By Sarah Sonies
Leaders at the Warren Alpert Medical School at Brown University have recognized the need not only to educate more primary care doctors, but also to provide a diverse medical curriculum to enhance and emphasize active learning models. In January, the medical school announced plans for a dual-degree primary care and population health program. Wing of Zock Associate Editor Sarah Sonies sat down with Dr. Edward Wing, dean of medicine and biological sciences, to discuss the origin and development of the program.
WoZ: What needs will the new program address? How will it benefit population health?
Wing: We made a decision to establish this program based on what we feel is important in the changing health care system. Health care has to move away from an expensive hospital-based care system, and start with a basis of primary care and population health—in that sense, we need health care reform. We need to change medical education, just as health care in the country is changing. This type of program could develop around the country and influence the development of medical education..
Although primary care and public health share similar goals, these two have historically operated independently of one another. Brown has always had a very strong primary care foundation, but now we are taking advantage of the strength of our medical students and cultivating an environment with students who will be primary care-oriented, but population health-based. Our goal is for students to come out with a Master of Science in Population Health and to develop more specialized expertise, which is so important for the future.
WoZ: The program is patient-centered and focuses on active learning. How do you plan to merge primary care training with internal medicine and surgery in nine months, for a comprehensive medical education?
Wing: We plan to combine and compress the introductory medical sciences and the physiology into two years. Students will be taking the introductory medical sciences during the first year, while taking courses in population health simultaneously; such as behavioral medicine, statistics, health care policy, and evidence-based medicine.
We want to implement a longitudinally-based curriculum that gives students more enthusiasm to practice. We will take the model of Cambridge Health Alliance and some other successful programs, where students are assigned to a primary care doctor, assigned to a certain number of patients, and follow those patients over their third year. During that time, they will see and treat patients with a wide array of conditions: births, heart attack patients, cancer diagnoses, obesity, and substance abuse patients. With this model, the students will come out with the same or more information from a traditional curriculum, but with more direct patient experience.
Students will also be able to pick a scholarly concentration to focus on an area of academic interest such as population health or behavioral medicine; they will do a project within that area to qualify for their Master of Science.
WoZ: The program will offer ongoing mentorship from Rhode Island-based primary care physicians in the form of long-term clerkships. How will students be paired up with their mentors?
Wing: We are still in the process of working out many of those details. We have a lot of strong primary care faculty in our community hospitals and clinics, and students will be assigned to one of them. One of our CEOs is the former CEO of Cambridge Health System in Boston, and we have benefitted from his expertise in developing a model for how to assign these students to their physician mentors. In that system, physicians are randomly assigned to the interested doctors, They meet every morning to review their patients with their mentors and ask questions.
WoZ: How is the program funded? Are there funding opportunities or incentives for students to enter?
Wing: We are currently looking at additional funding models for the program, as well as scholarships for students. The actual program funding will probably have to have some capital funding to ensure we have enough room for the students and adequate educational facilities.
Our advisory committee consists of the stakeholders of this initiative. We have a community advisory board helping us put the program together. Rhode Island is a smaller state, so it allows us to work closely with the health department and state officials. We’ve talked a lot about funding models in interdisciplinary education. This program will bring the two fields of primary care and population health together because they share similar goals. During the third year, when students are assigned to a physician, they will have the opportunity to gain experience in areas like dermatology, ophthalmology, as well as internal and family medicine.
WoZ: Your article in Brown Medicine states that students for the program will be chosen based on their connections to Rhode Island. It is your hope that students will enter residency programs in Rhode Island after completing their education?
Wing: When you start talking about no lectures, active learning, and longitudinal clinical experiences, we think elements of that will transfer to some extent into our regular program as well. We have around 120 students in our regular program, about 480 students total, and we will be adding about 24 new students per class with this current program. These students will come in under a separate admissions process. We are looking for a very different type of student. We are very interested in the students who have had experience in this area, might be more mature, committed, and specifically interested in primary care or population health.
It is our hope that those who want to go into primary care and population health will do so in Rhode Island. Our students go all over the country, but many show a strong commitment to our community and to the state. We plan to have a number of slots for residency at Brown in primary care fields, like family medicine, internal medicine, and pediatrics reserved for students in this program. We also think this will be a route for general surgery, which is a little bit outside the box, but this track is really for those interested in general practice and population health.
WoZ: What are one or two of the most important skills to instill in the future workforce, especially those entering primary care?
A patient-centered medical home should be the starting point for population health, utilizing preventative care and catching things early. Hospitals and specialty care should be the backup, not the first care step. Hopefully, in the next 10 years, we will see a transformation of medical care, previously hospital-based, to outpatient primary care and population-based.
We are in a very exciting time to be in health care and medical education, but there has to be a shift. You can’t educate doctors in the old way. There needs to be a greater emphasis on primary care in the future of medical education.