stakeholders. The findings will inform future interventions to address the needs of the community or assess the impact of a program already in place. This research project provides residents with opportunities to create an abstract, poster presentation, conference presentation, Grand Rounds presentation, and/or a publication in a peer-reviewed journal. Past projects have looked at STI risk factors among teenagers, suicide ideation and attempt among teenagers, and the effectiveness of Centering Pregnancy.
You can learn more about the Youth Development Leadership Forum here:
Implicit Bias and Anti-Racism Curriculum
The goal of the implicit bias and anti-racism curriculum is for resident physicians and learners to explore the concepts of implicit bias and structural inequities, their historical and social roots, and the implications on healthcare disparities. Additionally, the participants reflect on their own implicit biases and learn mitigation tools to lessen the effects of implicit bias. The curriculum consists of 4 yearly workshops (about 2-3 hours each) built into the community medicine (CM) Thursday afternoon academic half day. The workshops focus on establishing a foundational understanding of implicit bias and structural racism and its implications to in clinical and educational settings. Specific topic areas and mitigation strategies are reviewed throughout the year. Workshops consist of opportunities for self-reflection, small group discussion, and large group discussions. Participants have an opportunity to discuss and apply new concepts and skills throughout the workshop. The topics rotate on a ~2-3 year cycle.
2018-2019
Session 1: Intro to implicit bias/ground rules/developing a shared language
Session 2: Intersectionality and Privilege
Session 3: Three levels of racism/implicit bias in teaching
Session 4: Combatting implicit bias/allyship
2019-2020
Session 1: Defining implicit bias/bias in healthcare
Session 2: Code-switching
Session 3: Combatting microaggressions
Session 4: Imposter syndrome
2020-2021: Change of curriculum to Implicit Bias and Anti-Racism
Session 1: Historical legacy of structural racism and oppression
Session 2: Racism vs Race in Medicine
Session 3: Racial caucusing/Having conversations about race
Session 4: Becoming antiracist: a personal journey for lasting change
2021-2022:
Incoming interns: Introduction to implicit bias and anti-racism curriculum
Session 1: Creating an equitable learning environment and mitigating implicit bias in teaching
Session 2: Creating equitable curriculum/presentations
Session 3: Creating equitable patient encounters
Session 4: Creating equitable learning environment workshop provided as service-area wide faculty development – additional residents able to attend who missed session 1
Bonus session: Belly of the Beast documentary viewing and discussion
2022-2023:
Incoming interns: Introduction to implicit bias and anti-racism curriculum
Session 1: Imposter syndrome – Systems and self-directed Action
Session 2: Code-switching
Session 3: Creating safe spaces: Addressing Microaggressions and gaslighting
Session 4: Allyship and Action
Each year:
- Set ground rules
- Provide context setting session with incoming interns
- Provide resources for further exploration, self-study (i.e. ACGME Equity Matters modules)
- Revisit/recap materials from sessions to date throughout the year
Resources:
- UCSF Teaching for Equity and Inclusion Certificate Resources
- Toolkit for Teaching about Racism (STFM)
- Various videos, Ted talks, books (see individual sessions for resources)
Global Health
The leadership of Kaiser Permanente Napa-Solano Family Medicine Residency Program values cultural immersion opportunities which promote competence to work with diverse populations and to cultivate a non-judgmental approach as healers. Global Health is thus offered as an integral component of Community Medicine, with the belief that local is global and global is local. While not mandatory, we actively encourage participation in international health electives and ask residents to consider global health sites for the required third year community medicine rotation. Residents may also use elective time for global health work. Our program emphasizes care for indigenous populations that reflect the diverse cultural backgrounds of Napa Solano’s minority populations. Residents are further supported through Kaiser Permanente Northern California Regional Graduate Medical Education with travel stipends up to $3500 annually per approved international rotation.
Global Health sites include:
- ENLACE Foundation, Taulabe, Honduras
- Hospital de la Familia, Nuevo Progresso, Guatemala
- Cacha Medical Spanish Institute, Rio Bomba, Ecuador
- Da Nang Orthopedic & Rehabilitation Hospital, Da Nang, Vietnam
- Tibeten Delek Hospital, Dharamsala, India
- The Tiba Foundation (Matibabu Clinic), Ugenya, Kenya
- University Teaching Hospital, Lusaka, Zambia
Read about recent Global Health experiences from our residents, fellows and faculty here:
http://taulabetalk.blogspot.com/
http://xelaguatemala2015.blogspot.com/
http://riobambaruminations.blogspot.com/
For more information, please visit our Global Health page.
Highlights and more!
By Kelsey Krigstein, MD, Class of 2019
- Why I Chose the Kaiser Permanente Napa-Solano Family Medicine Residency Program
- What Makes Kaiser Permanente Napa-Solano Special
- The Scope of Training at the Kaiser Permanente Napa-Solano Family Medicine Residency Program
- What I’m Doing Now and How Residency Prepared Me
- Community Medicine
- Some Final Thoughts About the Kaiser Permanente Napa-Solano Family Medicine Residency Program