Pulse
Class Project
Last year, between mastering human anatomy and getting their first taste of rural medicine, about a third of the first-year medical students at the University of Minnesota-Duluth campus were also selling tacos and coupon books. The students were part of MEDS (Medical Education through Diversity and Service), an elective that was started as an extracurricular activity by students a decade ago.
The course (credit is now awarded through the Department of Community and Family Medicine) culminates in students traveling to a region of the United States or another country that is medically underserved where they volunteer. In addition to fundraising, they plan their own trips, which are approved by advisor Ruth Westra, D.O. When they return, they write papers and present what they learned to their peers and faculty. This year, the MEDS experience will include sessions on global health topics.
“Our model is unique,” says Mariya Hachey, a second-year student who served as president of MEDS last year. Although she wouldn’t turn down a large grant that might end the need for the taco sales, Hachey says the work the students do up front builds camaraderie and motivates them to study hard that first year. “You think, the more I study and learn now, the more I can apply this summer on this trip that I’m taking,” she says.
Last summer, 17 students went to nine countries. Hachey herself traveled to Papua New Guinea, where she worked with a Roman Catholic nurse. Although it wasn’t Hachey’s first medical mission—she worked as a nurse in Ecuador prior to starting medical school—she says this trip made her aware that each developing nation faces its own health care challenges. In Papua New Guinea, simply getting to where people live is one of them. “You have to fly between cities on small charter airplanes,” she says. “Once you get to a provincial capital, then you go by car or hike on primitive roads to the villages.”
Hachey says intercultural health care experiences expand knowledge and inspire compassion. “You learn how much work there is to be done,” she says. And she believes they make people better doctors. “Even if we stay in the United States, we’re going to be dealing with more and more diverse populations. To become more culturally sensitive at this stage in our training is imperative.”—Carmen Peota
A Tuned-Up Track
This was supposed to be the year that sweeping changes would be implemented at the University of Minnesota Medical School. A five-year plan called MED 2010 was to culminate in an overhauled curriculum. Lecture-based courses were to have been replaced by education that was more experiential, self-directed, and tailored to individual students’ needs.
The label “MED 2010” was scrapped about a year ago, but some of the components of the plan have made it beyond the drafting board. Although the changes are more a tune-up than an overhaul, the first-year experience at the university’s two campuses is different this year than it was last year.
On both campuses, a couple of half days each week are left open for study and small-group discussions. Case-based learning is being emphasized as well. “Rather than typically having just a sage-on-the-stage lecturer, who would talk to the class for 50 minutes, we’re giving them cases to interact with so they can learn the same kind of material,” says Richard Hoffman, Ph.D., associate dean for medical education and curriculum at the Duluth campus, who helped design the new curriculum there.
Both campuses also are working to get medical students into clinics, hospitals, and communities much sooner than they did previously. The trend in medical education is earlier clinical experiences, according to Linda Perkowski, Ph.D., associate dean for curriculum and education at the Twin Cities campus. “The Flexner model was two years of basic science and two years of clinical. Over the years, we’ve realized, and the literature has pointed out, that the best way to learn is in context,” she says. “Having them work with patients from day one is probably the best way for us to help them figure out how some of the science is going to be applied.”
In addition to these changes, the Twin Cities campus has introduced integrated courses. Instead of taking separate courses in anatomy, histology, and embryology, students this year will have one course called “Human Structure and Function,” which combines all three topics. In “Science of Medical Practice,” they’ll study genetics, biochemistry, nutrition, translational medicine, and population health. And in the two-year “Essentials of Clinical Medicine” course, they’ll learn clinical skills and explore professionalism, ethical, and societal issues.
The Duluth campus has instituted block scheduling—where students take one class at a time. The first-year students started in September with a seven-week block called “Foundations of Medicine.” That was followed in October by a two-week “Introduction to Rural Family Medicine” block, where they went out to communities they will visit periodically over the next two years. Hoffman explains that faculty felt having courses running concurrently was a detriment to learning. “[Students] were making choices,” he says, “Do I pay attention to this material or that material?”
Hoffman says educators on the Duluth campus won’t really know the effects of the changes for several years. “Ultimately, our benchmarks are these outcomes—What do our students do in terms of practice? Are they matching into primary care? Are they practicing in small-town Minnesota?” he says. “All of that is years down the road.”—Carmen Peota
RPAP Goes Urban
Ben Pederson is taking a new approach to the University of Minnesota’s rural physician associate program (RPAP). Rather than spending nine months in a rural community, the third-year medical student is doing his nine-month clerkship in north Minneapolis.
Pederson is one of two students who in September began what the university is calling MetroPAP—a version of the 40-year-old RPAP in which students are placed at the Broadway Family Medicine Clinic. “The goals are to get students in underserved urban areas, give them a stronger exposure to primary care and the principles of continuity of care and longitudinal care, and get them to interact with the community,” says Shailey Prasad, M.D., M.P.H., who practices at the clinic and is one of the preceptors for MetroPAP.
The MetroPAP students will spend their first and last six weeks doing an elective under the guidance of their preceptor. They also will complete their surgical, ob/gyn, and emergency medicine rotations at nearby North Memorial Medical Center and do a family medicine clerkship and a primary care elective with faculty and residents from the North Memorial family medicine residency program. “North provides us with the opportunity to do medical student education in more than just family medicine,” says Prasad, who has served as a visiting faculty member at RPAP sites.
Having the chance to work in north Minneapolis, where a large percentage of the city’s poor, uninsured or underinsured, and recent immigrants live, appealed to Pederson. “It really resonated with how I see my future practice unfolding,” he says.
Like the RPAP students who live in the communities where they do their clerkships, Pederson moved just two blocks from the clinic before beginning the program. (According to Prasad, students are not required to live in the area.) “By living in the community you’re serving, you understand the social context, where a lot of your patients are coming from. And you’re taking care of your neighbors,” he says.
Pederson says he’s looking forward to following families—especially pregnant women and patients with chronic conditions—over time. “I’m really interested in issues of access and creating different models of care delivery such as home visits and community outreach visits,” he says. “We need to go out and meet people where they are at. I think that’s the future of improving health care.”—Kim Kiser