Guest Editorial

Help Save Our Med School Program and Its Primary Care Focus

May 20, 2016 07:29 pm Melinda Kong, M.D., M.S. Berkeley, Calif. –

Do you remember your first day of medical school? Were you packed in a large lecture hall with a hundred other anxious first-year medical students, worried about impressing your professors as well as your peers?  

[Melinda Kong, M.D., M.S. headshot]

Did you toss and turn the night before, reviewing the few anatomical landmarks you remembered from your undergraduate studies, while somewhere in your head the cranial nerve mnemonic kept reverberating?

Personally, I might have had that insomniac night, but on my first day of medical school I actually sat at a little conference table with the 15 other students in my cohort, and we prepared to work in small groups to come up with a design that would allow a raw egg to drop three stories unscathed.

It sounds like a high school experiment, right? None of us were trained engineers, and we were only given basic materials of construction paper, string and some tape. No group succeeded in the task; the remnants of our egg yolks splattered all over the asphalt next to the University of California, Berkeley, (UC Berkeley) School of Public Health building. The hidden lesson, however, was to get to know our classmates, learn to communicate and work together as a group.

I can't help but think that another side lesson was probably to deal with the feeling of failure, which we are all bound to experience in medicine.

As things stand, our medical education system is failing our country. The United States is projected to need an additional 44,340 physicians by 2035, but given our current rate of production, we will fall short of that number by more than 33,000(www.annfammed.org). The average U.S. allopathic medical school is only graduating 8.7 percent of its students into family medicine and only 12 percent into primary care specialties overall.

And that is why I want to tell you about my med school.

Sixty percent of graduates from the UC Berkeley - UC San Francisco (UCSF), Joint Medical Program (JMP)(sph.berkeley.edu) enter primary care medical specialties, including 20 percent who go into family medicine. Yet despite those incredible numbers -- and the fact that California needs more than 8,000 additional primary care physicians by 2030(www.healthleadersmedia.com) -- the JMP is facing closure because of budget constraints(www.eastbaytimes.com)

I heard this horrible news on the eve of my graduation day, right before I packed up to prepare for my family medicine residency. So that's how things ended for me at JMP.

My journey through medical education began with that egg drop. That offbeat introduction was essential to the medical students in the JMP because for the next three years, we were not only going to be classmates -- we also were going to be each other's teachers and students.

There are three major features that make JMP a unique medical program. First, instead of the traditional passive, lecture-style learning, JMP students learn exclusively through a problem-based learning (PBL) approach in which they teach each other basic medical sciences by working in small groups to understand simulated medical cases. The JMP won the Association of American Medical Colleges' Shining Star Award for innovation in 2014 because of this PBL curriculum.

Every Monday, we were given a new case where a patient's condition would unfold. As a group, we would form questions we could ask the patient and questions to help guide our understanding of the illness the patient was experiencing.

"Is the patient short of breath? What processes can cause shortness of breath? What medicines can we give to relieve the symptoms, and how do these medicines work?"

At the end of these sessions, each student was tasked with learning about some aspect of the case, writing a summary, and coming in the following day to teach the rest of us what he or she had learned.

But beyond just understanding the pathophysiology, we also dived into getting to "know" our simulated patient.

"Why did she take so long to visit a doctor? Does she have adequate access to health care? Is she hiding an abusive relationship?"

And that's where the JMP's second key feature comes in: its focus on social context. We learn to not view our patients solely as clusters of signs and symptoms -- only focusing on the physiology -- but instead to understand the context in which they live and how we can provide better health care given that understanding.

Medical students choose to matriculate to the JMP -- even though it requires an additional year and a heavier class load to earn a Master's degree in the Health and Medical Sciences from the school of public health -- in large part because of the unique opportunities JMP students are given to work directly in the community.

These students help run the Suitcase Clinics(www.suitcaseclinic.org), a group of community clinics in Berkeley that aim to provide basic health care to under- and uninsured populations.

We are also given opportunities to precept in federally qualified health centers and county hospitals such as Highland Hospital, as well as to participate in communitywide projects. While I was in the JMP, for example, I interviewed elderly Chinese immigrants and assessed their understanding of type 2 diabetes, which later became a part of my master's thesis. I also helped conduct a yearlong community needs assessment of school-age children in a poverty-stricken area, and I traveled to Nepal to help provide health care to migrant workers in Kathmandu.

It's no wonder more than half of JMP graduates enter primary care. From day one we are ushered into an environment that imbues in us the basic tenets of primary care and family medicine, focusing not just on the medical knowledge but also on the individual patient in his or her social and environmental context. Granted, we do have classmates who go into other specialties, but everyone leaves the JMP with a deeper understanding of the public health issues we face in this country and around the globe. It's no wonder JMP students are widely recognized by clinical faculty as having the most consistently outstanding and empathetic bedside manner of all UCSF graduates.

The third unique aspect of the program is that this innovative curriculum is already successful at putting out leaders and experts in the social determinants of health, many of whom continue on with research in public health and clinical fields and continue on as faculty and attendings in academic and community hospitals and other health care settings.

It sounds pretty good, right? So what insurmountable sum, you ask, is threatening the program's future? In a state that spends more than $20 billion -- yes, that's billion with a "B" -- on health care, the JMP is on the chopping block because of a $600,000 shortfall. UC Berkeley receives more than $3 million in resources yearly for the JMP, but only $1.3 million makes its way to the school of public health to pay for our $1.9 million program.

I urge you to take action. If you live in California, please sign our petition(www.ipetitions.com) and help us with our letter writing campaigns(savethejmp.com). If you live outside California, your help can be valuable, as well. Please spread the word and help us prevent the closure of this wonderful program.

The Patient Protection and Affordable Care Act continues to bring millions of traditionally underserved people into the health care system. These are precisely the people JMP graduates are trained to care for. We should be producing more such physicians, not fewer.

As I learned from my hidden lessons at the JMP, we all have to work together.
If you want to learn more about the JMP and our current situation, please visit savethejmp.com(savethejmp.com) and support us on social media by using #savethejmp.

Melinda Kong, M.D., M.S., is a 2016 graduate of the UC Berkeley - UCSF Joint Medical Program and is a rising first-year resident at the Contra Costa Family Medicine Residency.


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