Three-year Med School Track Boosts Family Medicine in Texas

December 16, 2015 03:08 pm Michael Laff

Robert Cooper, M.D., graduated medical school in just three years with no worries about where he would complete his residency or how he would pay off tuition debt.

Ron Cook, D.O., M.B.A., (standing) chairman of the Texas Tech University Health Sciences Center School of Medicine's Department of Family and Community Medicine, teaches second-year Family Medicine Accelerated Track program students.

While his colleagues were interviewing for residencies or volunteering overseas during their fourth year of medical school, Cooper was already starting his residency in family medicine.

Cooper is a member of the inaugural class of the Family Medicine Accelerated Track program(www.ttuhsc.edu) at the Texas Tech University Health Sciences Center School of Medicine (TTUHSC). The three-year curriculum, which the Liaison Committee on Medical Education (LCME) approved in 2010, allows a handful of students to begin their residency one year sooner and includes a scholarship for at least one year of medical school.

Two of the program's main goals are to encourage more students to enter family medicine and to increase the number of primary care physicians in Texas.

"Only 10 percent of medical students choose family medicine," said Steven Berk, M.D., dean of the TTUHSC School of Medicine. "Now we have a national crisis, so we wanted to bend the curve toward family medicine."

Story Highlights
  • Texas Tech University is aiming to encourage more students to enter family medicine and increase the number of primary care physicians in the state through its medical school's Family Medicine Accelerated Track.
  • Thanks to a scholarship and one less year in school, students in the program typically graduate with just $22,000 of debt.
  • School officials intend to keep the program small and selective.

Clear Choice

Cooper made his decision to enter family medicine long ago. He was in high school when he began observing Brent Wadle, D.O., a family physician in Winnsboro, Texas, now practicing in Tyler, who became his mentor and guided him toward a medical career.

He said the accelerated program positions him well for his plan to join a small practice in Sulphur Springs, Texas, after he completes his training in the Family Medicine Residency Program at Texas Tech's Amarillo Health Sciences Center.

Cooper said he will be ready for the transition even without a fourth year of medical school and its usual residency interviews and off-site rotations.

"I don't see how the fourth year is such an important part," Cooper said. "I knew what specialty I wanted to enter and I wanted a residency in West Texas, so that reduces much of the reason for it. There are fourth-year rotations in the ICU and geriatrics, but we put those in the third year."

It was difficult to budget time to study for Step 2 of the United States Medical Licensing Examination (USMLE) during a third year filled with clinical rotations, but Cooper said the tight deadlines actually left him better prepared for his residency.

"When I graduated medical school after the third year, I felt the transition from the third year to residency was scary, but it was smoother than I expected because we didn't have the fourth year that breaks up the clinical knowledge," he said.

Indeed, school administrators tracked student progress and found that those in the accelerated program were ahead of their four-year peers in terms of clinical preparedness.

With the state's acute primary care shortage in mind, Cooper said all Texas medical schools should offer a fast-track program for family medicine.

Program in Focus

Texas Tech officials intend to keep the accelerated program selective and small, with classes that typically range in size from eight to 15 students. Halfway into their first year, students are partnered with a mentor on the family medicine faculty. They also attend lectures by family physicians during their first summer.

Family medicine department Chair Ron Cook, D.O., M.B.A., chats with Molly Rooney and Danica McAden, two students in the department's accelerated curriculum program.

In their second year, students on the accelerated track do clinical work twice a week and complete their family medicine clerkship. For the third year, they complete rotations in internal medicine, OB/Gyn, psychiatry, surgery and pediatrics, a regimen that is normally completed during the fourth year in a standard program.

According to an FMAT Fact Sheet,(www.ttuhsc.edu) the TTUHSC medical school's accelerated curriculum covers 149 weeks of instruction, well above the minimum LCME requirement of 130 hours.(www.lcme.org) The school's four-year curriculum covers 160 weeks.

Students can change their mind at any time and transfer into the four-year program if they wish, but those who leave family medicine for another specialty must pay back their scholarship. Berk said very few students have chosen this route, and, on average, only one student each year moves to a four-year track.

Graduates of the accelerated program complete their family medicine residency at sites in Lubbock, Amarillo or the Permian Basin in West Texas, all affiliated with Texas Tech.

When conceiving the program, school officials referred to a state health department map that highlights the shortage areas, particularly in West Texas and the Panhandle.

"We need primary care everywhere in Texas," Berk said. "The rural areas are in crisis, and in the big cities, a lot of people can't find a primary care physician."

Students in the accelerated program typically graduate with just $22,000 in debt compared to four-year students, who accumulate more than $100,000 in debt, on average, according to school figures. But that wasn't the primary motivation in the program's creation.

"We did this to promote primary care," Berk said. "We're not doing it to make medical school faster and cheaper for anybody who wants to do it."

Sights on Family Medicine

Like Cooper, Keeley Bramblett, M.D., entered family medicine thanks to the influence of physicians who practiced in the small towns where she lived.

Another member of Texas Tech's first accelerated class, Bramblett graduated in spring 2013 and will complete her residency at the school's Lubbock site in summer 2016. She is still deciding about her career but plans to practice in rural West Texas and pursue an academic post.

Because of the compressed timeline, Bramblett said students in her program had to be more intense. As Cooper also noted, they did not have time off to prepare for the USMLE Step 2 exams, as four-year students do.

"As far as the curriculum goes, I can't think of anything we didn't get that our counterparts (in the four-year program) got," she said. "We had just as much contact hours between our first and second year as our peers did."

When talking with friends studying in the four-year track, Bramblett learned they spent much of their final year doing interviews for a residency or elective rotations, which required extended periods away from school.

"I never felt that I was at a disadvantage," she said. "We already knew we were already guaranteed a residency, so we didn't need extra time to figure it out."

Addressing Critics

Some medical school deans have expressed skepticism about the accelerated curriculum, but Berk responds that students receive a degree for reaching a specific level of competency, not for completing a timeline.

"If they can meet all of the competencies in three years, that should not be an issue," he said. "A Ph.D. student does not get a Ph.D. after eight years. He gets it once all the requirements are met."

One other positive outcome of the accelerated curriculum is that family medicine is now a highly competitive program at Texas Tech.

"We made family medicine more prestigious," Berk said. "In the past, when a good student said he was going into family medicine, the faculty would say, 'Why are you doing that?' We don't have that here. Now there are more fourth-year students choosing family medicine."

Related AAFP News Coverage
Fresh Perspectives Blog: How Long Should It Take to Train a Family Physician?
(6/15/2015)


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