Making the Case for Pathway Innovation

“As an immigrant and the first generation in my family to attend college, I believe that diversity, equity and inclusion are not only important, but also possible,” said Leong, assistant dean for pathways innovation, and director of longitudinal and accelerated pathways at the Penn State College of Medicine. “While I am proud of my accomplishments, I owe much of my success to the support of many mentors and sponsors. I want to pay it forward and mentor aspiring leaders of tomorrow.”

After the death of Leong’s father, her mother brought the family to the United States from China when Leong was still a child. Leong later attended the Sophie Davis School of Biomedical Education at City College of New York and earned her medical degree from the New York University School of Medicine.

The City College program’s purpose was to bring underrepresented minority students to medicine with the hope that they would practice in underserved areas. The six-year program made medical school more affordable and connected her with invaluable role models.

“Becoming a physician had not been on my radar,” Leong said. “Finding out about the Sophie Davis biomedical program opened doors for me. The mentorship and support from faculty in the program were invaluable.”

After completing her training at Swedish Hospital Family Medicine Residency, Leong continued to practice in Seattle in a low-income neighborhood for nearly a decade. When her husband, Keith Cheng, M.D., Ph.D., was recruited to Penn State, she took a job as an assistant professor in the school’s Department of Family and Community Medicine. Meeting national leaders in the specialty through her involvement with the Society of Teachers of Family Medicine inspired her to address the need for more primary care physicians.

“I believe that medicine needs to be redesigned, so aligning medical training with the health care needs of the nation has been something I’ve been pursuing throughout my academic career,” said Leong, who was honored this fall with the AAFP’s Thomas W. Johnson Award for her contributions to family medicine education.

Leong, as a professor and associate vice chair for education, led the efforts to develop a three-year accelerated program at Penn State College of Medicine. The school accepted its first student in an accelerated family medicine pathway in 2014, and has since added three-year pathways for 12 other specialties.

Leong said Penn State now takes four to six students in the accelerated family medicine pathway each year and one or two students each year in the other three-year pathways.

Accelerated pathways allow students to complete medical school in three years and enter practice one year earlier. This is associated with more than $270,000 in financial gain for students, Leong said. She said the model also helps health systems recruit excellent residents into their programs and makes it more likely that residency graduates will be retained by their health systems.

Leong said acceleration is not for everyone, and students who aren’t ready to commit to a specialty are encouraged to use a traditional four-year path.

“If you want to be a family physician, the family medicine accelerated pathway offers many benefits,” she said. “The UME-GME continuum offers the three-year acceleration pathways the opportunity to customize the training and to build a curriculum that is best for family medicine. The mentoring helps the learner to be successful as a resident. We integrate the learners into the department early on, so they get to know the faculty, residents and staff, allowing them to discover their professional home.”

Penn State’s three-year pathways are associated with their residency programs. Leong said students who perform well in the accelerated pathways are ranked highly by Penn State residency programs during the National Resident Matching Program.

“If students meet the standards we set and choose to stay — and most of them do — then they generally will match into the Penn State program,” she said. “That’s one less stressor to deal with. Many students tell us that besides all of the financial benefits, knowing where they’re going to be for the next six years allows them to put down roots. When you match in to a residency, you don’t have to start over. You already know the system, the people and your patients, making it a much smoother transition.”

Penn State isn’t alone in primary care accelerated tracks and pathway innovations. More than 30 medical schools in various stages of development participate in the Consortium of Accelerated Medical Pathway Programs. CAMPP, funded by the Josiah Macy Jr. Foundation, focuses on developing a community to share best practices and conduct research for accelerated programs.

“Teaming up with other three-year medical schools has been wonderful because it allowed us to come together and learn from each other,” Leong said. “We were able to publish manuscripts together, despite each program being small, by pooling our results.”

The consortium’s findings, published earlier this year in Academic Medicine, were important because they “support accelerated programs as a potentially important intervention to address workforce shortages and rising student debt without negative impacts on student perception of burnout, education quality or residency preparedness.”

Leong said Penn State students from the three-year pathways have fared better on United States Medical Licensing Examinations than their four-year counterparts, and other schools in the consortium found that students from three-year pathways are more likely to become chief residents.

Nearly 30% of students who have participated in Penn State’s accelerated family medicine program come from underrepresented backgrounds.

“If we really are serious about diversity, equity and inclusion work, then we need to translate that into action,” she said.

Leong made another big impact on family medicine training before she began working on accelerated pathways. From 2008-2010 she led the development of fmCASES (now Aquifer Family Medicine), a set of virtual patient cases used to teach the national core curriculum for family medicine clerkships. She said 96% of U.S. medical schools subscribe to the service, and students complete more than 1 million cases each year.

“It’s now embedded in most medical school curricula for family medicine, and clerkships rely on these cases to make sure that their students are learning the core content as defined by STFM,” said Leong, who was founding editor-in-chief of fmCASES from 2010-2015 and has served as senior director for the past seven years.

Leong said she had a dream about “a classroom without walls” that would allow students to learn from expert faculty regardless of their locations. She was already developing “computer cases” for her own clerkship in the 1990s before the Liaison Committee on Medical Education established ED-2, a standardization requirement that called for students to receive comparable experiences across all teaching sites.

“I started online cases for my clerkship needs,” she said, “but when LCME required the standardization of the education, it became a national need. I had published on this subject and have the expertise.”

Leong was the chair of an STFM committee addressing the ED-2 requirement and online cases, and was contacted by Aquifer CEO Leslie Fall, M.D., to collaborate.

“We developed this excellent relationship of sharing and collaborating,” Leong said. “Medicine evolves and guideline policies change, so Aquifer Family Medicine has a whole team that works to keep the cases up to date.”

Leong said choosing family medicine was one of her best professional decisions.

“It is here that I found my people to collaborate with, to share my passion and to build my dreams,” she said. “I hope aspiring leaders will discover their dreams with family medicine as well.”