For more than three decades, the University of Washington (UW) School of Medicine has given its medical students hands-on opportunities throughout the Pacific Northwest and Alaska to learn how their medical training can be directly applied to addressing societal needs. Some of these programs have added new approaches to enhance what the students gain from these experiences.
The Rural/Underserved Opportunities Program (R/UOP) for the past decade has been placing medical students one-on-one with physicians in small towns or inner city neighborhoods during the summer after their first year of medical school. By accompanying the physician as he or she cares for patients, the student learns first-hand what it is like to practice in a medically underserved locale. This year the program added a new pilot component that enables medical students to conduct research projects at their R/UOP sites. The local physician and a UW faculty scientist act as a team in supervising the student’s research.
E.coli outbreaks in rural Wyoming, fish handlers’ disease in coastal Alaska, and antibiotic resistant infections are some topics students have explored. Another new component of R/UOP trains students in giving health presentations in the towns where they train. Students have done health promotion on osteoporosis prevention before 4-H clubs, at county fairs, and in local supermarkets. The new rural research pilot is funded through the Theodore J. Phillips Endowed Professorship in Family Medicine, and the community education component is supported by a donation from a retired Yakima, Wash., physician.
Dr. Roger Rosenblatt, professor and vice chair of family medicine, directs R/UOP. He recently co-authored a chapter in Rural Health in the United States on potential solutions to persistent geographical maldistribution of health personnel. Rosenblatt is a co-principal investigator of the UW’s WWAMI Rural Health Research Center and the WWAMI Center on Health Workforce Studies. WWAMI is an acronym for Washington, Wyoming, Alaska, Montana and Idaho, the five states joined in a medical education partnership with the UW School of Medicine.
The WWAMI sites for the family medicine clerkship give students the chance to learn about family practice and the role of the family physician in the health-care system. The clerkship is offered in two dozen settings throughout a five-state region, ranging from rural Alaska to the plains of northern Montana. Because many sites take only one medical student at a time, the student benefits from the one-on-one teaching by the site faculty. However, some students miss the collegial interactions with their peers. To remedy this, the UW has just established a Virtual Clinic for students at different sites to meet online in groups of approximately eight. The students discuss a case using a problem-based learning format.
The current case explores end-of-life care. Two future components will be on giving consideration to patients’ spiritual beliefs and on the changing U.S. health care system. According to Dr. Tom Greer, an associate professor who heads the medical student education section of the UW Department of Family Medicine, these topics were chosen because they’re not emphasized elsewhere during the clinical training years. The Virtual Clinic, which uses a secured, asynchronous e-mail format, is funded by a Tools for Transformation Grant from the UW.
The Community Health Advancement Program (CHAP) is a voluntary public service organization for UW medical students. Founded more than 20 years ago, the program draws medical students to public service activities in King County. The students work with community groups to identify unmet needs, then develop ongoing service projects. Projects have included a Saturday Clinic at a subsidized urban housing development, a dermatology clinic at a downtown shelter, a flu shot clinic for the elderly, a diabetic foot care program, cooking for people homebound with AIDS, and pre-sports physicals for high school students. The program has recently added teen mentoring and health promotion for youth.
CHAP gives medical students the skills to address public concerns in an effective manner. It has added training sessions to keep students informed on pertinent issues, such as the problems of the homeless, how to reach out to adolescents, and how to provide medical care to persons with chronic mental illness. Dr. Sharon Dobie, an associate professor of family medicine who was an urban planner before becoming a physician, is the CHAP faculty advisor.
Each of these programs, and several others at the UW medical school, are part of the medical school’s mission to train physicians capable of meeting the health care needs of the public in the five-state region it serves.