As important to the program as the Family Health Center itself is the community in which it is found. Northern Manhattan's Washington Heights' population comprises both longtime residents and recent immigrants from such diverse locations as Russia, Mexico, Bolivia, Cuba, and West Africa, and a large contingent from the Dominican Republic. A simple stroll down one of the neighborhood streets reveals the colorful mosaic of cultures and languages of the people who call this community "home."

While the community is mainly residential--predominantly made up of multiple-family dwellings--there are also several large institutions, many commercial establishments and bodegas, and several nursing homes, senior centers, and Housing Projects. For many people within this community, educational deficiencies, unemployment, and poverty create health problems and limit access to health care. Many recent immigrants also face difficulties with language and cultural adjustment, and some fear deportation. Nevertheless, despite these problems, the community is alive and vibrant with a richness of tradition, survival, and hope.

Because of the neighborhood's special characteristics, the traditional "family practice" model addresses only one part of the community members' health-care needs. Indeed, many of their health-care problems result from social causes rather than cellular disintegration. Accordingly, the Family Medicine Residency Program views the entire community both as a patient and as a partner in developing a strategy to address its overall concerns.

This approach, known as community-oriented primary care, or COPC, is one of the foundations of the Family Medicine Residency Program at the New York-Presbyterian Hospital: Columbia University Medical Center. Residents in the program learn to analyze a community, build an active, mutually respectful relationship with its members, and develop and implement an effective intervention to improve the community's health.

In their first year, residents spend one month in the COPC rotation, during which they receive didactic education on the different populations and agencies in the community. Residents also learn the basics of medical Spanish, gain proficiency in the computerized informatics systems at the medical center, and become familiar with the various epidemiological data bases. In their second and third years, residents work on a COPC project in which the community and the faculty are involved.