This curriculum will focus on the many different aspects of providing care for underserved and marginalized patient populations; including patients of different racial, ethnic, and socioeconomic profiles. Nearly 50 million Americans (and 18% of Arizonans) are uninsured, and another 30 million Americans are underinsured.1 Patients without insurance are less likely to receive care in all settings except the emergency department.2   They are less likely to receive recommended preventive services, adequate chronic disease management, appropriate medications for chronic conditions, and potentially life-saving diagnostic and therapeutic interventions.3 Irrespective of insurance status, disparities in health care and health outcomes persist between patients of different ethnic and racial backgrounds.4

Overarching Goals of the Fellowship Program

  • Train evidence-based physicians skilled at delivering the highest quality care for marginalized and underserved patients.
  • Develop community-responsive physicians with skills necessary to advocate for people made vulnerable by the social and structural determinants of health.
  • Develop clinicians who are systems thinkers - mindful of public health, epidemiology and population health, health economics and political systems.
  • Familiarize fellows with resources and support available in Phoenix and the state of Arizona with the goal of those physicians choosing to stay in our community to practice after fellowship; increase the supply of primary care physicians serving vulnerable Arizonans.
  • Train skilled educators that will provide supervision, mentorship and teaching of medical students and residents.
  • Develop high-quality scholarly work that supports the advancement of health equity and justice in our city and state, but also nationally and internationally.

Fellowship Learning Objectives

Patient Care
  • Fellows will refine their skills in caring for patients with varying cultural, socioeconomic, ethnic, and religious backgrounds; sexual orientation; language; and literacy levels.
  • Fellows will be able to formulate a patient plan which takes into consideration the community, social, economic and environmental factors affecting the patient’s health.
  • Fellows will be able to identify community and cultural influences which affect the patient’s health and adherence to proposed plans of care.
  • Fellows will develop the skills necessary to conceive of and manage a patient care plan which is culturally acceptable and financially feasible for underserved patients.
  • Fellows will practice evidence-based medicine and best-practice population health practices.
Medical Knowledge
  • Fellows will refine competency in diagnosing and caring for common illnesses and health- related conditions prevalent in the underserved setting.
  • Fellows will learn strategies for screening and prevention of disease and promotion of health in the underserved setting.
Societal Awareness and Responsiveness
  • Fellows will be familiar with the role of healthcare providers, community health centers, and insurance plans as they relate to patient care.
  • Fellows will become familiar with the resources available to patients within the community and collaborate with allied health personnel and other organizations to provide quality care to patients.
Interpersonal Communication
  • Fellows will refine their communication and relationship-building skills, with focus on cultural competence and humility.
  • Fellows will use shared decision-making models to improve patient care.
  • Fellows will provide patient-centered care with attention to cultural differences, patient values, and patient literacy.
  • Fellows will effectively utilize interpreters, consistent with best practices.
  • Fellows will demonstrate honesty, integrity, compassion, empathy, and respect in all patient encounters and with members of the healthcare team and community.
  • Fellows will identify their individual strengths and weaknesses, as well as motivations for working with the underserved.
  • Fellows will reflect upon their own biases and blind spots as well as the emotional challenges related to their work.
  • Fellows will identify the difficulties experienced by physicians in providing high quality health care to underserved, uninsured, marginalized and racially diverse patient populations.
  • Fellows will engage in systems advocacy efforts to address the improvement of patient care and outcomes.
Critical Appraisal and Quality Improvement
  • Fellows will develop proficiency with available technology and resources to make effective decisions and improve their medical knowledge.
  • Fellows will engage with QI improvements with their clinical teams.
  • Fellows will be able to use clinical evidence-based medicine skills at the point-of-care effectively to aid in diagnosis, treatment, and prevention of disease.

Fellows will review journal articles in order to improve their own personal knowledge in caring for patients in the underserved setting, and support medical students in their development of critical appraisal skills.

Sample Schedule

Sample Schedule (PDF)

Sample Schedule

CHIP - Community Health Initiative Phoenix: 1st and 2nd year medical students evening clinic at Wesley Clinic. Required once per week, but also potential option to add additional evening clinic on a second day.

Distribution of Effort:

  • 65% FQHC Clinical Activity at Wesley
  • 25% Paid Research Time
  • 10% Administrative and Study Time


  1. U.S. Census Bureau, Current Population Survey, 2009-2012 Annual Social and Economic Supplements
  2. Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century.  Washington, DC: National Academies Press, 2001.
  3. National Research Council. Care without Coverage: Too Little, Too Late. Washington, DC: The National Academies Press, 2002.
  4. Cene CW, Cooper LA. Death Toll from Uncontrolled Blood Pressure in Ethnic Populations: Universal access and Quality Improvement May Not Be Enough.  Ann Fam Med 2008; 6:486-489.