The MSM PH/PMR is fully accredited to provide training in the specialty of preventive medicine. Its mission is to train qualified physicians to promote healthy behaviors and prevent disease, injury, and premature death. The program teaches residents to understand the health risks associated with social, cultural, and behavioral factors; identify and address health needs in individuals and populations; understand and address the impact of health disparities among racial and ethnic groups; and recognize and eliminate behaviors that lead to injury and death. The specific program goal is to train minority physicians to assume leadership positions in public health administration, public policy, academia, research, and the private sector.¹²

One of the primary training objectives for the MSM PH/PMR is to train residents to collaborate with community-based organizations to achieve positive health outcomes through the completion of a health needs assessment and an intervention. The PH/PMR is structured to allow residents to complete a longitudinal, community-based, service–learning project with a faith-based organization during the 2-year residency training program. For the past 7 years, MSM PH/PMR residents have completed these longitudinal assignments within faith-based organizations, through the Faith-based Community Partnership Rotation (FCPR). Residents work at the faith-based organizations in groups of two or three. Each resident spends a minimum of 15 hours per quarter with the organizations, although some resident groups have exceeded the minimum requirement.

The goals of this community-based training have been to: (1) train residents to establish effective community partnerships, and (2) affect health outcomes through the related health promotion and education activities. A set of educational objectives, which could also be used in general community-based activities, drive the methods for the achievement of this project (Table 1). Churches are recruited to participate in this program through the medical school’s affiliation with a local theological center and through referrals from faculty members and community leaders.

To be selected, each faith-based partner must have the support and engagement of its pastor. The church must also have regular community outreach activities (e.g., a soup kitchen, a community garden, activities for children or senior citizens), must be able to provide space for meetings and activities associated with the rotation, and must be located in the Atlanta metropolitan area to facilitate resident access to the church community.

The pastor is asked to identify a church leader involved in the health ministry, or other programs related to health, as the liaison for the partnership with the residents. A health ministry is a committee or unit within a church that oversees its health education and promotion activities. Typically, health ministries have at least three members, but the health ministries of large churches may have as many as 20 or 30 members. Health ministries frequently include nurses, physicians, and dentists. Membership may also include individuals who do not have health- related degrees but may serve as a caregiver in other capacities within the church. Partnering with churches can provide residents with experience collaborating with a multidisciplinary, community-based team with an existing focus on health.

Residents are introduced to the health ministry of the church by the pastor or health ministry leader(s). Orientation to the organization of the church, health ministry, and surrounding community occurs during the resident’s initial meeting at the church. This meeting typically occurs shortly after the resident begins the residency program. Residents are also given a tour of the church buildings and grounds at this time.

The health needs assessment of the community consists of several components: (1) Windshield Survey; (2) Key Informant interview; (3) Focus groups; and (4) Surveys. The assessments usually begin with a windshield survey during which residents conduct a visual assessment while walking or driving through the community. The walk or drive allows residents to make subjective and objective evaluations that include descriptions of the community and any evidence of trends, stability, or changes that may contribute to the health of the population. Key informant interviews are interviews with integral community stakeholders such as spiritual leaders (e.g., ministers, elders, and deacons), administrative staff, ministry leaders and members (e.g., health ministry, teen ministry, and recreation ministry), maintenance staff, nursery/day care providers, and food service providers or organizers.

The information from the key informant interviews is used to guide the composition of the focus groups. Focus groups may be composed of members of the general population or key informant interview participants. The information gathered in the focus groups is used to narrow the residents’ focus and directs them to determine which members of the faith-based organization receive a survey. In some instances the entire congregation may receive one, or perhaps a targeted segment of the congregation may receive it. For example, if the focus group reveals an interest in youth-related health activities, then only the youth of the congregation may receive the survey. Surveys are reviewed by church leaders prior to distribution, and revisions are made with their input. Residents may also use public data sets and census tract data to inform their projects.

Residents, with the assistance of the health ministry, implement a combination of these assessment tools as appropriate for their faith-based community. The needs assessment is critical in identifying the community’s health priorities. Residents analyze the needs assessment information to identify important health issues and potential interventions. The issues and interventions are reviewed with the church leadership, and together, health intervention goals, objectives, and plans are made. This process ensures that if sensitive issues (e.g., sexuality, substance abuse) are identified, the community’s buy-in is inherent.

Intervention programs frequently focus on chronic disease prevention, cancer prevention, teen pregnancy prevention, men’s health, and other related topics. Additionally, residents research the literature to identify best practices and models that could be applied to their faith-based community setting. Examples of interventions completed through this program include health seminars with a “Disease of the Month” focus, consistent with the topics identified through the assessment period. Residents have designed healthy-eating workshops and cooking demonstrations, coalition building activities such as assisting several small churches within the community to collaborate to plan health interventions for their combined congregation and the surrounding communities; walk-a-thons; health fairs; caregiver workshops; and men’s health conferences.

Residents have also implemented evidence-based programs in the faith-based communities. For example, a group of residents conducted a train-the-trainer work-shop for the Body and Soul Program,¹³ which is a nationwide, evidence-based health and wellness program tailored for African-American churches. Residents also evaluate the intervention’s effectiveness, summarize the findings, and share the results with the health ministry and pastor. Table 2 provides a timeline for a sample needs assessment and intervention from the FCPR.

Faith-based organizations participate in the FCPR without any direct financial cost extended to the organizations. Initially, resident projects were funded through the Morehouse School of Medicine Center for Community Health and Service-Learning, which received funding from the Corporation for National and Community Service. The residents received a budget of $1750 per project. More recently, the residency program began to use operational funds to provide limited support to resident projects, as needed. Residents are encouraged to cultivate relationships and partnerships with other health and community organizations to secure resources, in-kind support, and technical assistance.

The FCPR serves as a vehicle for residents to achieve skills in all domains of Public Health Competencies developed by the Council on Linkages between Academia and Public Health Practice,¹⁴ as well as each of the Accreditation Council for Graduate Medical Education (ACGME) Core Competencies.¹⁵ The specific domains/competencies are listed in Table 3. The residents record their experiences quarterly in a learning portfolio.

Over the years, the program has learned valuable lessons that affect the effectiveness of its relationships with faith-based communities. Many of these lessons are essential to any community partnership and include working with a community liaison who has the authority to represent the church and has an interest in partnering with the training program; stating the mission, goals, objectives, and anticipated outcomes of the partnership early and clearly; working with community partners to revise and redesign these goals and objectives as needed; and sharing similar evidence-based interventions and strategies either from literature reviews or from other organizations with similar populations. Residents must also communicate progress and concerns consistently; maintain buy-in throughout the partnership; and create a reciprocal relationship that provides opportunities for training, technical assistance, and recognition for partners involved in all phases of the work.

In addition to the general guidelines above, some considerations are unique to faith-based collaborations. As an increasing number of churches take a more holistic approach to the well-being of their congregants, their health and wellness goals are more closely aligned with their spiritual goals. Therefore, these faith-based organizations are more likely to seek collaborations with partners in order to further their efforts. Likewise, institutions that desire to work with such communities must understand the importance of establishing mutual health goals and objectives from inception. Seeking partnerships with churches that have differing goals or that do not perceive a need for a health intervention is counterproductive.

To prepare residents for these partnerships, the MSM PH/PMR provides training experiences in cultural competence and sensitivity. This training is completed in the Community Health Promotion course offered through the MSM Master of Health Program, as well as in the residency didactic sessions. These experiences are designed to enable residents to better understand the relationship between spirituality/religion and health. Although residents may not subscribe to the faith or belief system of their assigned community partner, understanding this connection is important to their growth as physicians from a social, cultural, and behavioral aspect. In the program’s experience, church leaders have welcomed the inclusion of health professionals, regardless of their religious affiliations, in furthering the community’s health goals. Additionally, although this program’s partnerships have included Christian faith-based communities, the principles that have governed these collaborations can apply to other faith-based alliances.

The FCPR reinforces the principle that a public health professional’s perception of a community health need or concern does not justify the imposition of an intervention or treatment plan on that community. Without the community’s collaboration in the health-needs assessment process, the community may disagree with the assessment of its needs and the role of the health professional in the partnership. It is also important to note that while many faith-based organizations respect science and medicine, a totally evidence-based approach may contradict the basic tenets of their beliefs, which are centered on faith. A better approach is to first engage the community to determine its health priorities and then proceed with health promotion activities that incorporate their spiritual sensibilities. For example, solely providing community members from a Christian church with evidence that a low-fat diet or increased physical activity improves health outcomes may not be as effective as also incorporating a Biblical reference regarding their spiritual responsibility to maintain their bodies. In order to positively affect the health of the community in both the short and long term, the language and beliefs of the community should prevail in all health-promotion efforts.

Lastly, in working with faith-based institutions, one must expect change. Personnel in faith-based organizations frequently change roles and responsibilities. Therefore, re-assessing and re-establishing priorities may be necessary.

Faith-based community partnerships can be a mechanism for training residents in the competencies that are expected of new medical and public health practitioners. The partnerships can provide longitudinal training experiences that incorporate public health into the continuum of medical education and can prepare residents for roles that they may assume within the numerous academic, governmental, and nonprofit organizations that conduct health promotion activities in tandem with faith-based organizations.

Although the FCPR may contribute to improving the education of PH/PM residents, further study is needed to assess resident and community perceptions of the rotation as well as its long-term effectiveness. Additional research is also needed to investigate the impact that the rotation has on the church’s health status, the sustainability of resident interventions, and the degree to which residents use the knowledge and skills gained from their FCPR experiences.

The model presented may be replicated in other general public health/preventive medicine residency training programs, and it may also serve as an example to residency and fellowship programs in other specialties. Through faith-based community partnerships, all residency and fellowship specialties may enhance the visibility and relevance of public health content in physician training. Interactive relationships between graduate medical education programs and faith-based community partners provide opportunities to develop and refine competencies related to interpersonal and communication skills, professionalism, and systems-based practice across all medical specialties. Health promotion activities may be designed to reflect specialty-specific medical knowledge. Through faith-based partnerships and the resultant health interventions, graduate medical education programs can train their residents and fellows to respond in a more coordinated and effective manner to societal health needs on relevant health topics.