Milestone Luncheon honors CCHS faculty

A Milestone Luncheon was held on April 21, 2014, at the Bryant Conference Center to honor faculty members who have reached 10, 15, 20, 25, 30, 35, 40, and 45 years of service to The University of Alabama. President Judy Bonner, PhD, gave the welcoming remarks and attendees enjoyed lunch while slides of the honorees scrolled at the conference center.  Among the honorees were several College of Community Health Sciences faculty members:

10 Year Honorees
Chelley Alexander, MD, Associate Professor and Chair, Family Medicine
Dan Avery, MD, Professor and Chair, Obstetrics and Gynecology
Brant Lehman, MD, Assistant Professor, Internal Medicine

15 Year Honorees
Susan Guin, MSN, CRNP, Associate Director of Rural Health Programs and Assistant Professor, Community and Rural Medicine
Bill Owings, MD, Professor, Family Medicine

20 Year Honorees
Bob Ireland, MD, Associate Professor, Family Medicine

35 Year Honorees
Jim Leeper, PhD, Director of Education and Evaluation of Rural Health and Professor, Community and Rural Medicine

Consultant directs College on new community curriculum

The College of Community Health Sciences hosted Kathleen Brooks, MD, MBA, MPA, in April as a consultant to assist in the development of the Tuscaloosa Longitudinal Community Curriculum (TLC2) – 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.

Kathleen-Brooks-Skype

Brooks, the director of the Rural Physician Associate Program (RPAP) and an assistant professor in the Department of Family Medicine and Community Health at the University of Minnesota Medical School, serves as a national consultant to medical schools interested in implementing longitudinal integrated clerkship (LIC) models.  She defines LICs as a model of medical education that allows students to participate in the comprehensive care of patients over time, maintain continuous relationships with patients and clinicians and meet the clerkship requirements.

The RPAP at the University of Minnesota, a nine-month LIC for third-year medical students that began in 1971, demonstrates that students who complete the program enter primary care at a rate higher than traditional students. Seventy-six percent of the 1,400 students who have completed the program are currently practicing primary care; two-thirds of those are practicing family medicine and half practice in rural settings.

While LICs have been part of medical education for some time, medical schools are beginning to create these programs as evidence of their effectiveness and benefits accumulates.

“The conclusion of many studies shows that we no longer need to do equivalence studies on longitudinal integrated curriculums. The students do well,” Brooks says.

Richard Streiffer, MD, dean of the College of Community Health Sciences, said at an April meeting with Brooks and the College’s Board of Visitors that the College’s strategy is to have a model like the RPAP over time, including an admissions component.

A pilot of the College’s LIC, TLC2, begins in May with two students enrolled. “Right now, the pilot is looking like the University of Minnesota’s program but will continue to evolve,” says Streiffer.

The College’s LIC initiative is a direct product of a strategic plan that determined, in part, that the majority of the College’s stakeholders agree that an integrated, longitudinal program would provide a more effective education to medical students.

In addition to meeting with the College’s Board of Visitors, Brooks also met with the College’s Medical Student Education Planning Committee, the TLC2 Planning Committee, the College’s preceptors and clerkship directors, and students. The Board of Visitors is a group of 32 volunteers whose purpose is to affect a close working relationship between the providers and consumers of health care and the College, to act as an advisory group to the dean and to influence the advancement of the College,

During her visit, Brooks was able to talk with the two students via Skype who will be piloting TLC2 starting in May and answer many of their questions.

Brooks also spent some time at the University of Alabama School of Medicine in Birmingham where she met with the School of Medicine’s administrators to discuss the logistics of starting a new curricular track and the School’s leadership for an idea and goal sharing dinner.

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.

Director of Medical Student Affairs retires

Cathy Gresham, MD, is retiring from the College next month after more than 18 years of service. Gresham was the director of Medical Student Affairs and a professor in the Department of Internal Medicine.

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 subset of School of Medicine students.

Brittney Anderson, president of the UASOM – Tuscaloosa Regional Campus Class of 2014, presented Cathy Gresham, director of Medical Student Affairs, with an award of gratitude at a retirement reception held in conjunction with a Match Day celebration.

In her role as director of Medical Student Affairs, Gresham fostered the professional and personal development of undergraduate and medical students, advocated for the students and helped guide them to their career of choice. She also served on the University of Alabama School of Medicine and Rural Medical Scholar admissions and interview committees, all while providing care to countless patients and teaching hundreds of medical students, residents and shadow students. According to Gresham, she did it all with a goal of “ingraining holistic and respectful care of patients.”

“Those responsibilities,” Gresham says, “have allowed me to have friends and colleagues in practice throughout Alabama and all around the United States.”

The College hosted a retirement reception for Gresham in early April to celebrate and acknowledge her contributions to the College’s educational mission. The reception was coupled with the medical students’ Match Day celebration – a ceremony that celebrates the medical students’ selection into residency programs across the country. Current College faculty and staff, retired faculty, School of Medicine leadership, family and friends were all present at the reception.

“Remaining on the job through April was important to [Gresham], as she wanted to see the current year’s admissions process and Match for our fourth-year students through to the end,” says Dean Richard Streiffer, MD.

Developing a Patient-Centered Medical Home

A patient-centered medical home model of care is exactly what Chelley Alexander, MD, envisions for University Medical Center. Alexander, chair of the Department of Family Medicine at The University of Alabama College of Community Health Sciences, which operates UMC, is helping lead a pilot program that will create such a model of care at the multi-specialty medical center.

UMC began working with MedNet West on the pilot program several years ago. MedNet West is a provider-designed, nonprofit network that serves more than 14,000 Medicaid patients in an eight-county area – Bibb, Fayette, Greene, Hale, Lamar, Pickens, Sumter and Tuscaloosa counties.

The network was created by Whatley Health Services, Inc., the College, the Tuscaloosa County Public Health Department, physician practices in West Alabama and DCH Regional Medical Center, in partnership with the Alabama Medicaid Program.

Alexander, an associate professor at the College and a family physician at UMC, also serves as medical director of MedNet West.

As part of the pilot program, MedNet West contracts with the state’s Medicaid program to perform several tasks at UMC. First, care managers identify and accept referral of high-risk patient, and work closely with providers to eliminate barriers to care. “Patients who formally frequented the emergency room are often found to have barriers, like a lack of transportation or air conditioning, that when removed, markedly improve patients’ ability to care for their diseases, which in turn improves their quality of care,” Alexander says.

Second, regular medical management meetings are held by care teams that provide physicians with data on their population of patients showing, for example, the percentage of patients who have had flu shots.

“Providers are thrilled to finally have data on their patients,” Alexander says. “When the group identifies an area that needs improvement, such as the number of inappropriate ER visits, the group brainstorms and then implements changes to ensure improvement. They feel empowered to make a difference.”

She says providers also receive updates about medical problems that have clear, quality guidelines, such as asthma or congestive heart failure, which are common reasons for preventable hospitalizations in West Alabama.

“The MedNet West pilot has proven that changing our model of care, even slightly, can improve the quality of care and reduce cost,” Alexander says.

According to preliminary data, the UMC pilot has resulted in a reduced cost of 5.8 percent compared to non-pilot areas in Alabama, saving the state’s Medicaid program $3.5 million in 2012 and 2013, or approximately $331 per enrollee per year. Much of the savings is due to improved access to a health-care team for patients with chronic conditions, preventing unnecessary emergency room visits and hospitalizations.

In February 2014, the start of a PCMH was implemented within UMC’s Family Medicine Clinic. Among the changes: physicians were provided with report cards showing their performance on prevention (scheduling mammograms) and chronic disease management (getting diabetic patients on lipid-lowering therapy). Teams of providers also evaluate, for example, group visits and additional self-care training for patients.

“The teams will provide better continuity of care for patients and will work together to transform care for our patients,” Alexander says.

The PCMH model is also becoming part of the College’s curriculum. “We want to teach our medical students and residents how to study their care of populations of patients – to look at their panel of patients and identify strong and weak areas, and by identifying best practices, help each other put processes in place to make quality improvement continuous,” Alexander says.

She says the next steps are to fully implement the PCMH model in all UMC clinics – pediatrics, internal medicine, OB/GYN, psychiatry, sports medicine and the Faculty-Staff Clinic.

College hosts 6th Annual Research Day

The College of Community Health Sciences held its Sixth Annual Research Day on April 16. The annual event is hosted in order to give medical and graduate students, resident physicians, faculty and staff who are working on various research projects the opportunity to display their findings. It is designed to show collaboration among CCHS departments and across The University of Alabama.

“It was exciting to have another successful Research Day as scholarly activity is growing in the College,” says coordinator Lea Yerby, PhD, assistant professor for the Department of Community and Rural Medicine and the Institute for Rural Health Research. “This shows that faculty and students are placing increased value on research and working together to answer meaningful questions.”

(From left to right) Razel Remen, MD, a second-year resident, Cynthia Mouton, MD, a third-year resident, and Brittney Anderson, a third year medical student, discuss a research poster at the College's Sixth Annual Research Day.

(From left to right) Razel Remen, MD, a second-year resident, Cynthia Mouton, MD, a third-year resident, and Brittney Anderson, president of the UASOM – Tuscaloosa Regional Campus Class of 2014, discuss a research poster at the College’s Sixth Annual Research Day.

Two projects tied for first in the faculty category for research: Dan Avery, MD, professor and chair of Obstetrics and Gynecology, and his research, “The Economic Impact of Rural Family Physicians Practicing Obstetrics in Alabama,” was one of them. The project was also authored by Dwight Hooper, MD, professor in Obstetrics and Gynecology; John T. McDonald, MD, assistant professor in Obstetrics and Gynecology; Michael Love, a fourth-year medical student; Melanie Tucker, PhD, assistant professor in Community and Rural Medicine/Institute for Rural Health Research; and Jason Parton, PhD, assistant professor in Information Systems, Statics and Management Sciences.

Avery says the topic is important to the College’s mission so that physicians who are trained and placed in rural Alabama can provide economic growth in addition to good medical care.

“These topics are what we are and what we do to make a difference in the healthcare of rural underserved Alabama,” Avery says. “It is our mission.”

The other victor in faculty research was Karen Burgess, MD, associate professor of Pediatrics, whose research “Caregiver and Child Perception of Weight,” was also authored by Melanie Tucker.

“Childhood obesity has always been of interest to me since it was something I dealt with when I was younger,” says Burgess. “I’ve always wanted to help kids who were in a situation like me. I hope providers understand the importance of addressing weight status with families at each visit and that providers won’t minimize overweight kids. Parents and children often don’t realize when the child is overweight.”

Here is a full list of the winners:

RESEARCH:
Faculty Category (a tie):
The Economic Impact of Rural Family Physicians Practicing Obstetrics in Alabama. Daniel Avery, MD; Dwight Hooper, MD; John T. McDonald, MD; Michael W. Love, MSIV; Melanie Tucker, PhD; and Jason Parton, PhD.

Caregiver and Child Perception of Weight. Karen Burgess, MD; Melanie Tucker, PhD.

Resident Category:
The Effects of Garden Exposure on Behavior and Achievement in Elementary School Children. Razel Remen, MD; Caroline Boxmeyer, PhD; Courtney Ricciardi, undergraduate.

Student Category:
Does Irradiation of the Stem Cell Niche Change Prognosis in Glioblastoma? William Ennis, MSIII.

SCHOLARLY ACTIVITY:

Faculty Category:
Librarians Can Help: Resources for Occupational & Environmental Health for Rural Health Professionals. Suhua Fan, MA, MLIS.

Student Category:
Sickle Cell Trait and Wound Healing; Beware the Use of Epinephrine. A Report of Three Cases. Chelsea Cernosek, MSIII; Luis Vasconez, MD; Jorge de la Torre, MD.

Family Medicine Residency Continues Expansion

When Friend started full time in May 2013 (he first worked part time starting in December 2012), one of his priorities as director was expanding the residency from 36 to 44 slots. Currently, the College is approved for 48 slots as it seeks additional funding for the residency.

The goal to expand the residency is the College’s response to Alabama’s and the country’s growing need for primary care physicians. The national demand, which is projected to grow more rapidly than physician supply, is expected to reach a potential shortage of 20,400 physicians by 2020*, according to a November 2013 analysis from the Health Resources and Services Administration.

The state ofAlabama also has a serious primary care physician shortage, ranking nine out of 50 in terms of the most underserved states based on Health Professional Shortage Area (HPSA) scores.

“I think we need to continue to respond to the needs of the community and the state,” Friend says. “We need to look at potential expansion in the future as a means to meet the growing demand for well-trained family physicians.”

Expanding the residency has long been an interest of the College, and though it has run across some hurdles, it has seen growth before. No legal barriers exist to prevent a residency from growing, but funding and accreditation can stand in the way. In 1997, the total number of resident slots were frozen nationwide and within each hospital by law, making it practically impossible for affordable graduate medical education expansion. 

So when the Centers for Medicare and Medicaid Services created a one-time reallocation ofunused slots in 2009 to allow some programs to expand, the College jumped at the chance and applied for more positions through the Affordable Care Act signed in 2010. 

The residency leadership at the time applied for and received approval from the Residency Review Committee to potentially expand to a 48-slot program. The residency then learned it was awarded eight additional residency slots, bringing the total approved and funded residency slots from 36 to 44. 

Since that growth, more faculty have been added as more residents have joined the program. In the last three years, the residency has seen seven newcomers: Jared Ellis, MD, associate residency director and assistant professor in Family Medicine; Catherine Scarbrough, MD, assistant residency director and assistant professor in Family Medicine; Harriet Meyers, PhD, an associate professor with joint appointments in Family Medicine and Psychiatry and Behavioral Medicine; as well as Jennifer Clem, MD, an assistant professor, H. Joseph Fritz, MD, an assistant professor, Drake Lavender, an  assistant professor and Anne Halli-Tierney, MD, a geriatrician and assistant professor, all in Family Medicine.

Friend says there has also been a significant increase in interest in the program from medical students. The residency received about 2,000 applications for 15 slots in 2013—a 30 percent increase from 2012.

Part of that may be due to the fervent recruitment and promotion of the program. Chief residents Mark Christensen, MD, JD Engelbrecht, MD, and Jonathan Parker, DO, have led the efforts to improve the marketing strategy and digital presence of the residency.

Or it may be that more are recognizing the importance of family doctors, Friend says. According to the Merritt Hawkins 2013 Review of Physician and Advanced Practitioner Recruiting Incentives, health care employers recruited more family physicians than any other specialty in 2012 and 2013.

“We all know there are not enough family physicians to meet current demand,” Friend says. “We’re seeing salaries for family physicians rise while salaries for specialists are declining. We’re seeing more qualified medical students who previously chose specialty care going into primary care.”

And for those medical students, Friend says there has been talk of creating a rural track for the program. Residents would complete their first year in Tuscaloosa and the second and third years in rural communities as a way to increase the number of providers for those communities.

“That’s our job,” Friend says. “I think we have the infrastructure to provide outstanding physicians to these communities, and I think part of our mission is to enhance our training and provide physicians for these communities—well-trained family physicians.”

*Under a scenario in which the rapidly growing nurse practitioner and physician assistant supply can effectively be integrated, the shortage of 20,400 physicians in 2020 could be reduced to 6,400 primary care
practitioners, according to the HRSA analysis.

 

A Strategy for the Future

The College of Community Health Sciences began a strategic planning process in fall 2012 to develop a five-year plan that builds on the College’s deep roots in primary care and family medicine education while responding to the changing health care needs of communities.   

A plan was developed during an intensive nine-month process, in consultation with the firm CFAR Inc. and guided by a Core Team and Steering Committee that included College faculty, clinical staff, administrators, alumni, community leaders and others.

The goal was to create a shared vision of how best to achieve the College’s mission of primary care, education and research in a health care environment that is shifting from reactive and illness care to prevention, and to develop a road map for how the College can achieve that vision.

Now the College is transitioning the work ostrategic planning into the work oimplementation.

“This is the beginning of a journey,” says Dean Richard Streiffer, MD.

The College’s previous mission statement focused on providing “the physicians and expertise needed for accessible, high-quality and compassionate health care for the citizens oAlabama … with a special emphasis on rural areas.” Since its founding in 1972, more than 400 family physicians have completed the College’s residency, with 50 percent
practicing in Alabama and halfofthose in rural areas. The College’s medical student program steers graduates into primary care specialties at a rate more than twice the national average, and its award-winning rural pipeline program has placed nearly 50 doctors into rural practice.    

Today, the mission is not just producing doctors but improving the health ofAlabama’s population, coupled with community engagement and social accountability.

“The strategic plan is intended to be a living, breathing document that guides the work of the College,” Streiffer says. “The strategic plan, and the initiatives that comprise it, will ultimately be integrated into the everyday work of the College.” 

The strategic planning process began with individual interviews ofCollege faculty, staffand alumni, and stakeholders across The University ofAlabama and the community. Focus groups were conducted with residents and medical students. Based on the results, a survey was developed and administered to College faculty and staff, select faculty of UA and the University of Alabama School of Medicine, residents, medical students, alumni and community members.  

More than 350 respondents completed the survey, including all College faculty. Survey results, coupled with an in-depth analysis of the College, were used to create strategic options that were the centerpiece of a strategic planning retreat and used to shape the College’s strategic plan. The all-day retreat was held in March 2013, and the 100 plus attendees hashed through various strategic planning options.   

“Engaging as many people and their thinking as possible, and really welcoming their input, was vital to developing a meaningful strategic plan,” Streiffer says.

The planning process was undertaken with the expert assistance ofCFAR consultants Jessica Geiben Lynn and Christopher Hugill. From offices in Philadelphia and Boston, CFAR serves clients across a range of industries worldwide, including health care, life sciences, higher education, nonprofits and family and closely held enterprises. The firm’s approach combines an understanding of business with insights into the human systems that make up organizations.

The College’s plan contains four strategic priorities: build on the strong foundation of the Family Medicine Residency; provide an innovative and community-oriented undergraduate medical education experience; transform the clinical enterprise to deliver exceptional patient-centered care; and foster a passion for scholarly pursuit in line with the College’s mission. Four Strategic Action Teams, or StATs, were formed and charged with implementing each priority. Here are highlights of work completed by the StATs in 2013:

The Residency StAT created a curriculum committee and a marketing plan to improve residency recruiting. A clinical rotation in emergency medicine was added, and an emergency medicine fellowship for primary care physicians is under consideration. Work is underway to add community medicine, dermatology and practice management experience for residents. The College’s Department of Family Medicine added five new faculty who are working closely with residents.

The Medical Student StAT is implementing the Tuscaloosa Longitudinal Community Curriculum, which will give third-year medical students an opportunity to live and train in communities under the supervision of practicing primary care physicians, be involved in the comprehensive care of patients over time and to have long-term relationships with patients’ physicians.

The Clinical StAT is advancing a patient-centered medical home (PCMH) model of care within University Medical Center, which the College operates. A PCMH provides a team-based approach to comprehensive patient care. Led by a physician and including such health professionals as nurses, social workers, psychiatrists, nutritionists and pharmacists, the PCMH organizes primary care to emphasize coordination and preventive care.

The Scholarship StAT is working to create a passion for research at the College. A monthly lecture series began in February 2014 featuring College and University faculty who present their research. The College participates in a research breakfast program with other colleges on campus to share research and find ways to collaborate. A Summer Scientific Writing Workshop is planned for College faculty. 

Keri Merschman honored with Excellence in Rural Health award

Each year the Institute for Rural Health Research in the College of Community Health Sciences honors one University of Alabama MS III or MS IV who demonstrates academic interest in rural medicine and is engaged in rural research and/or scholarly activity. This award is designed to encourage medical students to pursue activities in rural medicine. 

Medical students present at Larry Mayes Research Society Faculty & Student Dinner

Twice a year, medical students at the College of Community Health Sciences get the chance to present their research and scholarly activity to CCHS faculty at the Larry Mayes Research Society Faculty & Student Dinner.

LarryMayesDinner

Above: Chelsea Cernosek presents on sickle cell trait and wound healing / Below: Jamie Powell presents on DVD intervention to improve knowledge and reduce secondhand and thirdhand tobacco smoke exposure.

The most recent dinner was held Thursday, April 10, at Cypress Inn, and Jamie Powell and Chelsea Cernosek, both third-year medical students, presented.

Powell presented her research on using a DVD as intervention for parents and caregivers of children hospitalized for  respiratory illnesses to improve knowledge and reduce secondhand and thirdhand tobacco smoke exposure.  

Thirdhand tobacco smoke exposure is the residual smoke that remains on clothes, hands and hair after smoking. 

“This is a very low-cost type of intervention,” Powell said. She also said participants in her study demonstrated retention of knowledge and some reported a decrease in smoking.

Cernosek presented her scholarly activity on sickle cell trait and wound healing and the use of epinephrine in breast reduction procedures.

Heather Taylor, MD, assistant director of Medical Student Affairs, says these events give students a chance to practice formally presenting their research before giving oral presentations at conferences. Cernosek, for example, will present her research again in June at an international plastic surgery conference. 

“So this was a valuable opportunity for her to practice and see what kinds of questions she needs to prepare for,” Taylor says.

The overall goal of the dinner is to support and encourage student scholarly activity, says Taylor. The objective of the Larry Mayes Research Society is to expose medical students to research being conducted at The University of Alabama and encourage them to engage in research with the College and the University. 

“It gives the students and faculty a chance to hear about the projects our students have been working on and often stimulates ideas for future projects,” Taylor says.

Opening the event and introducing the speakers were Larry Mayes Research Society president and vice president Stevie Bennett and Jody Watson, respectively, third-year medical students who were elected to their positions earlier this year. 

This year, the society experienced a reorganization of structure, including regular student meetings to discuss and present research.

University Medical Center launches Wellness Walls for Art program

Something old can become something new.

More than two decades ago, artists affiliated with The University Women’s Club at UA began volunteering their time to keep the walls of the former Capstone Medical Center’s patient waiting areas filled with bright and vibrant paintings.

Today, this activity has a name, Wellness Walls for Art, and a coordinator, Tuscaloosa artist Deborah Hughes. Hughes says she is committed to keeping the walls of University Medical Center, which replaced Capstone Medical Center in 2004, filled with art work.

“I am excited that the Wellness Walls for Art program presents an opportunity to identify a rich array of art, bring it into focus and spotlight it in a public and accessible space,” she says.

University Medical Center is located on the UA campus and provides comprehensive patient-centered care to the UA community and West Alabama community in the areas of: primary care, including family medicine, internal medicine, pediatrics and geriatrics; psychiatry and behavioral medicine; women’s health, including obstetrics and gynecology; and sports medicine. On-site laboratory and x-ray services, nutrition counseling and mental health counseling for individuals and families are also provided.

Richard Streiffer, MD, dean of the UA College of Community Health Sciences, which operates University Medical Center, says the art displays not only enhance the environment for patients but also for the College’s employees. He says art can play an important role in medicine and healing.

“In addition to helping patients with dementia and Alzheimer’s, art used as therapy has successfully helped people with anxiety, depression, chronic pain, high blood pressure and other health conditions,” he says.

As part of Wellness Walls for Art, a new collection will be displayed every three months. A painting show currently on exhibit at University Medical Center features the work of Hughes and members of The Tuscaloosa and University Painters group – Karen Jacobs, Lorrie Lane, Pam Copeland, Emily Mitchell, Diana Franco and Ann Stickney.

In May, a new show will spotlight the theme “The Many Faces of Art in Adult Continuing Education” and will feature the work of residents of UA’s Capstone Village retirement community, UA’s OLLI program (Osher Lifelong Learning Institute) and Shelton State Community College’s Lifelong Learning Program.

A reception to officially recognize the Wellness Walls for Art program, which includes a viewing of the May show, will be held May 7 from 5:30 pm to 7 pm at University Medical Center. The reception is open to the public.

The Tuscaloosa and University Painters group formed about 20 years ago and included individuals from the University and the Tuscaloosa community who met once a week to paint together and to hang their artwork at the former Capstone Medical Center and University Medical Center. In 2012, TAUP members decided the group would have to discontinue the hangings due to a lack of volunteers. Hughes offered to continue coordinating and hanging exhibits.