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MEDICAL EDUCATOR
Learning primary care in rural South Carolina by Cindy A. Abole, Public Relations It isn't the good old days of house calls when doctors treated their friends and neighbors instead of patients, but the goal is much the same. Just ask Kevin Springle about the four-weeks he spent with the people of Williamston. Or talk to Will Coble about his work at the Peeples Health Center in Varnville. And Sidney Smith will never forget the satisfaction of helping develop Newberry's community diabetes project. These juniors returned to MUSC with a new appreciation of the role of a rural physician. In fall 1998, the College of Medicine joined the University of South Carolina in creating joint clerkships for third-year medical students to learn the basics of primary care medicine. The Deans' Rural Primary Care Clerkship is a four-week experience which supports medical education in rural areas of South Carolina. The students were expected to acquire valuable experience working with nurse practitioners, physician assistants, pharmacists and others in the interdisciplinary heath care team. Preceptors supervised their work, evaluated it and were role models for the students. Did it work? “The program has truly been worthwhile,” said Springle, who worked last fall at the Williamston Clinic, one of four rural practice sites affiliated with the state's Area Health Education Centers. Eighty percent of student's time is spent with patient care activities. The remaining 20 percent is devoted to participating in community care programs. “I see a large need to teach preventive medicine,” Springle said. “That's important for those who have little or no money or can't access good health care.” David Garr, M.D., professor and associate dean for primary care, and Alec Chessman, M.D., associate professor, both of the Department of Family Medicine, co-direct the program. “We want students to learn that they can increase their effectiveness with patients if they work with family members as well.” Garr said. “The real advantages for the student is that, through home visits, they become aware of the contributions the family and other health disciplines can make.” Will Coble, from Burlington, N.C., shared a similar experience at the Harrison Peeples Health Care Center in Varnville. The clinic is a model rural practice providing primary care to residents in Hampton County. The clerkship supports student participation in a community-oriented diabetes care project, developed as a way to permit students to assist with the care of the people with diabetes in the community. Coble worked with Hampton County's successful diabetes connection, a proactive community group composed of interdisciplinary professionals who support diabetes education and other primary care issues through awareness campaigns. The Varnville center is part of the Lowcountry Rural Health Education Consortium Inc. and Lowcountry AHEC. The clinic provides a full range of primary care and trains health professions students. “Most students who go through the clerkship understand that they can't fix the patients' problems within the four weeks they are here,” said Diane Kennedy, assistant director of Lowcountry AHEC Community-based Education. “The real beauty is how students soon discover that they've become part of something real.” Sidney Smith, who worked at the Lovelace Family Practice in Prosperity and Newberry, paired his community outreach program with packaging giant Louis Rich Foods, which has more than 1,600 employees. Smith identified a population of 600 Louis Rich employees of Hispanic descent. He discovered that many in this group had diabetes but lacked access to good primary care beyond routine checkups provided by their employer. Smith worked with the plant's health clinic and with the S.C. Chapter of the American Diabetes Association and drug manufacturer Eli Lilly, to distribute Spanish-language pamphlets about diabetes during the company's Health Awareness Week. For Greenville native Springle, choosing the rural clerkship in nearby Williamston was natural. A National Service Corps scholarship recipient, Springle knows he will be working in an underserved setting somewhere within the Palmetto state. “It's easy to see that this is not the way most medicine is practiced today,” Springle said. “Overall, it's better for the patients. People seem to be appreciative in receiving our services.” “Working with people who have diabetes provides a unique opportunity for students to assist with the care of people with potentially serious chronic disease in a rural setting,” said Garr, who practiced rural medicine in Utah for six years. “It helps the student realize that diabetes care involves more than telling the patient what to do. To be successful, the physician needs to become a partner with the patient in the care of people with this disease.” During their rural clerkship, students learn to apply the principles of Continuous Improvement. The principles provide a systematic way to help people make changes in their lives using a specific sequence of steps referred to as the plan-do-study-act cycle. “Students learn by providing care to individual patients and attending to systems of care that thread through people's lives, the practice, public health services and the community,” Chessman said. AAMC VP highlights changes in medical education Responding to the need to better prepare physicians for a new millennium in medicine, medical schools throughout the United States and Canada are in the midst of incredible changes in undergraduate education. Brownell Anderson, AAMC associate vice president for medical education, highlighted the changing landscape earlier this month during a visit to MUSC. She identified five “best practices” to promote more effective organization and teaching in medical student education. They are:
“A number of recent studies of medical education emphasize the desirability of an education that is student/learning oriented, rather than faculty/teaching oriented,” Anderson said. “Which requires that medical faculty offer educational experiences in which students are active independent learners and problem-solvers rather than simply passive recipients of information.” “In recent years, medical educators have come to recognize that the teaching hospital as an educational device has some deficiencies,” Anderson continued. “As a consequence, they’ve advocated alternative mechanisms particularly ambulatory settings and rural health settings to achieve the goals of clinical education.” The innovative curricula and teaching methodologies being used and evaluated across the country, Anderson explained, seek to “develop the medical student as an adult learner, one who is a self-starter, problem solver and critical thinker.” Changes in the MUSC College of Medicine undergraduate curriculum that have been made or are underway follow these and other learning guidelines suggested by the Medical School Objectives Project (MSOP). Curriculum changes to encourage life-long learning Recommendations to educate doctors to be life- long learners have the blessing of the Undergraduate Curriculum Committee. For first-year students, these curriculum changes will mean less time spent in the lecture hall and more time spent in active and self-directed learning situations. With contributions from first-year course directors, department chairs, residents and students, Curriculum Coordinating Committee members Chris Fredericks, Ph.D., and Frank Spinale, M.D., Ph.D., developed the recommendations, which were approved March 11. They aim to achieve three objectives:
“It’s critical that physicians independently seek out information related to their discipline, evaluate it, and modify their practice of medicine appropriately,” Spinale said. He explained that self-directed learning early in a medical student's career helps hone the ability to become a life-long learner. Weaving clinical elements into the first year of the curriculum, which is traditionally loaded with basic sciences, helps medical students connect classroom information with patient care. And by coordinating the basic principles of physical diagnosis with core curriculum subject material, students will be better prepared begin clinical rotations, Spinale explained. “By breaking down walls and eliminating redundancies among courses, we can create a more flowing and interdisciplinary approach to the first year teaching curriculum,” Fredericks said. To help eliminate “cycle studying,” where students skip one class to study for another, recommendations call for the creation of an “exam week” during which no formal teaching occurs. Spinale, professor of surgery, and Fredericks, professor of physiology, hope the new format will foster a more homogenous learning environment. Spinale sees tangible benefits for faculty as well. “We anticipate that changes made along these lines will impart a new sense of motivation and energy among the students, which translates into a more positive teaching experience for faculty.” Spinale and Fredericks hope to implement some of these integrative changes into the 1999-2000 curriculum. Continuing Medical Education Conferences: April 5—7 Ob/Gyn Spring Symposium Charleston Place Hotel This conference will cover prevention of prematurity, medical complications of pregnancy and obstetrical ultrasonography. 9 Stroke Update 99 Sheraton Hotel, Columbia, SC This conference will review current concepts in the comprehensive management of stroke patients. 9—11 South Carolina Radiological Society Meeting Charleston Harbor Hilton This meeting will provide radiologists the opportunity to discuss the latest knowledge and techniques pertinent to the clinical aspect of radiology. 28 Improving Blood Pressure Control Charleston Place Hotel This conference is designed for physicians whose practice includes a significant commitment to the care of hypertensive patients. 29—May 2 Postgraduate Course in Surgery Mills House Hotel This course will provide the practicing general surgeon with a high-quality program and update in clinical problems seen in daily practice and as a focus of review for the ABS recertification examination. May 21—23 Advanced Endoscopy Update Wild Dunes Resort This conference is designed for gastroenterologists/surgeons already performing endoscopy techniques, as well as GI nursing and technical staff. 27—29 New Drug Update Sheraton Hotel Recent developments in the pharmacotherapy of common problems in primary care will be discussed. For more information on Continuing Medical Education conferences call 876-1925. Teaching tips WHEN LECTURING to a large group, and even when teaching one-on-one, preview what you will say to the learners, make your points, and then briefly summarize it again at the end of the presentation. DURING PROBLEM-BASED learning and other small-group teaching sessions, allow the students to do the majority of the talking (i.e, keep quiet and LISTEN)! Don't miss this Upcoming Meetings: April 5—7 13th Annual Appletree Retreat for faculty development on teaching, St. Christopher Conference Center. The retreat's focus will be communication/classroom skills, use of the Internet in education and computerized testing. Contact Dr. Bill Stillway, 792-4321 or Marion Hinson, 792-5880 for more information. April 29—May 1 AAMC Southern Group on Educational Affairs Annual Meeting, San Juan, Puerto Rico. Call Dr. Amy Blue, 792-3409 for more information. May 7 is the submission deadline for the 1999 Annual AAMC Meeting Group on Educational Affairs Small-Group Discussion Proposals and Mini-Workshop Proposals. For information, visit the AAMC home page at <www.aamc.org>. June 7 is the submission deadline for the Innovations in Medical Education (IME) exhibit, a part of the 1999 AAMC Meeting on Educational Affairs. IME exhibits will highlight innovative ideas in medical education, from instructional design and evaluation of basic science courses to community-based health promotion/disease prevention programs. For more information, visit the AAMC home page at <www.aamc.org>. Graduate Medical Education April Internal Review Schedule
Medical-Legal Seminar “The Resident in the Courtroom: Practical Guidelines on What to Do (And What Not to Do)” Stephen J. Morewitz, Ph.D., CPSP, president, Morewitz and Associates, San Francisco, CA Wednesday, April 14 noon to 1 p.m. Main Hospital, room 270 (Radiology conference room) Thursday, April 15 4 to 5 p.m. Clinical Science Bldg., room 635B (Ob/Gyn classroom) To register for either presentation call Sandra, 792-2575, or Angela, 792-0761. |