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The Vision of Bedlam

A Product of Conversation with President Gerald Clancy, MD, University of Oklahoma , Tulsa ~ August 13, 2007 

Sustaining Service Infrastructure for the Provision of Health Care  

How does a research university with a public service mission prepare its students for the advancement of the public good?  This question is central to the founding and evolving character of the Bedlam Alliance for Community Health, a network of over 17 community-based health care sites undertaken jointly by the University of Oklahoma, Tulsa and collaborative partners in education, public housing, behavioral health services, and community development.  Housed administratively at the University of Oklahoma Medical School, Tulsa , the project now covers over 25,000 people who would be without adequate and accessible health care and dedicated medical homes if it was not for the Bedlam Alliance and its multiple community sites.  From the standpoint of the university, Bedlam is an expression of its social and institutional responsibility and its dedication to public service which translates into a long-term commitment of developing and sustaining innovative neighborhood-based health centers operating within communities deprived of adequate health care, and serving people who experience considerable risk as a consequence of poverty.  The Alliance has undertaken a strategy to blend graduate professional education (led first by medicine) in the health sciences with service and clinical research.  The blending itself will produce new generations of health care providers:   ones devoted to the advancement of the public good who see public service as an alternative to private practice, who are prepared for interdisciplinary collaboration, who have the tools and insight to expand the concept of health, and who truly value the delivery of responsive, collaborative, comprehensive, and accessible care to populations who require it the most, individuals struggling with the social and physical consequences of poverty.   

The Importance of Community-Based Collaboration  

Early development of the Bedlam Alliance for Community Health was successful in creating local collaborations supporting lean but responsive clinics situated in those communities in most medical need and nested in local hosts such as schools and public housing entities.  The structures integrate multiple health care providers with little distinction made administratively or operationally among physicians, nurse practitioners, and physician assistants.  In partnership with social service personnel, and members of the host settings, such as teachers, teams form around recipients who require warm and supportive care and a high quality process of health care delivery involving state of the art assessments, service plans, treatment, and continuous monitoring and follow along.  The integration of acute and urgent care, primary care, and health promotion at the individual or family level complements more expansive efforts to address the public and community health disparities local communities face.  Bedlam clinics recognize that poverty exacerbates or determines the health and medical issues providers must address and so linking health and poverty is an essential aspect of service delivery.  

The Emergence of Innovative Learning Experiences in the Health Sciences  

Bedlam will move into the deployment of curriculum, learning experiences, and socialization through the infrastructure the project has brought about over the past five years.  Learning contexts include the linkage of health care to housing, health care delivery in schools, and mobile capacities and outreach to public areas including parks, public housing, and public events.  Linking learning and infrastructure will involve “build out, build back” in which the scope of student involvement and learning experiences will increase as teaching and service faculty collaborate in innovative programs where public service is a defining ethos.  Initially, co-curricular activities will increase as students have opportunities for “free choice learning” and select both the settings and health care contexts they find most relevant to their career paths.  Students will expand their experiential learning in partnership with other learners from diverse health science disciplines and preceptors who can engage students in a process of social learning (that combines exposure to public service, complex cases exacerbated or otherwise influenced by poverty) and who unify various models of health care delivery into an integral model of professional and career development. “Realism in health science education and practice” will be a defining aspect of the core curriculum unifying the educational, professional socialization and service missions of the Bedlam Alliance.  Success of this approach will be expressed in its formalization within the standing curricula of the various health science disciplines at the University of Oklahoma , Tulsa and beyond. The core curriculum will emphasize community and public health and extend strategies of health care well beyond individual and family needs to encompass place, context, neighborhood, and community and group life.   

 Moral Development and Professional Self Efficacy of Students

 The moral development of students will be a central focus of professional socialization and stewardship fostering a sense of public and civic engagement among health science students and instilling excitement among students about the career potential and rewards of public service.  The importance of public service in health sciences will be amplified through numerous mechanisms the principal ones involving: (1) experiential education, (2) recruitment of students who are dedicated to public service and civic engagement, (3) debt abatement for those students involved in public service, and (4) elevation of the status of public service in health sciences through endowed fellowships.  These mechanisms will complement informal socialization experiences available to students as the university seeks to imbue public service with high standing and establish such service as a viable alternative to private practice. Exposure to highly supportive and competent teaching, clinical and research faculty with deep commitment to public service will bring together the four conditions of professional self-efficacy involving:  (1) inspiration and emotional arousal of students, (2) exposure to highly motivated and committed role models, (3) performance enhancement that strengthens professional confidence in the context of real service provision, and (4) breakthrough thinking and action to improve the health status of underserved populations. 

 Achieving Local Relevance and National Significance

 Within this vision, infrastructure and innovation for service and professional education will eventually intersect in the health sciences.  Emerging from this intersection will be local relevance that achieves national significance:  Bedlam will propagate models and approaches other entities will want to adopt and model.  Demonstrating this significance to new partners nationally will be an essential step in the evolution of the Bedlam Alliance for Community Health.