The Transforming Education and Community Health (TEACH) program is a federally-funded primary care training program for residents interested in caring for the medically underserved and becoming leaders in academic General Internal Medicine (GIM). The long term goal of the TEACH program is to improve access to high quality health services by training GIM physicians who provide well-coordinated, evidence-based, culturally competent care to underserved adults with chronic illness.

The UC Davis Health System, in partnership with the County of Sacramento Department of Health and Human Services have developed an innovative model of GIM education to serve the medically underserved of Sacramento County: the TEACH program. Although UC Davis Health System turns no one away from the hospital, the uninsured have difficulty obtaining outpatient follow-up, due in part to local primary care physician shortages. Furthermore, Sacramento is one of the most ethnically diverse counties in the United States, providing a unique setting for teaching culturally competent care. This community-based university collaborative program is aimed at reducing health disparities as outlined in Healthy People 2010, and increasing the number of primary care physicians in medically underserved communities.

The County of Sacramento Primary Care Center (CS-PCC), a new 100,000 sq ft comprehensive ambulatory facility that provides nearly all out-patient services to the region's medically underserved.

TIME magazine and the Civil Rights Project of Harvard University recently identified Sacramento as the most racially/ethnically integrated major city in America.

According to the California Department of Finance, nearly 20% of Californians were uninsured and 12% lived below the poverty level in 2001. Ethnic minorities are overrepresented in this statistic: 22% of Hispanic and 22% of Black Californians live in poverty. Approximately 200,000 Sacramento County residents are uninsured and ethnic minorities are the most rapidly growing segment of this population. The county population is 1,279,900, and the unemployment rate is 4.7%.

The CS-PCC patient population is approximately 30% Hispanic, 30% Caucasian (of which a substantial proportion is Russian speaking), 25% African-American, 10% Southeast Asian, and 5% other ethnicities. Over 70,000 annual outpatient visits occur at the CS-PCC and 22% patients require use of an interpreter. Primary languages spoken include: English, Spanish, Vietnamese, Hmong, Russian, Mien, and various Chinese dialects.

Because continuity is central to caring for ethnically diverse patients, all hospitalized patients are followed up by their personal resident physician in the hospital discharge clinic and in the TEACH clinic. TEACH continuity clinics are held at the CS-PCC and the in-patient component occurs at the UC Davis Medical Center. This experience allows the resident physician to care for patients during their acute illness, during their recovery, and in follow-up care.

The TEACH program is a yearlong experience that replaces the traditional third year of residency. TEACH residents spend 3 afternoons per week in continuity clinic at the CS-PCC and rotate through other university specialty and sub-specialty clinics (Fracture Clinic, GI Clinic, Orthopedic Clinic, Urology Clinic, Pre-op Clinic) as well as county-based clinics including the Gynecology Clinic, Minor Surgery Clinic, Dermatology Clinic, and the Sacramento County TB/Chest clinic. In the near future, we will begin rotating through the Homeless Healthcare Clinic at Freedom Park and urgent care clinic at Sacramento County Juvenile Hall.

Other unique features of the program include: on-site mental health services supervised by a dual-trained IM-psychiatrist (Dr. McCarron) to help residents manage patients with comorbid medical and psychiatric illness; and, an on-site disease management specialist (Dr. Kulkarni-Date) focusing on improving the care of patients with diabetes.

The Department of Internal Medicine TEACH (Transforming Education and Community Health) program received a Community Partner Recognition Award from the Sacramento County Department of Health and Human Services. The program has helped to improve access to care for the Sacramento County indigent population. Drs. Jessica Keane (TEACH resident) and Tonya Fancher (Associate Program Director) accepted the award on behalf of the department.

Residents continue to attend the required Monday afternoon didactics with all other internal medicine residents, as well as grand rounds and inpatient morning report. They also attend weekly TEACH seminars which include a health services research journal club moderated by faculty from The Center for Health Services Research in Primary Care (CHSR-PC) (http://som.ucdavis.edu/research/chsrpc), program development meetings with Drs. Fancher and Henderson, protected time to develop quality improvement and clinical research projects, and didactics covering health disparities, cultural competency, mental health in the primary care setting, chronic disease management and behavior change.

TEACH residents are also involved in teaching second year medical students in the Introduction to Clinical Medicine course and precepting at one of the five UC Davis School of Medicine's Student Run-Free Clinics http://icc.ucdavis.edu/areas/hbs/clinics.htm.

Each TEACH resident conducts CQI project focusing on some aspect of health care improvement in their patient population. Mentors for residents projects are provided from the Division of General Medicine and The Center for Health Services Research in Primary Care. The Center has conducted numerous studies addressing public health policy and primary health care delivery including but not limited to:

• Developing models to estimate the total national costs for occupational illness and injury
• Evaluating an intervention to prevent violence in high risk youth and adults
• Assessing how consumers, payers, and providers respond to the public release of hospital outcomes data.
• Researching the causes and prevention of adverse pregnancy outcomes among Hispanic women.
• Exploring relationships between the process of care and risk-adjusted hospital outcomes for acute myocardial infartion, hip fracture, and birth.
• Evaluating a program designed to provide health care for medically indigent residents of transitional housing.

The Division of General Medicine is a multidisciplinary group led by Dr. Richard White, an international expert on the diagnosis and treatment of venous thromboembolism. The Division leads several active clinical and research programs including:

• Anticoagulation therapy
• Clinical trials research
• General medicine consultation
• Women's health
• Preventive Medicine
• Clinical education
• Health services outreach
• Geriatrics and healthy aging
• Quality of care assessment
• Osteoporosis

The DGIM also jointly sponsors an academic primary care fellowship for residents interested in academic general internal medicine careers, the Primary Care Outcomes Research (PCOR) fellowship, which is funded by the Health Resources and Services Administration and directed by Dr. Patrick S. Romano.