Q&A with Felicia M. Borges, Program Manager of Cal-SEARCH

The Student/Resident Experiences and Rotations in Community Health (SEARCH) program offers opportunities for students and residents to experience clinical rotations on multidisciplinary health care teams in underserved communities. The Health Resources and Services Administration funds twenty-eight state-based programs across the country, each with rotations that are designed and implemented at the state or local level. California’s SEARCH program, Cal-SEARCH, places primary care students and residents in community clinics and health centers throughout the state for experiences which incorporate community public health and mentoring. This month, HWIC had the opportunity to interview Cal-SEARCH program manager Felicia M. Borges of California’s Office of Statewide Health Planning and Development Healthcare Workforce Development Division. In addition to her work with Cal-SEARCH, Borges also manages the Health Careers Training Program.

Could you tell us a little about how Cal-SEARCH works and the history of SEARCH in your state?

The Office of Statewide Health Planning and Development (OSHPD) as the State’s Primary Care Office (PCO), in partnership and collaboration with the California Area Health Education Center (AHEC) and the California Primary Care Association (CPCA), has created California’s first Student/Resident Experiences and Rotations in Community Health (Cal-SEARCH) program. Now in its second year, Cal-SEARCH is growing and continues to accept applications from interested students, residents, and sites.

Once applications are accepted, eligible students and residents are linked to an accepted community clinic and health center (CCHC) within a Health Professional Shortage Area (HPSA) or a Medically Underserved Area (MUA). Students and residents receive training, are linked to a preceptor who facilitates their 80 hours clinical experience, and are linked to a mentor who oversees their community project. A small stipend is paid to the student or resident upon successful completion of the program. The site also receives a small payment for hosting the student or resident.

Applications, program materials, and a current list of our accepted sites can be found on the Cal-SEARCH website: www.oshpd.ca.gov/hwdd/cal-SEARCH

Who are the key partners involved in your state’s SEARCH program? What types of collaborations have been developed to support the program?

The OSHPD’s key partners for the inaugural year included both the Statewide AHEC and CPCA. Both partners continue to work closely with OSHPD on program implementation. In year two, several of the Regional AHECs have also been engaged. Additionally, a wide variety of other partners, such as academic institutions and other statewide agencies and organizations, have been engaged to increase awareness of the program statewide.

Could you tell us a little about the multidisciplinary aspect of SEARCH? Which disciplines are eligible to participate in your program, and what do they learn by working together?

As part of the multidisciplinary team, students and residents have an opportunity to serve with a variety of primary care health providers, including: primary health care clinicians, allopathic and osteopathic physicians in family medicine, general internal medicine, general pediatrics, obstetrics/gynecology, psychiatry, dentists and dental hygienists, clinical psychologists, clinical social workers, psychiatric nurse specialist, and marriage and family therapists, family and primary care nurse practitioners, primary care physician assistants, certified nurse-midwives, etc.

Student and Resident applications are currently being accepted from the following programs:

• Physicians specializing in Internal Medicine, Family Practice, Pediatrics or Obstetrics and Gynecology
• Dental Hygiene
• Dentistry
• Nurse Practitioner
• Physician Assistant
• Certified Nurse-Midwife
• Clinical Psychologist
• Clinical Social Worker
• Marriage and Family Therapist
• Psychiatric Nurse Specialist
• Psychiatry

The Cal-SEARCH is an opportunity for students and residents to apply their education in a primary health care setting, to train as part of a multidisciplinary health care team, and to deliver culturally competent care in an underserved area. This enables them to experience serving as a community-responsive, culturally competent clinician in an area of unmet need.

Your program offers rotations in both urban and rural underserved locations. What are some of the differences you see in these locations, in terms of the experiences for the students?

Students and residents, who complete Cal-SEARCH rotations in either urban/inner city or rural/frontier underserved locations, are getting similar experiences in that they are serving vulnerable populations. Differences between urban/inner city and rural/frontier experiences include the size and diversity of the populations served, the types of services that are offered at a particular CCHC, and access to other services in the geographic area.

As part of the application process, students and residents select their preference for either an urban/inner city or a rural/frontier setting as well as desired geographic location. The Cal-SEARCH team uses these preferences, along with many others, to aid in matching the students and residents to a site. Often, students and residents make their selection based on time of year, school or home location, location of extended family, desire to network, etc.

It has been challenging to match some students and residents to rural settings due to transportation and housing challenges. The Cal-SEARCH will offer, on a case by case basis, a travel differential under these circumstances.

Participation in community projects is one of the requirements of Cal-SEARCH. Could you tell us how you select projects and what their value is to the students and the community?

The community project addresses a community heath need identified during the clinical rotation. Students and residents collaborate with their preceptor, mentor, and clinic staff to identify this community need then develop a plan for implementation and sustainability of the project. Community projects can be used to improve health services in the clinics through development and distribution of educational materials, etc. Past projects have included:

• Cardiovascular Patient Education Curriculum
• Dental Caries Prevention
• Heightening Awareness of Pertussis in the Community
• Hookah Smoking Among Adolescents and Young Adults
• How to Prevent Diabetes in Your Children
• Rapid HIV Testing
• Teen Clinic Surveys
• The True Face of Homelessness

Students and residents submit a written summary about their community project to the Cal-SEARCH team. The clinics can continue the community project effort indefinitely.

How do you identify and recruit students and residents to participate?

A wide variety of partners, such as academic institutions and other statewide agencies and organizations, have been engaged to increase awareness of the program statewide. Students and residents from all eligible programs are encouraged to apply.

What are some of the characteristics of participants who do well in SEARCH?

Ideal applicants include students and residents who are interested in working with the underserved in a HPSA or MUA and who are participating in the National Health Service Corps Scholarship program or who will likely be eligible for the Loan Repayment Programs. However, the program is open to students and residents from all eligible programs. Cal-SEARCH is an opportunity to determine if working in a HPSA or a MUA in the future is really the right fit and to begin networking with primary care providers that may become a future employer.

What types of outcomes do you see from the SEARCH experience? What types of impact do you look for, both for the students and for the communities who participate?

Outcomes from the inaugural year included placement of 26 students and residents within HPSAs or MUAs throughout the State. The program is on track to place over 60 students and residents this program year. Additionally the program far exceeded its initial goal of 15-20 sites in the first year. Today there are currently 48 sites throughout California, with additional sites applying regularly.

Students and residents have reported that the Cal-SEARCH program has exposed them to interacting with primary care providers, group approaches in caring for the underserved, and learning more directly about cultural competency. They’ve also reported that the program has provided an opportunity to “give back,” and it has influenced or solidified their career goal of practicing in primary care and working in an underserved area.

Sites have reported that the Cal-SEARCH students and residents are able to experience a wide range of clinical experiences which is mutually beneficial. The preceptors and mentors have shared positive feedback on the community projects and likelihood to continue use well into the future.

What advice do you have for people seeking to build interest in service to underserved communities?

Collaborative statewide and regional partnerships have been key to the success of the Cal-SEARCH program. For example, at the statewide level resources can be maximized for raising program awareness in a broad sense through a variety of outreach efforts. Local level resources are then able to focus on one-on-one interactions with educators and CCHCs. Additionally, engaging a wide variety of stakeholders, such as academic institutions and other statewide agencies and organizations, that serve the targeted student and resident populations will ensure the message is delivered.

Is there anything else you would you like to add?

The Cal-SEARCH program is just one of many opportunities and resources that are available to students and residents that are seeking a health career. Visit www.oshpd.ca.gov for additional information or to join our list serve.

Felicia M. Borges can be reached at fborges@oshpd.ca.gov or 916-326-3768.

Please note that the views expressed in this article are the opinions of the interviewee and do not reflect the official policies, positions, or opinions of the Health Workforce Information Center or its funder.