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Faculty Interview: ATSU-School of Osteopathic Medicine in Arizona

Created 11.10.08 by Lee
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This is the second interview in the Student Doctor Network series of “community-based medical education” interviews.

(See the previous interview with Gerard Clancy, MD, the Dean of the newly established University of Oklahoma (OU) School of Community Medicine in Tulsa.)

The A. T. Still University School of Osteopathic Medicine in Arizona is located in the Phoenix suburb of Mesa. The structure of the school differs from that of other medical schools in having only the first year of medical school in Mesa, and the remaining three years for each student located in one of 11 participating community health centers.

SDN interviewed four members of the A. T. Still University faculty in Mesa.

SDN: Doctor Wendel, as Associate Provost of the A. T. Still University, please give us an overview of your new community-based medical school.

Dr Wendel: Our understanding of the need for a new medical school grew out of a relationship the A. T. Still University had developed with the National Association of Community Health Centers (NACHC). We realized that there are an estimated 50 million people in the United States with unmet health care needs.

There has been a lot of lip service to the idea of medical schools preparing students to meet that need, but not a lot of programs designed to address unmet needs as part of the educational program.

We plan to recruit people from the community and strengthen their ties to the community in which they were raised. We educate the students we have recruited about the missions and goals of our community-based medical school from Day One.

Because three clinical years are spent in the Community Health Center, we believe that the students and their families establish roots in the communities.

SDN: When doctors graduate from your school, what happens during their postgraduate years?

Dr Wendel: We do expect challenges in this area. Although some residencies exist with compatible goals, it is an open question whether there will be funding for creating more residency positions specifically designed to deliver care within community health center facilities.

That said, our graduates will enter residency programs with far more experience with chronic disease than students educated in most tertiary care-oriented academic health centers. Tertiary care is important, but the great majority of health care is the non-acute treatment of diabetes, hypertension and depression.

As an osteopathic medical school we add public health interventions. And, we are, in fact, a campus with a complex of health professional schools, each committed to interdisciplinary training. We all believe that having a health care team improves the health care system, but there are few places where one can model interdisciplinary health care for medical students. We believe that in most community health centers (CHCs), the interdisciplinary model predominates.

SDN: How did you choose the CHCs that are your partners in this educational program?

Dr Wendel: We started with several hundred CHCs, and developed a sophisticated screening process through which we chose a group to work with directly. We conducted site visits and, utilizing criteria to rate the CHC’s dedication to education, its community ties, its administrative support and the available space, we selected 11 CHCs for the program.

SDN: Dr Kasovac, as a member of the medical school faculty, how do you envision the first year of the A. T. Still University – School of Osteopathic Medicine in Arizona (ATSU-SOMA) in Mesa, Arizona differing from a typical medical school?

Dr Kasovac: The first year will take place on the ATSU-SOMA campus in Mesa, with all of the freshman class taking courses together. All courses will be part of a “clinical presentation” model curriculum, which we adapted from one developed in 1994 at the medical school in Calgary, Alberta, Canada

SDN: Can you describe what a clinical presentation model curriculum is, and how it works?

Dr Kasovac: Unlike the typical school first year, where students take separate courses in the basic sciences – anatomy, physiology, biochemistry, microbiology – the course content will integrate all of these sciences around specific clinical presentations from the very first week. There are approximately 120 clinical presentations that patients go to see a doctor about, such as cough, headache, back pain, chest pain, upset stomach, etc.

For example, during the first year there will be six courses, which will include Principles of Medicine, Musculoskeletal, Neurosciences, Cardiopulmonary, Renal and Endocrine.

SDN: It sounds like you are well along in designing the curriculum.

Dr Kasovac: Yes, there has been considerable work by our faculty. We have had the assistance of the physician who developed the original curriculum in Calgary, who is here for a one year visiting professorship.

Some aspects of the model have been tried at two other osteopathic medical schools, and is expected to be tried at one new MD medical school, but the ATSU-SOMA program is going to fully implement the model with all of the last three years of medical school occurring in one of the 11 participating CHCs, to which Dr Wendel referred.

SDN: Professor Nayeri, you will be coordinator of one of the 11 clinical sites, based at Phoenix Community Campus. What happens in the second year to the students that will be at that site?

Prefessor Nayeri: There are several notable differences between the typical second year medical school in the 2+2 model and the curriculum requirements for ATSU-SOMA students, with the community health centers and population-based medicine being central to the unique differences.

The SOMA students will spend sixty percent of their time in small group didactics, orchestrated by the main campus. There will be substantial use of electronic media, including PowerPoint and schemes, supplemented with lectures. The School of Medicine faculty at each site will facilitate the students’ learning by leading structured small group case presentation and discussions.

Our medical students receive course-specific cases, utilizing the Case Presentation (CP) method to deliver didactic education that integrates basic sciences and facts, i.e., anatomy/physiology and pathophysiology, histology, embryology, biochemistry, immunology, pathology, pharmacology, and nutrition.

Another educational opportunity that sets us apart are the weekly CP, related to the courses of study in Osteopathic Principles and Practice followed by laboratory where the medical students receive hands-on training.

The on-site School of Medicine faculty, beyond leading the structured didactic presentations, will act as academic advisor to the medical students, and will recruit and oversee the clinical adjunct professors who will observe and train students in patient care activities.

SDN: Doctor Simon, you have administrative responsibility for evaluation of students’ academic performance, faculty, and the medical school curriculum. Will there be ongoing feedback from the 11 clinical sites on the clarity, quality and relevance of every lecture and every PowerPoint.

Dr Simon: Yes, and that is only one aspect of the evaluation processes. Each student’s progress will be continuously evaluated.

SDN: Describe how students will be evaluated.

Dr Simon: Over the course of the four years, we will use a combination of many traditional methods of evaluation – examinations of students at the midpoints and the ends of all courses.

We will look at individual skills, coupling them with evaluations that are more non-traditional. In the very first year, the students will have structured encounters with a number of standardized patients, and they will manage a number of patients that are represented by the human patient simulators.

In regards to the basic sciences, we want students to demonstrate a grasp of concepts in the most concrete way possible as soon as possible. These early clinical type encounters not only allow them to demonstrate their “book knowledge” and “hands-on” skills, but also the interpersonal skills required for dealing with difficult patients.

Once the students leave campus after the first year they will have a combination of a half -week of didactic coursework in the mornings that will be evaluated by both written and practical exams.

The clinical work in the afternoon will be evaluated daily by their preceptors, much like a traditional third year student. There will be a 360-degree examination from their onsite facilitator.

The 360-degree evaluation will gather information from each student’s clinical preceptor, from nursing staff, and from support staff. Patients will be asked to complete satisfaction surveys. Feedback will come from a much wider group than the physician evaluations that are typical of traditional medical education.

Students will take the “shelf exam” at the end of each year, although any deficiencies in skills will be exposed much earlier. Their onsite evaluator will be observing them in patient encounters taking histories, doing physical exams and providing patient education.

We think that we will have a lot more data to pass along to the residency programs to which they apply. We will have all the quantitative data, such as test scores, but we will have more qualitative data, from the first year exams and the onsite evaluators on interpersonal skills, staff and professional colleagues.

SDN: Let’s return to what happens in the second medical school year.

Dr Simon: The second year for students, regardless of the site to which they are assigned, will consist of an integrated clinical experience (ICE).
Its objective is to provide that core clinical education which is essential to the professional development of every medical student, regardless of his or her eventual choice of specialty.

Each student will have assigned community-based projects that will focus on health professions and wellness.

The individual clinical adjunct faculty members are the students’ clinical supervisors. The clinical patient care activities will comprise about 40% of the second year students’ time. Every student’s clinical activities will include broad training in family medicine, internal medicine, pediatrics, OB/GYN, behavioral health and Emergency Room.

The second year students will be involved mostly in shadowing, and preparing for their third and fourth year clinical preceptorships. However, all students will be assigned ten patients that they will continue to see over the next two years of their medical school training.

By the third and fourth year of medical school, through their preceptorships, the students will be engaged in supervised clinical practice.

SDN: Doctor Nayeri, since you are coordinating the Phoenix Community Campus, please give us some background on the what the medical students based there will experience.

Professor Nayeri: The medical school has established a successful partnership with Clinica Adelante, Inc., a community health center which will be a model of inter-professional medical care and practice. The collaboration fosters medical education and will result in an increase in the number of potential osteopathic physicians who will probably serve in the rural areas caring for the underserved, farm workers, as well as suburban constituents.

This is a wonderful opportunity for our students to gain exposure to a diverse population, each with their own subsets of cultural values, including the Latino/Latina and American Indian communities.

SDN: Would you elaborate on the access issue?

Professor Nayeri: There are remarkable disparities among certain ethnic groups in our communities in accessing healthcare. Historical data show that some members of the lower socioeconomic status and disparate population have higher incidents of morbidity and mortality rates compared with the general population. For example, the average life span of an American Indian is significantly lower than that of the general population. The Hispanic males delay accessing health care and thus present with more severity. These are but a couple of examples of the risk factors that our medical students will have the tangible opportunity to learn about.

SDN: Will the students at the Phoenix site be given special training in delivering care to American Indian and Alaskan Native populations?

Professor Nayeri: Our students may choose to explore the opportunity to gain competency in a number of cultural subsets and the unique challenges in delivering care to them, including the American Indian/Alaskan Native people.

SDN: How will your medical students be involved in addressing these access problems?

Professor Nayeri: The second year, in addition to continued didactics, as mentioned earlier, includes Early Clinical Experience where students are immersed in community health centers in the greater Phoenix area and Central Arizona, when they will focus on health promotion/disease prevention. Medical students in year-two will begin to apply their knowledge of basic sciences acquired through integrated case presentation method and schemes, along with clinical reasoning and skills, in utilizing proper medical attention, that prevents acute episodes within a chronic disease, such as diabetes or cardiovascular disease, and further complication sequlae, hence improved quality of life – wellness being the focal point of the year-two ICE curriculum objective.

SDN: Describe the third and fourth medical school years.

Professor Nayeri: All of the education during the first two years have prepared students for the third and fourth year clinical preceptorships. They are taught basic sciences, OCSE, clinical reasoning and medical skills, beginning in their first year. In second year, they are assigned longitudinal patients, perhaps a family unit, and by knowing the family, the community, and the health care institution in which they are based and given this wraparound background they begin their early clinical experience.

We use the RIME model, on which there is considerable literature. RIME stands for R (reporter) I (investigator), M (manager), E (evaluator) for each progressive phase of the clinical education to systematically train the students, based on their demonstrated knowledge, skill, abilities and other professional attributes at corresponding level when they can diagnose, manage and treat the patient using evidence-based medicine.

At our campus there is an opportunity for students to learn to provide health care to underserved and underinsured persons whose health care delivery has often been like that of the third world countries. An ongoing criticism of medical school students providing care to underserved populations, is that they learn the skills they need and leave, rather than becoming involved with the community and staying there to serve. The common perception among the underserved areas such as Indian reservations are that scientists show up to do studies, publish their findings, get academic promotions back at their institutions, but never give anything back to the community that benefited them. The community sees such behaviors – whether by medical students or their professors – as “taking” and running.

SDN: What will your medical school students do to leave a different impression?

Professor Nayeri: Our CHC-based students will learn from the community, with this difference – that they are especially recruited and encouraged to pay back by caring for the underserved in rural areas of the United States.

SDN: It seems that some of your sites will be good places to learn rural health care.

Professor Nayeri: There will be opportunities at select Indian Health Care Delivery System sites where our medical students will be able to select individual rural experiences. For instance, one particular Indian reservation comes to mind, that due to its isolation and location can only be accessed by pack mules, on foot or by helicopter.

SDN: Does the traditional holistic preference of some osteopathic medical schools resonate with certain ethnic populations your medical students may be serving?

Professor Nayeri: Our four year curriculum integrates the “whole person approach” – embedded in our mission as “Body-Mind -Spirit” – which is the foundation of the osteopathic approach to medicine, and is a traditional theme in the history of ATSU, whose venerable Kirksville, Missouri campus has deep roots in the osteopathic medical profession. The philosophy of the school, in my opinion, is complementary to the holistic spiritual beliefs across cultures, including that of the American Indian and Alaska Native communities.

SDN: How will this “whole person” medicine translate into the medical student’s broader education.

Professor Nayeri: Our medical students will have a chance to appreciate the day-to-day interdependent operational aspects of a clinic as they train with physicians, interface with interdisciplinary clinicians, patients representatives and other staff. The students may further be invited to meet the native healers and may have the opportunity to participate, by invitation from the community, in native ceremonies.

Most physicians, during their medical education, do not get the perspective on how and what the doctor does impacts the community and the other team members.

SDN: Will special attention be given to medical school applicants from American Indian and Alaskan communities.

Professor Nayeri: Yes, ATSU is invested in recruiting American Indian/Alaska Native applicants, as well as those applicants with demonstrated commitment to serving the underserved and rural areas. This year, ATSU graduated the highest number of Dental Students with Native American backgrounds of any health professions school. The Physician Assistant (PA) program graduates about 20% of the nation’s Native American PA students, and the School of Medicine proportionately has a high percentage of Native American medical students.

Traditionally, the third and fourth year clerkships in the affiliated hospital(s) have had medical students, during the year, at different rotation intervals, from a variety of settings. We have found already that the students from the CHCs have exhibited much higher skill levels than the traditional medical student.

SDN: Thank you.

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Comments

  1. Mike says:

    Lol, At first I thought that someone had vandalized the ASU sign again.

  2. Steve says:

    I’m curious how these students will do on the boards

  3. brucecanbeatyou says:

    Great article, thanks! I don’t have any doubts about how the students will perform, if anything, I expect them to perform above average. I guess time will tell, though.

  4. ed gee says:

    Good luck paying off students loans while caring for the underserved.

  5. AB says:

    Ed- I dont need luck to pay off student loans while caring for the underserved. Instead ill pay them off with the numerous Loan Repayment programs available to physicians willing to work with the underserved.

  6. AB says:

    Very good article! Thanks for posting it.

  7. steve says:

    Actually, they will probably have low board scores (I imagine). Working in community clinics does not equate to studying pharm, path, etc. Overall, it is a good thing most of these students will end up in primary care residencies —-> They will not have the scores to end up in gen surgery, rads, ortho, etc.

  8. brucecanbeatyou says:

    I definitely agree with you that DOING pharm, path, doesn’t equate to reading it in a book, haha

  9. Alena says:

    Actually Steve, MS2’s at SOMA are receiving coursework on top of being given the opportunity to see it come into play while at their respective community campus. They are studying pharm, path, etc. while simultaneously experiencing patient care firsthand before they even reach their third year (like most medical schools). Not only are they reading it in a book – but they get the chance to apply it right away in the clinic environment.

  10. Steve says:

    Yawn, We will see when boards come around. I am sure something is lost with this “early clinical experience.” What about legit hospital rotations? I don’t care what you say, clinics will never compare to inpatient settings.

  11. John says:

    It sounds like they are training glorified nurse practicioners.

    Also, as someone who is familiar with the IHS, if Professor Nayeri thinks that he can send his students to Supai (accessible only by mule/ foot/ helicopter) he must be doing drugs. Just read the last issue of Phoenix Magazine.

  12. Camel says:

    great article, I feel as if some people reading this article either don’t go to medical school or are entirely ignorant. I’m a first year med student, not at this school, and find their approach just as effective as your traditional route. John, clearly you aren’t a medical student b/c you would know what a medical curriculum is all about.

  13. omgwtf says:

    WTF? How does a first year medical student know what approach is “effective”? You’ve never even done clinical medicine. And yes, this basically does sound like a nurse practitioner curriculum. Perhaps they can split the difference to “DONP”.

    Next we’ll have premeds coming on to tell us what the best model of residency is. Jeez.

  14. MedStudent says:

    sounds like a great idea! I know someone who goes to school there and they are impressed with the faculty, small groups, and the ability to take care of real patients in the second year. the school emphasizes creating great physicians, not nurse practitioners, by teaching the basic sciences with the clinical presentations.

    Way to go, A.T. Still!

  15. Brownman says:

    Wow, this is ridiculously stupid. This really sounds like a joke…I’m in awe. Why not get rid of the first year and have students learn through vision quests in the desert.

  16. ronnie says:

    Yea the school sounds ridiculous. I’m curious of the admission standards here!

  17. Brownman says:

    Imagine doing rounds with these chumps…..”celiac trunk obtrusion results blood anastomosing how?”

    “Uh, in the body…..listen I care about rural health…..so I’ll chose compassion.” hhahahaha, try social work instead.

  18. Wildcat says:

    Hmmm…. UofA Medical students saw patients their first day of medical school. And they continue to see and care for patients every week, including patients that also fit to what ever organ block is being studied. Not to mention seeing patients at a large academic hospital instead of a clinic. And on top of that UofA med students also do case based instruction. I wonder why MedStudent’s friend was soo impressed about something that almost all med schools do already. And rural health training does nothing to help future specialists, only that one or two percent that will be going into Family practice. Sounds substandard teaching to me

  19. Chuck says:

    So much jealousy from a**holes who wish they were already in medicine( oh and if you already are, your admissions people really screwed up by letting the likes of you in ie. ronnie, brownie and wildcat). Its ok im learning clinical medicine, working with patients who need care, and am getting an excellent medical education. Oh yeah, and by the way, my classmates and I are already doing rounds and holding our own really well against 3rd and 4th years. Been already told by the attendings at my location that they expect us to be the example for the other 3rd years next year. So im not worried! For those of you truly interested in working w/ underserved populations, do your own research in to this program. Dont listen to these losers. Just let them crawl back to their dorms, dreaming about the day they get into medical school. And then MAYBE they might even get a girlfriend)!

  20. brucecanbeatyou says:

    Haha, this “discussion” has really degenerated…

  21. Danzman says:

    I interviewed at ATSU SOMA, but was scared away by the faculty. We had one guy sit and talk with us at lunch about biofeedback and spiritual healing. The idea is neat, get students to do more patient based work, and maybe someday it could work, but at the time the whole thing seemed like a big mess to me. Being forced to spend three years in some remote location doing community medicine really does not give you an idea about all the different types of medicine practiced at tertiary hospitals. When I asked about how they thought they were going to do on the COMLEX, they said they had low expectations for the first year. Again, it seems like a good idea until you factor in USMLE/COMLEX. I can’t wait to see how the test goes for them and I hope for the best…

  22. Wildcat says:

    Hopefully Chuck will listen to you Danzman. And thank you for your well written response.

    By the way Chuck, I was accepted at UofA but turned it down, and now I am a second year at Washington University in St Louis

  23. studentdo says:

    Wow. There are some very negative people repsonding to this article.
    I believe it is presumptuous of many of you to base your opinion of the curriculum and early clinical experience at ATSU based soley on this article.
    If you took initiative to do any research on the program you would see that the curriculum includes ALL the necessary sciences, simply re-organized into system-based presentations.
    Also, learing at community health centers (or simply “clinics” as some of you call them) is invaluable to experiencing numerous diseases and patients of various backgrounds. Did you know that those minority populations account for the vast majority of all ill people?
    In addition to learning in the clinics during 2nd year, the 3rd and 4th year rotations are pretty much the same set up as all medical schools. Students WILL get experience with inpatient settings. All of the clinics chosen are located near large hospitals and students do their other rotations there. As a matter of fact, the Brooklyn, NY clinic is located INSIDE the hospital with access to virtually EVERY specialty. ATSU students simply have the advantage of heading into those 3rd and 4th year rotations with a year of experience with OB/GYN, peds, primary care, behavioral med (and in brooklyn many other areas) already under their belt.
    I think ATSU students will do well in patient care. There is always the question of the boards, but EVERY new medical school or school that changes its curriculum has lower scores at first and then tend to improve. Thus, the scores of the first year of graduates are not necessarily the only judgement to make of the quality of the program.

  24. currentstudentatSOMA says:

    haha, this is really funny. why do people who don’t go here care so much???

  25. alsocurrentSOMA says:

    I appreciate what chuck and currentstudent said. I find it very sad that many people feel like attacking our program since it is different from theirs. Our curriculum, and the clinical presentation model, makes a lot of sense for adult learners. It is a great way to learn, and I personally feel like i’m getting a quality education. Please don’t attack something out of ignorance. It does no one a favor. I have found the faculty to be extremely qualified and they work hard to incorporate all the basic science comprehensively into the schemes. Only time will tell, but just because a program is new doesn’t mean it doesn’t deserve a chance.

  26. $tudentdoctorMD says:

    This school sounds way too practical. Learning medical skills, and getting patient exposure while at the SAME time learning the basic sciences?

    Why would anybody in medicine want to learn compassion?

    You guys have fun in unrewarding and unfufilling primary care. Me and my God Complex are gonna make lots of money working in my lab$$

  27. allaboutthe$$ says:

    Wow what an idea? I dont know about all of you, but I dont want to help people unless they can pay me the $$$. Seriously what kind of doctors would you be without compassion and care for your patients? Admissions people across the country have serious issues with correct staffing if they already let you into a school with that kind of attitude…..If someone on the street collapsed and you were a doctor would you ask for payment before checking them out?

  28. DrMattOglesby says:

    I highly suggest those interested in learning more about this unique curriculum to research vertical and horizontal integration of basic sciences and clinical medicine. You can also look into the effectiveness of Clinical Presentation Models.

    I am heavily considering this school and these are the things I am taking the time to learn more about. If you are interested in this school, I would suggest doing some research of your own and ignoring the anonymously posted, unfounded, derisive comments you might come across from uninformed nay-sayers.

  29. DrCGrant says:

    I question why there are critical comments about Native student doctors who want to do the work you don’t. Would you prefer underserved continue being underserved? By 2050, the US population is predicted to be 50% of what are now considered minorities. The shortage of physicians is also rising. If, in the future, I was faced with hiring someone who demanded a lot of money while still using the term “injuns” and referring to them as “immigrants”, or someone who is multilingual with compassion and is not demanding a Beverly Hills salary – the jury wouldn’t even have to leave the room. The reason it is so important to have a school like ATSU and the impressive quality students that fit this philosophy is because of all the health care gaps and financial drains created by people going into medicine for many of the immature and I-centered reasons mentioned above. The quality of medical care is not based on the salary of the practitioner. Good luck to your patients.

  30. Fluidsmash says:

    It is a new program. We have not yet taken the boards. There are a lot of unknowns looking to the future, but it is something different.

    I chose the school because I worked in these “clinics” that many of you talk so negatively about. Our current medical system has a fair share of flaws and I felt like this was one of the few medical schools that recognized the problems and is actually trying to solve them. A lot of schools know that people are not getting the medical care they deserve, and they publish articles about it in peer reviewed journals . This school actually tries to help those people. That is why I am happy I am here.

    Those of you that think the program is a bad idea, you are granted that opinion. We don’t really have any information on board scores or residency matches. On the other hand the feedback I have heard from physicians that work with our second year students is positive and I am confident that I made the right decision in coming here. I would encourage anyone that is interested in this school to read more than this article and these comments. It is a different program and it is worth checking out.

  31. absdoctor says:

    Wow! I cannot believe the negativity of some of you!! For those of you who believe that being a primary care doc is unrewarding and unfulfilling, and who are going into medicine for the paycheck, I hope you aren’t seriously considering being a doctor. Ever heard of bedside manners and compassion??? Doesn’t sound like it. Maybe you should consider a different profession. You can be trained in the facts and figures and the how and why of medicine, but you can’t be trained to CARE FOR OTHERS. I’m pretty sure that helping others get well is a reward in itself, and it is certainly fulfilling to know that you’ve helped someone who could not otherwise have gotten medical care.

    One of the doctors I work with, recently asked me if I knew the two most important things to being a GOOD doctor. He said, “First, you have to CARE about your patients. Second, you have to show that you care about your patients.” For those of you who are so self-confident and ARROGANT, maybe you should take this to heart. You may end up with an MD after your name, but if you don’t care about really helping those who come to you, that MD is not going to mean much. In the end, it will just be a piece of paper and two letters after your name. You patient base isn’t going to be very large, and without patients, your paycheck isn’t going to be so large either.

    Instead of criticizing those who want to help the very people who you apparently think aren’t worthy of care, why don’t you focus on becoming a good doctor. None of us are above anyone else. This is, or should be, especially true of doctors, who are SUPPOSED TO HELP OTHERS!

  32. admin says:

    Discussion on this post has been closed. Please discuss this further in the SDN Forums.

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