FP Report -- November 1998 What's up
in primary care education?
No more ivory towers. No more silos for separate disciplines.
Primary care education should be community-based and multidisciplinary. That will help students and communities the most.
This was the consensus of educators and administrators at the meeting on "Primary Care Education for the 21st Century: Lessons From National Initiatives" Sept. 24-26 in Baltimore.
Katie DiMasi does her first check of a patient's nose. George Spitzer saw DiMasi and FP Bill Minier, M.D., in Omaha.About 400 representatives of six initiatives, involving 98 health education institutions, shared what they've learned since the early nineties. They've spawned programs to educate medical students, nurses, midwives and physician's assistants in underserved areas. They've often trampled barriers between disciplines.
Rebecca Henry, Ph.D., of Michigan State University in East Lansing reported the view of students evaluating an interdisciplinary service project: "Some faculty get it, some just don't." Students saw academic-based faculty as more territorial about their roles. But community-based physicians focused on the case or the problem.
"Suddenly, when things were patient-centered, everything fell into place," said Henry. "We realized how much we undermine when we do projects in the academic setting instead of the community."
IGC Project
The AAFP and the Society of Teachers of Family Medicine helped create the five-year, 10-school Interdisci-plinary Generalist Curriculum Project, which convened the Baltimore meeting. The IGC gives community-based experiences to first- and second-year medical students."The first year of med school is books, books, books," said Katie DiMasi, a first-year student at the University of Nebraska in Omaha, one of the IGC sites. "Sometimes it's hard to remember what you're in med school for."
The IGC zaps that problem. "I love working here," DiMasi said last month at the Social Settlement, which offers senior services, daycare for kids and a one-room clinic where IGC students help physicians provide care.
In the IGC, family physicians, general pediatricians and general internists create generalist courses and line up preceptors. "All of us were concerned about losing our identities," said FP Jeffrey Susman, M.D., IGC codirector at the university. "People didn't want us to sell out or dilute family medicine. That concern hasn't played out."
Susman said it helps to have first- and second-year students spend more time in physicians' practices and a bit less in class: "You have to ask, 'What's the end product?' We're training compassionate, competent physicians, not biochemists or anatomists or histologists."
Crediting the IGC, a microbiology teacher quoted in last year's IGC annual report said, "The students have been more engaged in the course than in any of the preceding 30 years I've been doing it. ... They're asking questions that are to the point of clinical situations."
Community partnership
The Baltimore meeting focused on community partnership, which means putting citizens at the table, said pediatrician-psychologist Don Weston, M.D., vice chancellor of health sciences for West Virginia's university system.Since the early 1990s, the state has created a network of 13 rural health education consortiums, with 130 health centers and departments. Each consortium has a citizen board. "The rural citizens have to approve what we do in their communities," said Weston. At the state level, rural citizens sit at the table with deans of the health science schools to decide how the health education program will operate.
The network is working: The number of health professionals in rural West Virginia has increased by 11 percent.
Far to go
At the meeting's close, Harvard internist Thomas Inui, M.D., Sc.M., of Boston pointed to issues noticeable by their absence in the discourse: "Primary care folks never talk much about the biomedical revolution. There's little reference to genetics in primary care."Inui also charged, "We do our best job with arthritis, myocardial infarction, depression or name-your-favorite-chronic-condition when we collaborate, generalist and specialist. We don't talk much about that in primary care. We need to."
By Jane Stoever, Managing Editor
FP Report is published by the AAFP News Department. Copyright © 1998 by American Academy of Family Physicians.
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