Two Novel Urban Health Primary Care Residency Tracks That Focus On Community-Level Structural Vulnerabilities

  • Benjamin J. Oldfield
  • Bennett W. Clark
  • Monica C. Mix
  • Katherine C. Shaw
  • Janet R. Serwint
  • Sanjay V. Desai
  • Rachel M. Kruzan
  • Rosalyn W. Stewart
  • Sebastian Ruhs
  • Leonard S. Feldman
Innovation and Improvement: Innovations in Medical Education



Although residency programs are well situated for developing a physician workforce with knowledge, skills, and attitudes that incorporate the strengths and reflect the priorities of community organizations, few curricula explicitly do so.


To develop urban health primary care tracks for internal medicine and combined internal medicine-pediatrics residents.


Academic hospital, community health center, and community-based organizations.


Internal medicine and combined internal medicine-pediatrics residents.

Program Description

The program integrates community-based experiences with a focus on stakeholder engagement into its curriculum. A significant portion of the training (28 weeks out of 3 years for internal medicine and 34 weeks out of 4 years for medicine-pediatrics) occurs outside the hospital and continuity clinic to support residents’ understanding of structural vulnerabilities.

Program Evaluation

Sixteen internal medicine and 14 medicine-pediatrics residents have graduated from our programs. Fifty-six percent of internal medicine graduates and 79% of medicine-pediatrics graduates are seeking primary care careers, and eight overall (27%) have been placed in community organizations. Seven (23%) hold leadership positions.


We implemented two novel residency tracks that successfully placed graduates in community-based primary care settings. Integrating primary care training with experiences in community organizations can create primary care leaders and may foster collective efficacy among medical centers and community organizations.


primary care postgraduate medical education socioeconomic factors community-based interventions 



We thank Linda Grossman, MD, and Adrienne Trustman, MD, for their contributions to the manuscript. We thank Myron Weisfeldt, MD, for his support in the creation of the Urban Health Residency programs. Dr. Oldfield is supported by the National Clinician Scholars Program, with additional support from the Veterans Health Administration. The Urban Health Residencies are supported by the Josiah Macy Jr. Foundation, the Bunting Family Foundation, and the Health Resources Services Administration.

Compliance with Ethical Standards

Conflict of Interest

All authors declare that they do not have a conflict of interest.

Supplementary material

11606_2017_4272_MOESM1_ESM.pdf (408 kb)
ESM 1 (PDF 408 kb)


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Copyright information

© Society of General Internal Medicine (outside the USA) 2017

Authors and Affiliations

  • Benjamin J. Oldfield
    • 1
    • 2
  • Bennett W. Clark
    • 3
  • Monica C. Mix
    • 3
    • 4
  • Katherine C. Shaw
    • 3
    • 4
  • Janet R. Serwint
    • 4
  • Sanjay V. Desai
    • 3
  • Rachel M. Kruzan
    • 3
  • Rosalyn W. Stewart
    • 3
    • 4
  • Sebastian Ruhs
    • 5
  • Leonard S. Feldman
    • 3
    • 4
  1. 1.Department of MedicineYale School of MedicineNew HavenUSA
  2. 2.National Clinician Scholars ProgramYale School of Medicine and Department of Veterans AffairsNew HavenUSA
  3. 3.Department of MedicineJohns Hopkins University School of MedicineBaltimoreUSA
  4. 4.Department of PediatricsJohns Hopkins University School of MedicineBaltimoreUSA
  5. 5.Chase Brexton Health CareBaltimoreUSA

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