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Spring 2014
BMM Current Issue
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OPINION
 
Med Ed 2.0
A new program will train the future primary care physician.

President Obama’s second term assures further implementation of the Affordable Care Act, and with it, the acceleration of sweeping changes in American health care. Amid these changes, our current workforce may no longer meet the demands of the future health care system. With more insured patients and a greater focus on primary care and prevention, we’ll need more comprehensive, whole-person, first-contact care provided by generalists such as family physicians, primary care internists, and pediatricians.

But the primary care of the near future can’t just be the primary care of the present merely on a larger scale. In the emerging system, primary care doctors must be leaders in caring for communities and populations, in addition to providers of excellent care to individuals. Tomorrow’s doctors must be as facile in matters of population health, information technology, and care coordination as they are with using a stethoscope. Medical schools must re-imagine medical education.

At The Warren Alpert Medical School of Brown University, with the support of Brown’s leadership, we are planning for a unique primary care program for 24 additional medical students beginning in 2015, pending regulatory approval. Its focus is described in its title: the Primary Care-Population Health Program. To our knowledge this is the first program of its kind in the United States.

The new program is consistent with an emerging national realization, well expressed in a recent Institute of Medicine report, that primary care means doctors not just treating the person or family in front of them, but also managing the entire group of patients who regularly see them, and the community from which their patient panel comes. Paying attention to population health leads to better individual care and vice versa. For example, ensuring near-universal childhood immunization rates across Rhode Island, helping all those with diabetes get their glucose levels and blood pressures into the normal range, or combating the prescription narcotic addiction epidemic would improve the health and wellness of the state as a whole. At the same time, it would reduce suffering for individual patients—and even save money.

Physicians need to understand what is happening in the community to identify such problems and to craft interventions. What are the rates of alcohol and drug abuse? What percentage of pregnant women gets easily accessible prenatal care? Is there adequate education and nursing support for people living with diabetes? What are the rates for heart disease risks, and what programs exist to reduce smoking, hypertension, and obesity? In short, doctors should examine the population as well as the patient.

This shouldn’t just be learned on the job. It is time to bring this philosophy into medical education. The new program will combine the usual emphasis on basic and medical science, with training in population health, epidemiology, and health policy. Students will be selected for their commitment to primary care and population health and, in part, their connection with Rhode Island. The curriculum will be patient focused, driven by information technology, and team based. There will be a focus on active learning with few lectures in a curriculum that integrates topics in a seamless fashion. Our hope is for students to pursue both an MD and a master’s degree that adds rigor, scholarship, and broadened horizons in population health to their skills.

There will be additional leadership training as well as ongoing mentorship from the best primary care physicians in the state. Rather than chopping up clerkships (medical student rotations) into the usual six-week rotation blocks, we’ll offer students “longitudinal” clerkships of nine to ten months to combine the core specialties such as internal medicine and surgery. This will provide them with continuity of teachers and, most importantly, patients. Students will follow a panel of patients through the health care system—from inpatient hospitalizations, surgeries, and births to outpatient visits in primary care and specialty clinics to nursing homes and patients’ homes.

The program will draw on Brown’s strengths in public health, as well as other parts of the University. There is much to learn from other professionals in health care—pharmacists, nurses, nurse practitioners, physicians’ assistants, and social workers. We hope to partner with other Rhode Island health professional schools to expand interdisciplinary training experiences.

 


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