Partnering for better health: UA partnership with Pickens County enters second year

The University of Alabama-Pickens County Partnership enters its second year with an increase in the number of student fellowships and health-related projects as work continues to provide health-care resources to the rural county.

Five recent UA graduates were selected as partnership fellows, up from four last year, and they will serve through June 2018. In addition, one prior fellow will remain for a second year to continue her work and also provide leadership for the new fellows.  The fellows will spend time working in Pickens County in community engagement and project development, and will participate in seminars about health and public policy, social determinants of health and leadership.

Along with the fellows, a total of 13 projects that address Pickens County health issues were funded in the second year, up from seven during the partnership’s initial year. Several of the projects are continuations from year one.

The overall goals of the UA-Pickens County Partnership are to expand health-care resources for Pickens County while simultaneously providing real world education and training for UA students in medicine, nursing, social work, psychology, health education and other disciplines.

During its recent session, the Alabama Legislature provided an additional year of funding for the partnership. The money is being used to provide stipends for the fellows and to fund new and ongoing health-related projects that involve UA faculty and students in collaboration with Pickens County organizations.

Rural counties throughout the country, especially in Alabama, face special challenges in sustaining health care services and addressing social factors that lead to a lower than average health measure. Pickens County is no different in that nearly one-third of its population lives below the poverty line and health outcome rankings show that the county is 41st among the state’s 67 counties.

The UA-Pickens County Partnership came about when the county feared its hospital, the Pickens County Medical Center, would close. The Friends of the Hospital in Pickens County, a citizen’s committee, worked with UA and its College of Community Sciences to help, resulting in this unique academic-community partnership.

The College’s mission is to improve and promote the health of individuals and communities in Alabama and the region, and one way it seeks to do that is by engaging communities as partners, particularly in rural and underserved areas.

Fellows 2017-2018:

August Anderson begins her second year as a fellow. During her first year, she worked with UA and Pickens County partners to establish sustainable programs to improve the overall health and well-being of residents, and she worked with children on comprehensive health and wellness education. Anderson has a bachelor’s degree in human development and family studies with a concentration in child development and addiction treatment.

Emma Bjornson graduated summa cum laude from UA in May 2017 with a bachelor’s degree in human environmental sciences/public health. As a fellow, she will help implement health programming and education to improve health outcomes in the county. She aspires to pursue a Master’s in Social Work with a focus on medically underserved populations and health disparities in rural and urban populations.

Crystal Bice is a registered dietitian and graduated from UA in May 2017 with a master’s degree in clinical nutrition. She earned a bachelor’s degree from UA in May 2016 in human nutrition. As a fellow, she will work to gain a better understanding of nutrition and health care in the county. She plans to become a physician’s assistant.

Steven Simmons graduated from UA in May 2017 with a bachelor’s degree in psychology. As a fellow, he will work to implement programs that improve access to mental health care for Pickens County residents. He is passionate about tele-mental health services and civic engagement with adolescents. He aspires to pursue a doctoral degree in clinical psychology.

Emily Stebbins graduated magna cum laude in May 2017 from UA with a bachelor’s degree in psychology. As a fellow, she will work to assess mental health awareness in the county and help educate residents about mental health, particularly as it relates to children, adolescents and county school systems.

Caroline Whittington graduated in May 2017 from UA with a bachelor’s degree in psychology and a minor in human development and family studies. As an undergraduate, she received the “Significant Contribution to Research in Psychology” award. As a fellow, she hopes to strengthen mental health resources within Pickens County, primarily for the elderly.

Projects (New) 2017-2018:

Women Wellness Workshops for Breast Cancer Awareness

Implement church-based, nurse-led educational sessions about breast cancer awareness and early detection among rural, African-American women, and train community health workers and undergraduate pre-nursing/nursing students to lead sessions.

UA partners: Dr. Mary Ann Kelley, Capstone College of Nursing

Pickens County partner: Pickens County Medical Center


 

Developing Awareness of Services Offered by Pickens County Medical Center

Work to better promote services offered by Pickens County Medical Center to address important health care needs in the county.

UA partner: Dr. Jef Naidoo, Culverhouse College of Commerce

Pickens County partner: Jim Marshall, CEO, Pickens County Medical Center


Automated External Defibrillators (AEDs) for Pickens County

Place AEDs in areas where large numbers of people gather on a daily basis.

UA partners: Glenn Davis, College of Community Health Sciences

Pickens County partners: Vicki McCrory, Manager, Pickens County Ambulance; Pickens County Board of Education; Pickens County and City Governments; Pickens County senior centers


EXPO Exploring Professional Opportunities in the Health Care Field

Continue this program for Pickens County 10th and 11th graders to explore health care careers.

UA partner: College of Community Health Sciences

Pickens County Partners: Jamie Chapman, superintendent, Pickens County Board of Education; Patti Presley Fuller, Pickens County Extension Office


Managing Frequent Attenders in Medical Care to Improve Patient Well-being and Reduce Provider Burden: Part 1 – Assessing the Scope of the Problem

Understand the degree and nature of unnecessary medical care in ambulatory medical practices and hospital settings in Pickens County.

UA partner: Dr. James Hamilton, College of Arts and Sciences/Department of Psychology

Pickens County partner: Jim Marshall, CEO, Pickens County Medical Center


Understanding Pain Management Needs among Community Dwelling Older Adults with Chronic Illness

Assess the need for pain management among older adults with chronic illness in Pickens County, and explore strategies to promote access to and use of palliative care in community settings.

UA partners: Dr. Hyunjin Noh, School of Social Work; Dr. Anne Halli-Tierney, College of Community Health Sciences

Pickens County partners: Ashley McGee, administrator, Aliceville Manor Nursing Home; Myra ShuffleBarger, director, Carrollton Senior Activity Center; Dr. Julia Boothe, Pickens County Family Medicine


UASSW-Pickens County Schools Partnership to Provide Behavioral Health Services to Students in the Context of a Positive School Climate

Increase access to behavioral health services for students.

UA partner: Dr. Laura Hopson, School of Social Work

Pickens County partner: Jamie Chapman, superintendent, Pickens County Schools

Projects (Ongoing) 2017-2018:

Improving Access to Cardiac Rehabilitation Services in Pickens County

Continue the partnership between UA and Pickens County Medical Center’s Cardiopulmonary Department to develop a sustainable, evidence-based cardiac rehabilitation program for county residents.

UA partners: Dr. Johnathan Wingo, College of Education/Department of Kinesiology; Dr. Avani Shah, School of Social Work

Pickens County partner: Sharon Wester, Pickens County Medical Center Cardiopulmonary Services


Disseminating the Power PATH Mental Health Preventive Intervention to the Pickens County Community Action Committee and Pickens County Schools

Provide the curriculum and training for school personnel at Pickens County Early Learning Center to implement the Power PATH mental health program with pre-school students and their parents.

UA partner: Dr. Caroline Boxmeyer, College of Community Health Sciences

Pickens County partners: Cynthia Simpson, Pickens County Community Action Committee and Community Development Corporation Inc.; Pickens County Head Start Program


Alabama Literacy Project: Supporting Early Literacy Development and Instruction

Continue support for early literacy and language development in Pickens County, including professional development for teachers, family literacy programs and vision and hearing screenings for young children.

UA partners: Drs. Carol Donovan and Nicole Swoszowski, College of Education

Pickens County partner: Fred Woods, Pickens County Head Start


Literacy Outreach as One Component of Health and Wellness

Expand literacy outreach to include community health.

UA partners: Drs. Nicole Swoszowski and Carol Donovan, College of Education

Pickens County partner: Jamie Chapman, Pickens County Schools


Improving Pickens County Residents’ Knowledge of Risk Factors for Cardiovascular Disease and Type 2 Diabetes through Increased Access to Screenings: The Pickens Health Improvement Program

Implement health promotion “clinics” in Pickens County to help change how residents think about risk factors, prevention and health behaviors, and to improve their knowledge of health risk factors.

UA partners: Drs. Michele Montgomery and Paige Johnson, Capstone College of Nursing

Pickens County partner: Patti Pressley Fuller, Pickens County Extension Office


TelePlay: Connecting Physicians, Families, and Autism Professionals to Increase Early Autism Identification in Pickens County

Connecting a primary care provider and parents in Pickens County with The University of Alabama Autism Clinic team to identify children at risk for autism by piloting Teleplay, an interactive secure online communication system.

UA Partners: Lea Yerby, PhD, College of Community Health Sciences; Angela Barber, PhD, College of Arts and Sciences

Pickens County Partners: Julia Boothe, MD, Pickens County Primary Care

CCHS Rural Programs Host Annual Rural Health Pipeline Programs

May 28–June 28, 2017

The University of Alabama’s Rural Programs recently hosted the 2017 Rural Health Scholars and Rural Minority Health Scholars annual summer programs, each comprised of select high-school-age students interested in pursuing medical and health care careers in rural Alabama. Part of the Rural Health Leaders Pipeline, each program ran for five weeks and offered on-campus living, college courses, field trips and seminars as an orientation for students as to what they might expect as they prepare to enter college.

The premise of the Rural Health Leaders Pipeline is that rural students trained in the medical field will be more likely to return and practice in their rural communities, thereby continuing the College of Community Health Sciences mission to improve and promote the health of individuals and communities in Alabama. In point, the College’s founding Dean William R. Willard posited that successful rural medical education in Alabama would, and should, begin with rural high school students.

Noteworthy this year is the celebration of the 25th class of Rural Health Scholars. The Rural Health Scholars program is an integral component of the Rural Health Leaders Pipeline because it serves as a way to recruit students from rural communities, with the goal of improving the production of rural health care professionals. Such is also true for the Rural Minority Health Scholars program, a spin-off of the Rural Health Scholars program initiated specifically to increase the number of minority students from rural Alabama who qualify for medical school and to provide opportunities for underserved populations and communities in the state.

The Rural Health Scholars program was a life-changing experience for me as a 16-year old girl growing up in rural Alabama. No one in my family was involved in the health care field, so it was my first exposure to medicine. The summer experience opened my eyes and gave me the confidence that I needed to continue down the path to become a doctor…without that experience I doubt I would have ever considered the medical profession. The state of Alabama healthcare is no doubt better because of the influence of this program.

Emily Feely, MD
Chief Medical Officer and Corporate Nephrologist
Naphcare, Inc. Birmingham, AL
3rd Class of Rural Health Scholars

Taken as part of the whole, these programs provide accessibility and support to rural students as they pursue future careers in the medical field. “It’s about the transitions that rural kids face as they near the end of high school, what looms before them,” said Dr. John Wheat, Director of Rural Programs. “The overarching hope is to offer opportunities for students to enter fields which they might otherwise have little access in their small communities.”

 

Learn about the Rural Health Leaders Pipelines and its affiliated programs.

2017 Rural Health Scholars

  • Mason Alexander Aldridge
  • Jessica Leanne Aplin
  • Annelise Grace Baker
  • JaKailyn Barnes
  • Keltanishaline Bates
  • Will David Bobbs
  • Shelby Gillis Juanita Boswell
  • Morgan Ashley Campbell
  • Makayla Ryann Coleman
  • Kayla Michelle Creighton
  • Rachael Ngozi Dike
  • Rebekah Chidinma Dike
  • Emmanuel James King
  • DaVonyae Lashae Miller
  • Lauren Katherine Moore
  • Jagger Dylan Morgan
  • Ivy Gabrielle Murphy
  • Ora Jocelyn Nelson
  • Emma Abigail Phillips
  • Joshua Kyle Raney
  • Lauren Destiny Shepherd
  • Taylor Elaine Skipper
  • Kaitlin Elida Truslow
  • Jakeira Shardell Washington
  • Shiann Nicole Weaver

2017 Rural Minority Health Scholars

  • Tomysha Danielle Boykin
  • Logan Aricie Broxton
  • Christopher Everett Daffin Jr.
  • Keyonna Dixon
  • Imberly Iesha Flowers
  • De’Larrian DeAnte’ Knight
  • Ciara Dawn Locke
  • Scott Nguyen
  • Jessica Brianna Richardson
  • Hillary Denise Strong
  • Garian Lucene Ware

Patient shares advice with new residents

Mary Jolly, a long-time patient of University Medical Center and a member of the University Medical Center Patient Advisory Council, spoke June 21 with the new class of residents at the College of Community Health Sciences. She shared thoughts and provided advice she gained from her experiences as a patient at UMC.

“From the very beginning, I’ve encountered medical students,” said Jolly. She said she enjoys working with students particularly because they are more likely to listen. CCHS also serves as the Tuscaloosa Regional Campus of the University of Alabama School of Medicine.

Jolly spoke with the students and told stories that described the important partnership between doctors and their patients.

She also shared a few thoughts and some ideas that she hoped the students would take along with them during their careers. Her main point was “being admitted to a hospital is the most vulnerable time in your life,” she shared, after telling a personal story about an experience in a hospital. Another important note was the power of empathy.

Empathy is a skill necessary for success in medicine because medicine demands human interaction. The need to tell stories is important because you can learn a lot about the patient from the stories he or she tells, said Jolly. Patients are often shy and uncomfortable around doctors (Jolly said she is not a typical patient because she is so comfortable talking with her doctors) but if a doctor asks the right questions, the patient can begin to feel more comfortable and start telling stories. It’s important for doctors to listen to those stories because they may reveal information about the patient’s condition that was previously concealed, Jolly said.

“Empathy is the key to high-value work,” she said. “Stories are powerful.”

Other advice Jolly gave to the students were tips she believed would help relieve patient anxiety:

  • Knock on the door before entering a patient’s room. Jolly believes, from her own experience, the ability to tell the doctor to come into the room gives the patient a feeling of strength and control.
  • Tell the patient your name and title. This is especially important for young doctors to establish credibility with the patient
  • Call the patient by his or her name.
  • Tell the patient why you are there. This is the most important because it lets the patient understand the role you play and how you will be able to help him or her.
  • Don’t be afraid to talk to the patient.

New Primary Care Track aims to increase Alabama primary care physicians

By Bob Shepard

To continue addressing the critical need for more primary care physicians in Alabama, the University of Alabama at Birmingham School of Medicine will offer a new track in its four-year medical degree program.

The Primary Care Track is designed to provide students a strong foundation in clinical medicine focused on preparation for residency training in primary care and other community-based specialty fields, through longitudinal experiences with patients, lasting relationships with mentoring physicians, and special programming on population health and physician leadership skills.

The Primary Care Track is in collaboration with the University of Alabama’s College of Community Health Sciences, which serves as the School of Medicine’s Tuscaloosa Regional Campus. Students in the Primary Care Track will spend their first two years completing the prerequisite basic science curriculum in Birmingham. Primary Care Track students will spend their third year in a model of clinical education called a longitudinal integrated clerkship, known as a LIC, based in Tuscaloosa or other communities around the state.

Beginning in 2017, students applying to the School of Medicine through the American Medical College Application Service will have the option to choose the Primary Care Track within the secondary application.

The School of Medicine has made increasing the number of students who pursue a career in primary care a key component of its mission to serve the state. A 2016 study by the Association of American Medical Colleges shows a drastic need for primary care physicians. The problem is especially acute in Alabama — in 2012, the state had 3,512 active primary care physicians for a ratio of approximately 73 per 100,000 people, ranking it 45th in the nation. The provider shortage is even worse in rural areas — 55 of Alabama’s 67 counties are considered rural, and eight Alabama counties have no hospital at all.

Primary care-oriented training is also an excellent experience for individuals who envision a community-based career in a variety of non-primary care specialties.

“The primary care needs in Alabama are important enough that we’ve created this track, not only to identify prospective medical students who are interested in primary care, but to offer students experiences, mentorship and guidance that will be valuable throughout their medical educations and into their careers,” said Craig J. Hoesley, MD, senior associate dean for Medical Education.

During the LIC, students learn clinical medicine, population health and the business of medicine in a community environment reflective of where most medicine is practiced. They work alongside faculty for a majority of the year to follow and care for patients longitudinally, learning across the core disciplines of medicine and in all settings, including outpatient clinics, hospitals, nursing homes and patients’ homes. This is a departure from the traditional model — a series of discipline-specific and hospital-dominant four- to eight-week clerkships. Students typically experience few encounters with the same patient and only single episodes of illness, very different from that of a community-based longitudinal experience.

“Most care is provided in the community, and all patients ultimately come from and return to the community, even when care is needed in tertiary settings,” said Richard H. Streiffer, MD, regional dean of the Tuscaloosa Regional Campus and dean of the UA College of Community Health Sciences. “Students in the LIC become part of the community, and hence have the unique opportunity to understand heath care, disease and wellness, and social influences on health over time and in the context of family, community and social influences. The fundamental unifying principle of this educational approach is continuity — continuity of teachers, of community and setting, of patient care. Relationships and trust build between students, their teachers and their patients, facilitating the learning and insight essential to the lifelong learner that community-oriented physicians need to be.”

“The addition of this program further emphasizes how UAB continues to innovate and grow,” said Selwyn Vickers, MD, FACS, senior vice president and dean of UAB’s School of Medicine. “Experience has shown that students who complete a LIC are highly competitive residency candidates — they graduate with self-directed learning skills, have a strong grasp of patient management and the consultation and referral system, and can effectively utilize community resources.”

The first group of Primary Care Track students will apply to the program this summer.

Residents, fellows honored at graduation

Nineteen physicians were honored June 17 at the 42nd annual graduation ceremony of The University of Alabama Family Medicine Residency and Fellowships.

The College of Community Health Sciences provides graduate medical education through both the three-year Family Medicine Residency and year-long fellowships for family medicine physicians seeking additional training in behavioral health, emergency medicine, geriatrics, hospitalist medicine, obstetrics, rural public psychiatry and sports medicine.

“Today is about celebrating excellence,” said residency Director Dr. Richard Friend, who welcomed graduates and their family and friends to the ceremony held at the Zone-South at Bryant Denny Stadium on the UA campus. “There is a lot to be proud of today.”

The graduating residents and fellows will soon begin their own practices in Alabama and other states, or will go on to complete fellowship programs.

To date, the UA Family Medicine Residency has graduated 478 family medicine physicians, and just over half practice in 48 of the state’s 67 counties, the majority in designated Health Professional Shortage Areas.

“Our College was founded because of a crisis – a need for family medicine docs all around Alabama,” said Dr. Richard Streiffer, dean of CCHS. “And there is still a need. There are still not enough family docs, and rural areas are still underserved.”

Dr. Dwight Hooper, professor of obstetrics and gynecology at Florida State University College of Medicine and former professor and chair of obstetrics and gynecology at CCHS who taught many of the residents, was a guest speaker at the ceremony. He told residents that he hoped he provided them with life lessons.

“When I look out at you, I see well trained, highly intelligent residents. Perhaps I had something to do with you learning to be a better you,” he said.

Dr. Jennifer Greer, UA’s associate vice provost for Administration, thanked the graduating residents and the fellows “for the difference you’ve made in our community while you were here. Every time you go to work, you will change someone’s life that day. That is an amazing thing.”

Added Dr. Robin Wilson, chief medical officer of DCH Regional Medical Center, a residency partner: “I’ve seen the tremendous impact of this program at DCH, on our patient care. You have a bright future ahead of you.”

Awards were given to many of the graduating residents.

2017 Graduating Residents

  • Dr. Shawanda Agnew
  • Dr. Brittney Anderson
  • Dr. Joseph Brewer
  • Dr. Carrie Coxwell
  • Dr. Blake DeWitt
  • Dr. Eric Frempong
  • Dr. Keri Merschman
  • Dr. Remona Peterson
  • Dr. Michelle Pike-Hough
  • Dr. Brooke Robinson
  • Dr. Keirsten Smith
  • Dr. Stephen Smith
  • Dr. Justin Vines
  • Dr. Courtney Weaver
  • Dr. Aisha Wright

2017 Graduating Fellows

  • Dr. Roma Teekamdas – Hospitalist Fellow
  • Dr. Brett Bentley – Sports Medicine Fellow
  • Dr. Monica Bui – Hospitalist Fellow
  • Dr. Lindsay Harbin – Obstetrics Fellow

Residency Award Winners

  • William R. Willard Award – Dr. Cory Luckie
  • Internal Medicine-Intern Award – Dr. Hailey Thompson
  • Internal Medicine-Best Resident – Dr. Brittney Anderson
  • Pediatrics Award – Drs. Keri Merschman, Keirsten Smith
  • Psychiatry Award – Dr. Keirsten Smith
  • Psychiatry/R3 Award – Dr. Justin Vines
  • Obstetrics and Gynecology Award – Dr. Justin Vines
  • Research/Scholarship Award – Dr. Eric Frempong, Brianna Kendrick
  • William W. Winternitz Award in Geriatrics – Dr. Stephen Smith
  • Society of Teachers in Family Medicine Teaching Award – Dr. Blake DeWitt
  • Clinical Competency Committee Awards – Drs. Cory Luckie, Ashley Wambolt, Blake DeWitt
  • William F. deShazo III Award – Dr. Blake DeWitt
  • 360 Award – Dr. Justin Vines

Chief Residents Recognized

  • Dr. Shawanda Agnew
  • Dr. Carrie Coxwell
  • Dr. Blake DeWitt

Rural Medical Scholar Graduates Recognized

  • Dr. Brittney Anderson
  • Dr. Remona Peterson
  • Dr. Justin Vines

The College’s Rural Medical Scholars Program is designed to recruit students from rural Alabama who want to become physicians and practice in rural communities in the state.

CCHS faculty present at AAFP Annual Meeting

At this year’s annual meeting of the Alabama Academy of Family Physicians, faculty of the College of Community Health Sciences provided presentations to family medicine physicians about quality diabetes care, and to medical students preparing to apply to residencies.

The meeting, held June 22-25 in Sandestin, Florida, allowed family medicine physicians from throughout the state to connect, earn continuing medical education credit and learn more about representing family medicine in the legislative, regulatory and public arenas.

Quality care for diabetics

Quality care measures for diabetic patients generally include blood sugar screening, retinal eye exams and nephropathy monitoring. “But there’s more that we want to do for our diabetic patients,” said Dr. Jared Ellis, associate professor of family medicine at CCHS. “It makes a difference to provide quality care.”

To make quality care a reality, “we need to rethink health-care delivery,” Ellis said in his presentation, “Improving quality care delivery for diabetic patients.” Care, he said, needs to be evidence-based and pro-active, not reactive. Patients should be cared for by a team of health-care providers, and reimbursement models need to be driven by quality, not volume of services provided. And, “we need to teach our patients to take better care of themselves and to be more engaged in their care,” Ellis said.

He shared with the audience steps he has taken to further improve the care he provides diabetic patients, which includes screening for blood sugar levels, checking blood pressure, urine and lipid panels, providing foot exams, referring patients for retinal eye exams, and encouraging patients to take aspirin, get flu and pneumonia vaccines and, if they were smokers, to stop.

Ellis focused on three quality care measures that he felt he could improve – retinal eye exams, foot exams and recommending flu shots. Instead of referring patients for eye exams, he now has his office make appointments for patients, and he makes sure to receive an eye exam report afterward. He helped create a template and prompt for foot exams in his practice’s electronic medical record. And he now documents when patients take him up on his recommendation to get a flu shot, and when they don’t.

In addition, Ellis huddles with nurses before patient visits to conduct chart reviews and to order pre-visit lab tests. “It saves 10 minutes on patient visits,” he said.

Ellis said after a second assessment, there was improvement in all of his quality-care measures. “I got 100 percent on everything,” he said.

Interviewing for residency

The University of Alabama Family Medicine Residency, operated by the College of Community Health Sciences, accepts 16 new residents each year but annually receives approximately 2,000 applications.

Across Alabama, family medicine residencies accept a total of only 55 medical school graduates per year.

“There’s lots of competition for spots,” Dr. Richard Friend, director of UA’s Family Medicine Residency, a three-year program that provides specialty training for physicians, told an audience of more than 50 medical students who will soon apply to residencies.

When medical school graduates apply for residency positions, they use the Electronic Residency Application System, or ERAS, which is a system that collects common information from all graduates. Friend urged those in the audience to “spend a lot of time on your application. It’s the first snapshot we get of you, and we pay attention to every detail.”

He said the application allows students to showcase their strengths, and explain their weaknesses.

Of the several thousand applications the UA Family Medicine Residency receives, 150 applicants are interviewed. “When we get you into an interview, we start assessing you right away,” Friend said. “Be prepared. Learn about the program. Read about the people who will interview you and learn their roles in the program.”