Program lets third-year med students train in community settings

An innovative program that enables third-year medical students to train in community settings over a period of months under the supervision of experienced primary care physicians will be piloted this spring at the College of Community Health Sciences.

The Tuscaloosa Longitudinal Community Curriculum (TLC2) will expose students to community medicine with longitudinal connections to patients and providers, and opportunities to experience the broader professional roles of physicians. 090373_TERM_Rural_Medicine_161

This education model, known as a longitudinally integrated clerkship or LIC, allows medical students to live and train in a community for a period of months, be involved in the comprehensive care of patients over time and to have long-term relationships with patients’ physicians. In the most common LIC model, students each have a principal preceptor and learn working with that physician through a variety of “threaded” experiences where students follow a patient through the health-care system, along with short intensive “bursts” of learning with a specific specialty physician, and even self-directed “mini blocks” with a teacher.

“What is fundamentally different about the LIC model is that medical students meet their required clinical competencies across multiple specialties simultaneously, longitudinally and in the community setting,” says College Dean Richard Streiffer, MD. This is different, he says, from the traditional separate and sequential discipline-specific block rotations, and from the largely hospital-centric experiences of the most medical school curriculum.

“It mimics the way physicians in practice themselves learn,” he says.

Students in TLC2 will experience full spectrum care in a community environment that is reflective of where most medicine is practiced. Students will participate in continuity of care of patients over weeks or months of a disease process, and see patients longitudinally and in multiple settings, including outpatient clinics, inpatient units, emergency rooms, nursing homes and patient homes.   

“Students come to understand health and disease in the context of where their patients live and in the variety of locales where health care services are delivered,” Streiffer says. Students will also interact one-on-one with physicians in different specialties and with other health professionals.

While LICs have been part of medical education for some time, medical schools are beginning to create these programs as evidence of the effectiveness and benefits accumulates. Medical students who have participated in LICs say they feel better prepared to care for patients. Studies show that LIC students perceive better clinical education and access to patients, are more likely than students in traditional clerkships to understand longitudinal processes of chronic disease as opposed to simply managing episodes of care, and that the continuity with patients promotes patient-centered attitudes.

The length of the experience also allows time for students to become involved in the community, complete a community scholarly project, develop trusting and respectful relationships as a team member with physicians, clinic and hospital staff and patients, learn about the business of providing health-care services, and appreciate the rewards and challenges of primary care.

“One of the other benefits,” Streiffer says, “is that students who complete LICs enter primary care at a rate higher than traditional students, that being an outcome we want as it is consistent with the mission of our College.”

The College previously offered a 16-week, LIC-like program called TERM (Tuscaloosa Experience in Rural Medicine). Lauren Davidson Linken, MD, who will be an obstetrics fellow at the College next year, participated in the TERM program and says she did it “to see the medical field in a different way than I had previously seen at big tertiary care centers.”

“I was surprised by the variety of cases I was able to be involved with and the variety of physicians I was able to work with, all in one small town. I had the opportunity to work with family medicine, obstetrics, pediatrics, internal medicine, general surgery, dermatology and pathology,” says Linken, who is completing a family medicine residency at the University of Massachusetts.

She recalls a patient she cared for while in the TERM program. The patient was diagnosed with an incarcerated ventral hernia by her family physician and referred to a local surgeon. Linken assisted the surgeon with the patient’s consultation and scrubbed in for surgery. Later, she and the pathologist looked at the patient’s specimen slides under the microscope. This longitudinal, multidisciplinary, “threaded” experience is not feasible in the usual rotation model of medical student education.

“This experience came up in all of my residency interviews, and it was great to tell how I had been affected by the relationships I developed with my patients – relationships that can only develop in a continuity setting, a setting that does not exist in the standard medical school curriculum.”  

The College’s TLC2, which will begin as a pilot program in May, will have other special curriculum components in primary care leadership, community engagement and population health that will be delivered through onsite and teleconferenced seminars throughout the nine-month experience. Admission to TLC2 is through a competitive selection process and limited to six students in the first year. Pilot placements are in both rural and urban Alabama communities.

The College, which also functions as a regional campus of the University of Alabama School of Medicine, provides the third and fourth years of medical education and clinical training for a cohort of School of Medicine students, emphasizing education that aligns with the College’s mission to improve the health of Alabama’s population and provide primary care physicians for the state. But TLC2 is not just for students interested in primary care.

“We know that this type of program will prepare future physicians with vigorous general professional clinical training,” Streiffer says, along with skills in community engagement, leadership and population health, enabling them to be highly qualified for residencies and future practice in fields in addition to primary care, including emergency medicine, pediatrics, general surgery, OB/GYN and psychiatry.     

College raises thousands for American Heart Association

In recognition of the American Heart Association’s (AHA) Heart Month in February, the College of Community Health Sciences held multiple fundraisers to benefit the association. As of February 17, 2014, the College had raised a total of $6,729, and money from the fundraisers is still being collected. Heart Walk

The various fundraisers included raffles for homemade items and store-donated items, various food sales, t-shirt sales and spirit nights held at local restaurants.

The College worked in coordination with other colleges and organizations within The University of Alabama for a total of $13,596 raised for the AHA.

 The fundraising activities concluded with the West Alabama Heart Walk, held at the Tuscaloosa Amphitheater on February 15, 2014. The annual race is the American Heart Association’s premiere event that brings communities together to raise funds and celebrate progress in the fight against heart diseases and stroke, two of the nation’s top killers. 

The race in Tuscaloosa had around 750 participants and raised $130,000 for the association.

Amelia de los Reyes, a nursing manager and telemedicine coordinator at the College who has been actively involved in this fundraiser for nearly 25 years, says, “This has evolved to such a huge event in Tuscaloosa. Because of this event, we’re able to come up with money to educate the public – through television, going to schools, going to faith-based ministries, going out into the community and handing out articles regarding prevention.”

According to the AHA, 473 of the 1,602 deaths recorded in Tuscaloosa County in 2009 were due to cardiovascular disease and/or stroke.

Patricia Parnell, senior accountant for the Student Health Center, which is part of the College of Community Health Sciences, and team captain for the College’s fundraising activities, says, “I am so proud of everyone who participated. They all showed such enthusiasm for the cause.”



Chief Residents named for 2014-2015

Three resident physicians in the Tuscaloosa Family Medicine Residency were selected as chief residents for the 2014-2015 academic year. They are: Hunter Russell, MD; Sarah Mauthe, MD; and Kelly Shoemake, MD.

The chief residents were elected by their peers for being outstanding clinicians and for demonstrating leadership skills throughout the first two years of training. Their nomination was approved by faculty and the residency director, Richard Friend, MD, FAAFP.

The Tuscaloosa Family Medicine Residency is a three-year program of the College of Community Health Sciences that provides specialized training in the discipline of family medicine. The College’s residency is among the oldest and largest in the nation.

“I chose my residency in Tuscaloosa partially because of the vast amount of OB/GYN experience I would receive, but also because, at its heart, the Tuscaloosa Family Medicine Residency provides quality care to the underserved patients of West Alabama,” Shoemake says.

Shoemake received her medical degree in 2012 from the University of Mississippi in Jackson and plans to pursue a one-year fellowship in obstetrics and women’s health upon graduation from residency in June 2015. “After the fellowship, I would like to return to Mississippi to join a rural practice in order to provide optimal, accessible, broad-spectrum health care to the underserved citizens of Mississippi.”

Russell, a graduate of the College’s Rural Medical Scholars program, received his medical degree from the University of Alabama School of Medicine. “I chose the Tuscaloosa Family Medicine Residency because I felt it offered the best opportunity for me to become a great physician,” Russell says.

The Rural Medical Scholars program is a five-year track of medical studies leading to a medical degree that focuses on rural primary care and community medicine and gives students experience in rural settings through field trips, service programs and shadowing rural health professionals. 

“I chose the Tuscaloosa Family Medicine Residency because of the genuinely friendly residents that I met while interviewing here,” says Mauthe, who earned her medical degree from Saba University School of Medicine in Caribbean Netherlands although she is originally from Canada. “I plan to be a hospitalist after graduation and to hopefully stay in Alabama.”

The residents will take the place of current chief residents: JD Engelbrecht, MD; Jonathan Parker, DO, MS; and Mark Christensen, MD.

“I think these residents will offer excellence in leadership and management of the residency team,” Friend says. “We have great expectations that the new chief residents will continue the wonderful work done by our outgoing chiefs.”

Larry Mayes Research Society elects new officers

The Larry Mayes Research Society (LMRS) has elected new  officers for the 2014-2015 academic year. Stevie Bennett and Jody Watson, currently third-year medical students of the University of Alabama School of Medicine, will serve as president and vice-president of the society for the upcoming year.130509_MW_medical_students

For the clinical training of a cohort  of third- and fourth-year medical students, the College of Community Health Sciences (CCHS) serves as a regional campus to the University of Alabama School of Medicine, which is headquartered in Birmingham.

This year, LMRS has experienced a reorganization of structure, including regular student meetings to discuss and present research. This new structure exposes medical students to research going on within the larger University of Alabama campus and encourages them to engage in research within CCHS and the University.

The Society has hosted one formal faculty dinner this year and the second formal dinner is currently being planned.  

Why CVS kicked the cigarette habit

There are more than 56,000 pharmacies in the United States, two-thirds of which are now owned by discount stores like Walmart, supermarkets like Publix, and drugstore chains such as Walgreens, CVS, and Rite Aid. In stark contrast to locally owned, independent community pharmacies which stopped selling cigarettes decades ago (or never sold them in the first place), virtually all of the chain drugstores still display cigarettes at the check-out counter.

CCHS Seeks Nominations for Rural Health Heroes

The University of Alabama Institute for Rural Health Research is seeking nominations for its 2014 Rural Health Heroes Awards. The awards honor rural health-care providers and others in Alabama who assist communities in preventing childhood diseases and illnesses.

CCHS Co-Sponsors African Film Event

The second annual Tuscaloosa Evening of African Film, co-sponsored by The University of Alabama’s College of Community Health Sciences, will be held Saturday, Feb. 22, at the Bama Theatre in downtown Tuscaloosa.