The Cyclopedia Project
On a bicycle, a pediatric resident finds healthy play for kids, connections to the community and lessons for his career.
To Geoffrey “Cappy” Collins, M.D. (R ’11), children don't play outside like they used to.
Collins remembers many days from his childhood in Niskayuna, near Schenectady, N.Y., when he would head to the Reist Wildlife Sanctuary, a woods just down the street from his home, for play and exploration.
“As soon as we were old enough to cross the street by ourselves, mom would start pushing us out of the house rather than let us sit in front of the TV,” he remembered. “There was a lot of unstructured and unsupervised time just seeing what's there, getting our hands dirty.”
Kids today are more involved in highly structured activities, like organized sports, or skill-based training, such as learning a musical instrument. And sedentary behaviors, including watching television, playing video games and spending time online, consume more and more time. The trend of children losing their free time outdoors has been termed “nature-deficit disorder,” Collins said.
“Cognitive development requires self-directed exploration. It involves testing the properties of things. It involves negotiating with other people. It involves problem-solving with the resources at hand,” Collins said. “Although nature-deficit disorder is not a medical diagnosis, the concept is supported by evidence showing that children who lack appropriate play and outdoor time are at higher risk for obesity, ADHD, poor school performance and even teen pregnancy.”
As part of the Pediatric Links to the Community/Child Advocacy Resident Education (PLC/CARE) program, an advocacy training initiative unique to the University of Rochester Medical Center, Collins created a project aimed at getting kids on bicycles to tour and learn about their city and region.
“This is a program that combines physical activity with collaborative online documentation to reconnect adolescents with their physical and social environments,” said Collins, who now is a fellow in pediatric environmental medicine at Mount Sinai Medical Center in New York City. “This is an exercise in primary preventive medicine that occurs outside the traditional medical setting, before medicine typically intervenes.”
Pediatric Links with the Community was founded in 1996 as a resident education program in community health and child advocacy. Each academic year, pediatric, medicine-pediatric, family medicine residents and nurse practitioner students participate in a two-week community-based rotation.
However, through the CARE track, second-year and third-year residents build partnerships in the community, developing critical skills for the residents while also benefiting children in Rochester as each resident works on a two-year longitudinal project.
The bicycle project, called Cyclopedia, is now concluding its second year. Cyclopedia has taken dozens of adolescents out on more than a thousand miles of riding and learning about Rochester.
The American Academy of Pediatrics awarded Collins the 2010 Anne E. Dyson Advocacy Award, and the Association of American Medical Colleges (AAMC) presented him with the 2010 Resident Physician Community Service Recognition Award.
The power of cycling
Cyclopedia had its first incarnation when Collins was a medical student at Mount Sinai in New York City.
Before medicine, Collins worked in graphic design. He returned to school, he said, thinking medicine would offer “amazing experiences, with the opportunity to make a difference.” But he found the rigorous, regimented hours of medical training blunted his ability to appreciate the experiences. His daily commute from the West Village to the Upper East Side consumed an extra hour twice a day.
Economic necessity merged with restlessness and Collins discovered the advantages of commuting by bicycle. New York became a series of small adventures as unexplored streets and neighborhoods appeared. The ride to and from the hospital was often the best part of a day. Riding provided not just an outlet from the grind of medical school, but a sense of empowerment.
During an environmental health elective in the fall of 2006, Collins met Louis Hernandez, a guidance counselor at J.H.S. 117 in East Harlemâ€”Mr. H to his students. Over the course of his 30-plus years in New York City public schools, he had brought hundreds of students along on dozens of his excursions: hiking, biking, canoeing, rock climbing, or camping. Even if it was just organizing a soccer game in a nearby park, Mr. H wanted to get kids out and active.
“These were kids living in poverty with tough lives at home and having tough times in school,” Collins said. “But, anecdotally, Mr. H noticed that behavior problems diminished when the kids were outside doing things, and some even improved their school performance.”
To provide students outdoor opportunities, Collins suggested they create a formal program. That program, called Los Aventureros, became a curriculum of bicycle rides that not only provided the health benefits of physical activity, but also taught the children about the city.
Through Los Aventureros, 14 children completed an average of 100 miles each over 15 trips. From their school in East Harlem, they traveled to all five boroughs, Westchester and the New Jersey Palisades.
“Despite living in Manhattan, a metropolis of global importance, these children had a small area of geographic awareness generally comprising the few square blocks surrounding their apartments and their school,” Collins said. “As Los Aventureros, they saw parts of the city they didn't know existed, and learned where their neighborhood was in relation to the rest.”
Los Aventureros as a formal program faded away after Mr. H retired, though he still meets former students out on their bikes around the city.
Despite the joy that running a bike program brought to medical school, Collins worried that residency would prove to be another endurance test. But after a short conversation with Andrew Aligne, M.D., M.P.H., director of the CARE track, the opportunities available at Rochester’s School of Medicine and Dentistry stood out and relieved his concerns.
“While all pediatric programs gave a nod to some form of advocacy exposure as part of national requirements, Rochester had laid the foundation years earlier for comprehensive training throughout residency,” Collins said. “The crucial difference was the longitudinal support for self-directed efforts. In other words, CARE was about empowering residents to empower children.”
Cyclopedia fits in the concept of Pediatric Links and the CARE track perfectly, Aligne said.
“The purpose of the CARE projects is ostensibly to improve health at a community level, but the main mission is to train future leaders who will go out and do this sort of work for their whole careers,” he said. “CARE projects are successful if the resident learns leadership skills even if the project itself does not reach all its goals, but Cyclopedia fulfills both objectives.”
In addition, Aligne said, Collins is an example of a successful CARE resident in terms of the skills he honed in the process of developing his project: forming collaborations with multiple community-based partners, recruiting volunteers, writing grants and award applications, and presenting at national meetings.
“At a time when people across the country are struggling to decrease burn-out in physicians, doctors like Cappy Collins are not just inspired but also inspiring others with their passion for improving health in their communities,” Aligne said.
Rochester connections and bike trails
During Collins’ CARE block in the summer of 2009, the residents were asked to create public service announcements for the Rochester Boys and Girls Club, located across the Genesee River from the University. During a site visit, Collins met an employee named Shawn Brown, who had attended the club himself growing up. He was enthusiastic about biking and the club was full of kids looking for something to do. The club had storage space for bikes, a computer lab for the riders to document their experiences on a website, and it was centrally located as a home base for riding to all parts of Rochester and beyond. It seemed like a natural fit.
But there was no website, there were no bikes and there was no money. As summer turned to the fall of 2009, the project seemed to stall.
CARE alumni often provide input and guidance. Aligne shapes the curriculum from year to year to meet the interests of the residents. With support from the core faculty and the extended family of CARE alumni and community partners, the resident projects build upon a tradition of success. Along with developing strong, evidence-based projects, the residents become advocates capable of teaching others.
“The strength of CARE lies in its individualized and longitudinal support for the residents,” Collins said.
Marc Lavender, M.D. (R ’09), a CARE alumnus and former chief resident who now practices in Rochester, also is a bicyclist. Aligne asked him to work with Collins. The two applied for grants and looked for bikes. By the spring of 2010, they had received a Community Access to Child Health (CATCH) grant from the American Academy of Pediatrics (AAP) and a local Community Pediatrics Advisory Council (CPAC) grant.
They found colleagues who had bicycles to donate. They also met Dan Lill of R Community Bikes, an organization that collects used bicycles in any state of repair, fixes them with a team of volunteer repair men and women, and redistributes them for free to the community. Lill donated several refurbished bikes to Cyclopedia. By the end of the spring, Cyclopedia had assembled a small fleet, with money to spare for program improvement.
Brown also took on a new position at the Boys and Girls Club as teen coordinator, with a mission to address the lack of programming for the adolescents. Aside from a room with a TV and game system, there wasn't much to offer these older kids. Cyclopedia was needed.
Cyclopedia is not school, but Collins usually devoted 15 minutes to a lesson with a quote or fact about bicycles, and then moved into the ride topic. The ride did not focus on mileage but on teamwork skills and the idea of exploration. After the ride, the kids posted comments on the website and, in the second season, uploaded their photos and tagged them on the ride map.
Each ride has a local theme. The Sam Patch ride, for example, started with details about the efficiency of bicycles. The word of the day was “cataract,” literally “striking down hard,” as Sam Patch did to conclude his infamous leap from the Genesee’s High Falls on a cold November Friday the 13th.
The Cyclopedia ride paralleled the journey of Patch’s body, encased in ice, floating north. The Cyclopedia riders navigated the river’s edge to Charlotte and found his gravesite. Along the way, they passed the edge of prehistoric Lake Iroquois, marked by the “ridge” of Ridge Road, and spotted a snowy egret, swans and a turtle plying the water below the boardwalk of Turning Point Park.
The inaugural 2010 season brought more bikes, more riders and more partnerships. Collins recruited John Culhane, a colleague from his design days in New York City, to help build the website. Gina Lord, a pediatric health educator at Rochester General Hospital, donated helmets for the riders. Links were established with the Rochester Cycling Alliance and the Healthi Kids Coalition. By the end of the first year, 19 riders had accumulated more than 800 miles on 14 trips in more than 70 hours of programming time.
The 2011 season was about expansion. Girls were expressly recruited for their own weekly ride for the second season. The Boys and Girls Club secured a Greater Rochester Health Foundation (GHRF) grant to fund a bike program for younger children. Cameras were purchased for the riders to use and the technology employees at the club helped riders upload and edit their photos of each trip. The preliminary data for the year show 30 riders accumulating 1,000 miles on 18 rides, comprising more than 100 hours of programming time.
With Collins in New York City, Lavender and Brown are keeping Cyclopedia going at the Boys and Girls Club. The PLC/CARE program was instrumental in buoying the program through the rough waters of implementation and now claims Cyclopedia as another success story. At Mount Sinai in New York City, Collins is gathering data on the efficacy of Cyclopedia Rochester in combating “nature-deficit disorder” and is laying the groundwork to restart Los Aventureros in the form of Cyclopedia NYC.
“The program's goal is still the same,” Collins said. “It's not about getting kids out of the place they live and into the mountains, or some ‘ideal’ form of nature. It's about getting kids into the place they live so they can be part of it. And so they can give back. It doesn't matter if you live in a city or on a farm; where you are is where you start. And with a bike, who knows how far you'll go?”
Visit www.cyclo-pedia.org to see more about the rides and the program.
Contact Cyclopedia at firstname.lastname@example.org if you'd like to get more information, make a donation, or if you'd like to contribute your time or skills.
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