TRIUMPH Student Projects Address Social Determinants of Health
Medical student, KaHoua Yang, MD ’22, was eager to begin her community health project, which is a key component of each student’s experience in the University of Wisconsin School of Medicine and Public Health’s Training in Urban Medicine and Public Health (TRIUMPH) Program.
She had planned to work with Fondy Food Center’s Fruit and Vegetable Prescription Program, in which primary health care providers write prescriptions for patients to buy fresh produce. Yang would be a liaison between Advocate Aurora Health clinics and the food center on the north side of Milwaukee. Her role would be to assess the clinics’ plans for the prescriptions and to follow up on individuals’ redemption of vouchers at farmers markets. Yang also hoped to enroll more clinic sites and increase the voucher redemption rate.
When the COVID-19 pandemic shut down the clinics, Yang had to pivot. She went to work for the Fondy Food Center and its Milwaukee Market Match, a pilot program that began in 2020. Funded by a grant from the Greater Milwaukee Foundation, the Market Match doubled the value of FoodShare dollars when used at any of five farmers markets in the city. Nearly 800 households used the match during the 10-week pilot, leading to a second pilot year in 2021.
Yang knew when she applied to medical school at UW that she wanted to expand and deepen her knowledge of the needs and assets of city environments. A native of Wausau, Wisconsin, she had earned a bachelor’s degree in biochemistry from UW–Madison and started her career by teaching high school biology, chemistry and astronomy in Chicago public schools. This experience helped her realize that working in an urban setting appealed to her. After returning to UW–Madison for a master’s degree in bacteriology and managing research laboratories on campus, she enrolled in medical school and was accepted into TRIUMPH. This urban training track within the school’s MD Program started in 2009 to help address health inequities and chronic physician shortages in Wisconsin’s urban areas.
I wanted to help students see the glass as half-full, to fall in love with the people and community, and to envision themselves as change agents to promote community health
– Cynthia Haq, MD
A “sister” program to the school’s Wisconsin Academy for Rural Medicine — which focuses on admitting and training medical students who are committed to improving the health of rural communities — TRIUMPH got its start when Cynthia Haq, MD (PG ’87), then a professor in the Department of Family Medicine and Community Health, gleaned knowledge from the annual County Health Rankings and Roadmaps, created within the UW Population Health Institute. Patrick Remington, MD ’81, MPH, professor emeritus in the Department of Population Health Sciences — the inaugural associate dean for public health when the roadmaps project was developed — pointed out to Haq that if data from Milwaukee County were removed from the rankings, Wisconsin would rank as the nation’s healthiest state.
“It was shocking to see that our most populous county had some of the greatest inequities and poor health outcomes,” recalls Haq, who approached senior leaders with the idea of establishing a new educational track focused on health inequities in Milwaukee. With their support, she began building the program essentially “from scratch.” In 2009, TRIUMPH’s first cohort of six students began a six-month pilot program.
From the beginning, Haq emphasized not just the challenges but the assets and gifts to be found in the urban community. She met with community leaders and identified the “bright lights” who were acting to create positive change there.
“I wanted to help students see the glass as half-full, to fall in love with the people and community, and to envision themselves as change agents to promote community health,” she notes.
Kjersti Knox, MD ’11, was among the second cohort of TRIUMPH students—the first eight to earn medical degrees in the full 18-month program. She is now the program’s director and a clinical adjunct assistant professor of family medicine. In addition to Knox, the TRIUMPH leadership team includes Michelle Buelow, MD ’11, MPH, and Theresa Umhoefer-Wittry, MD ’12, co-associate directors who were part of the first and third TRIUMPH cohorts, respectively, and Melissa Lemke, program manager.
Today, the program has expanded to enroll 16 students per year. TRIUMPH students begin medical school in Madison and then spend two and a half years in Milwaukee. With more than 50 partners for internships and hands-on experiences, TRIUMPH also has multiple teaching sites within Advocate Aurora Health and additional sites at federally qualified health centers and neighborhood-based clinics.
In line with program goals, 99 percent of TRIUMPH graduates have selected residencies in urban areas, and more than half practice in primary care.
“Many TRIUMPH alumni now practice in the clinics, hospitals and federally qualified health centers in which they trained, so they are offering medical care with a community-informed lens—and humility,” notes Knox. “Every day, they apply TRIUMPH skills, most importantly to listen, build relationships and connect with the community.”
These skills proved beneficial for Yang as she transitioned into TRIUMPH in her second year of medical school. In Milwaukee, her clinic training days began at 7 a.m. with a review of the day’s schedule and patient charts. And with those patients came the first of many lessons.
“When you read a patient’s chart, you sometimes have a preconceived notion of who they are — there’s a whole list of medical conditions that patients have — and I remember thinking ‘How is this patient still up and moving around?’ But then I would walk into the exam room, and the patient would be super alert and happy and look nothing like what I had pictured based just on what’s in their chart,” she recalls. “That would surprise me every single time. It was a reminder that I can’t judge my patients based only on what’s in the record. My patients are so much more than that.”
Being of Hmong descent, Yang thought Milwaukee, with its large Hmong population, would be a good choice for her career. Her primary contact with Hmong patients came during her inpatient rotations, when she could use her cultural knowledge to help patients and providers navigate cultural nuances to improve communication.
“When I’d walk in the room and the patients would realize I was Hmong, there was often a change in their demeanor. I could tell they were thinking, ‘Oh, you know me,’” she shares. “I’ve had many of those experiences.”
As the acronym “TRIUMPH” reflects, the program emphasizes both medical care and public health—specifically how to understand and act on social determinants—such as education, housing and nutrition—that powerfully affect health.
These factors are often the focus of the required student projects. For her pandemic-adapted project, Yang analyzed data on the number of purchasers using the Milwaukee Market Match, including how often they purchased items and their home ZIP code, and she put together a final report that allowed people to visualize the data.
In the match’s first pilot of 10 weeks, Yang found that nearly 800 households used matching funds for a total of $19,653. Most purchasers bought their produce at the Fondy Farmers Market in the Lindsay Heights neighborhood, but more than 30 Milwaukee ZIP codes were represented. By the end of the second pilot, participation had ballooned to nearly 1,700 households purchasing four times the dollar value of the previous year.
As the 2022 season approached, Meg Kilkenny — the healthy communities coordinator for UW Extension Milwaukee County and the co-facilitator for the Milwaukee Farmers Market Coalition with Fondy Food Center — was hearing from many former customers who wanted to use the Market Match again.
About Yang’s two-year TRIUMPH project, Kilkenny comments, “She went above and beyond all of our expectations for examining data and providing a thorough and visual, aesthetically pleasing analysis of our programmatic impacts. The Milwaukee Farmers Market Coalition has been actively using KaHoua’s work to illustrate the geographic reach of this program alongside its positive impacts on improving the health and well-being of thousands of low-income Milwaukeeans by increasing access to healthy, affordable food.”
Kilkenny continues, “Her work [has made] it possible for us to show the county and other decision makers how this program works and how important it is for the community. She did such an amazing job, especially with the 2021 program analysis, which she completed while being a new mom. Her TRIUMPH assignment will have positive ripple effects possibly for years to come.”
Using Yang’s data, Fondy Food Center and other partners went to the Milwaukee County Board to request a $1 million grant from the county’s American Rescue Plan funding. In late May 2022, the board voted unanimously to award the Milwaukee Market Match $1.1 million to sustain the program through 2024. Milwaukee County Executive David Crowley called the program “another step forward in our journey to bridge the gap in health disparities” in the county.
As Yang prepares to start a family medicine residency in northern Illinois, she says she feels proud of the outcomes of her TRIUMPH project and grateful that it could succeed at an uncertain time.
“Our TRIUMPH directors have been phenomenal, especially during the pandemic,” Yang reflects. “They helped ground us [students] and keep us informed and feeling safe. I sing their praises often.”
Knox concludes, “Our students like Dr. Yang are an inspiration to me and to the broad TRIUMPH community in Milwaukee. They have demonstrated exceptional flexibility and resilience, and they were a source of energy and support for each other and for their teams throughout the pandemic. I am profoundly excited for the impact that Dr. Yang and her colleagues will have in their communities throughout their careers.”
About the Statewide Campus
Early in their medical training, all medical students at the UW School of Medicine and Public Health begin developing their doctor-patient communication skills as they learn patient history-taking and physical examination techniques at community sites.
Hundreds of physicians throughout the state volunteer their time and expertise by serving as community faculty and mentors to students in the MD Program. In each of their four years of training, medical students have educational experiences with community faculty at hospitals and clinics throughout Wisconsin. Beginning partway through their second year, medical students receive more involved clinical training in rotations in Madison, Green Bay, La Crosse, Marshfield, Milwaukee and other Wisconsin communities.
Statewide partnerships are a hallmark of the school’s programs that address the need for physicians who practice in underserved rural and urban communities—the Wisconsin Academy for Rural Medicine (WARM) and the Training in Urban Medicine and Public Health (TRIUMPH) Program, respectively.
In addition to facilities in the Madison area, the statewide campus includes:
- Marshfield Clinic Health System/Northern Academic Campus
- Gundersen Health System/Western Academic Campus
- Advocate Aurora Health/Eastern Academic Campus
Advocate Aurora Health is a partner in the TRIUMPH Program, and with its association with Aurora BayCare Medical Center in Green Bay, it is a partner with WARM.
As the 10th largest not-for-profit, integrated health care system in the United States, Advocate Aurora Health serves nearly 3 million patients each year. It has more than 300 Milwaukee-based teaching faculty who train medical students in clinical settings and assist with community health projects. Students on rotations in the health care system’s Milwaukee sites have opportunities to care for underserved patient populations at the Bread of Healing Clinic and Walker’s Point Community Clinic, among others.