Answering calls to expand the U.S. physician workforce, four new allopathic medical schools seated their first classes last fall. Located in Pennsylvania, Florida and Texas, the schools have implemented various initiatives aimed at introducing students to family medicine and primary care, teaching students about the importance of primary care in the nation's health care system and boosting interest in practicing in primary care specialties in their regions.
The medical schools -- The Commonwealth Medical College in Scranton, Pa., the Florida International University Herbert Wertheim College of Medicine in Miami, the University of Central Florida College of Medicine in Orlando and the Texas Tech University Health Sciences Center Paul L. Foster School of Medicine in El Paso -- offer programs that give students clinical experience early, place them with families for continuity experiences or have extended primary care clerkships.
Located in rural northeastern Pennsylvania, The Commonwealth Medical College has embraced a community-focused approach to medical education and has started to address a shortage of physicians in the area. Robert D'Alessandri, M.D., who is president and founding dean of the college, told AAFP News Now that the school hopes that 50 percent of its graduates will go into primary care specialties.
One way to accomplish that, he said, is through the college's distributive model of medical education, which utilizes campuses in Scranton, Wilkes-Barre and Williamsport. From the start, students are assigned to one regional campus.
All students take their first two years of classes at the Scranton campus and participate in six weeklong community experiences. Their final two years are completed at their assigned campus.
According to D'Alessandri, students' clinical education starts during their first year, when each student is assigned a "continuity mentor" -- a family physician or general internist -- and a family that the student will follow throughout his or her four years of medical school. Students visit their families' homes, conduct interviews and learn about the socioeconomic context of health care and the health care system.
"Students will go into the home, see the home situation and look into the medicine cabinet. They may find bottles of pills never taken. They may find that people have to make a decision between buying medications and buying food. We want the students to be privy to those kinds of situations," D'Alessandri said.
Janet Townsend, M.D., who is founding chair of the college's department of family medicine and community health, told AAFP News Now that her department supports first-year students in carrying out community health projects from their respective regional campuses. Working with a number of primary care physicians and service agency providers in the community, the students launched 15 group projects this past October, she said.
The department also plans to support area physicians in their efforts to transform their practices into patient-centered medical homes, Townsend said, so students can be exposed to this innovative model of care.
The Florida International University, or FIU, Herbert Wertheim College of Medicine also boasts a keen community orientation, as evidenced by the school's mission statement, which points squarely to a special focus on community health throughout metropolitan Miami.
John Rock, M.D., founding dean and senior VP for medical affairs at the college, said its trademarked Green Family Neighborhood Health Education Learning Program, or Green Family NeighborhoodHELP, offers medical students long-term community-based experiences. Central to NeighborhoodHELP is the college's division of family medicine, whose faculty members mentor the medical students and supervise their community-based clinical experiences.
Beginning their first year, medical students are introduced to local issues of health disparities and community needs. Students visit community agencies whose missions address the social determinants of health that predispose communities to poor health outcomes. Each medical student then teams up with FIU students studying nursing, social work and public health to work with a household in one of four local medically underserved, multicultural communities. The teams visit the households every two to four weeks and work to improve household members' health and well-being.
"It's an immediate introduction to community medicine and a hands-on experience," Rock said. "We will be training students who are interested in primary care. They'll also be culturally sensitive and will celebrate diversity. If they go on to select another specialty, they will have a keen understanding of taking care of patients."
David Brown, M.D., founding chief of family medicine in the college's interdisciplinary department of humanities, health and society, said the dean is committed to having a 10:1 student to family medicine faculty member ratio, which allows faculty members to closely supervise students throughout the four-year family medicine clerkship.
To encourage young people to go into primary care medicine, The Commonwealth Medical College in Scranton, Pa., is building a Pipeline to Medical Colleges Initiative(www.thecommonwealthmedical.com). The college works with nearby universities, four-year colleges and community colleges to identify and support rural, disadvantaged, female, minority and first-generation college students interested in medical careers and likely to practice in the region.
In addition to reaching out to undergraduate institutions, said Dean Robert D'Alessandri, M.D., the medical college wants to expand the pipeline into area high schools and junior high schools.
"We're really focusing on young people who have an interest in the health professions and in serving their community. That's one of the best ways to increase the number of students who will go into primary care and stay and practice in the region," he said.
Another way to increase the number of primary care students is to mitigate student debt as a barrier to entering primary care careers, said D'Alessandri. Through philanthropic donations, the medical college offered scholarships totaling $80,000 -- $20,000 per year -- to each of 65 charter class members.
Thirteen of the 43 students in the charter class of Florida International University Herbert Wertheim College of Medicine in Miami received partial tuition scholarships ranging from $40,000 to $100,000. Another student received a one-year $25,000 renewable scholarship.
The Texas Tech University Health Sciences Center Paul L. Foster School of Medicine in El Paso gave 25 of its 40 charter students four-year scholarships totaling $60,000. The school also has a loan forgiveness program that allows five students each year to borrow as much as $20,000 annually; annual loans are canceled when graduates return to practice in the region.
Finally, all 41 members of the inaugural class at the University of Central Florida College of Medicine in Orlando received four-year loan packages totaling $160,000 each.
"We wanted students to follow their passion without worrying about the debt," said Lynn Crespo, Ph.D., assistant dean for undergraduate medical education. "When this class graduates, those who want to go into primary care can do so without worrying about the debt. They can practice the medicine that is in their heart and not because they have to pay off $200,000 in debt."
Another component of the clerkship, according to Brown, is that family medicine faculty members partner with a diverse group of other faculty members to integrate a longitudinal curriculum that encompasses ethics, intercultural competency, clinical skills, professional development, social determinants of health, community partnerships and service learning.
"By providing students longitudinal experiences in the community from the start and throughout their training, we are encouraging them to consider family medicine and primary care. Those inclined to go into primary care will have the experiences to reinforce their interest. Those who aren't will be prepared and will understand the value of primary care," Brown said.
Further north, the University of Central Florida College of Medicine in Orlando is a "full-service medical school" that encourages students to follow their dreams -- whether that leads them to patient care, research or population health, said Lynn Crespo, Ph.D., assistant dean for undergraduate medical education.
"As our dean, Dr. Deborah German, often says, the students come in three flavors: The first is the Mother Teresas, the students whose goal is to care for people one at a time; the second is the Nobel laureates, the cutting-edge researchers who want to find a cure; the third is the surgeon generals, the students who want to look at health and medicine from a population perspective," Crespo said.
From their first week in medical school, students visit community physicians' offices to learn how to communicate with patients, take a medical history and examine the socioeconomic needs of different populations.
"We want them to get lots of experience talking to patients and examine what is happening in that experience," Crespo said.
Also during their first year, medical students begin an individualized research project, which they present to classmates and faculty members during their second year. The research can involve primary care, public health or the underserved.
For third- and fourth-year students, the medical school offers a 12-week combined internal and family medicine clerkship. Students also can participate in volunteer community service experiences at outreach clinics.
Finally, the Texas Tech University Health Sciences Center Paul L. Foster School of Medicine in El Paso added the first and second years of medical education to its existing third- and fourth-year regional campus clinical training programs this fall. According to Jose Manuel de la Rosa, M.D., the founding dean, the school has a legislative mandate to provide physicians who will serve rural West Texas.
Among initiatives that encourage students to go into primary care specialties -- especially family medicine -- are FP mentor and adviser programs available during their first year; exposure to clinical and community practices beginning the first month, including pairing students with mentor families; an active family medicine interest group; a rural family medicine preceptorship supported by the Texas AFP; and a longitudinal third- and fourth-year family medicine curriculum, said de la Rosa.
In addition, in its admissions process, the medical school gives preference to students who grew up in rural communities, come from disadvantaged backgrounds or were the first generation in their families to go to college. According to de la Rosa, those characteristics lead physicians to practice in rural and underserved communities.
Mary Spalding, M.D., founding chair of the department of family and community medicine, said first-year students are introduced to clinical presentations and community medicine, including working with mentor families' genograms and gaining an understanding of the family life cycle and how it impacts health and well-being.
"The family life cycle is a powerful introduction to primary care and family medicine," Spalding said. "Students understand right from the beginning that a person has environmental accompaniments. It's not just a disease coming through the door."