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New Med School program to admit first class in 2015

The 24-student program will combine primary care and public health in a four-year curriculum

The Alpert Medical School’s new integrated primary care and public health curriculum will begin admitting 24 students per class starting in 2015, the school announced Jan. 28. The program may allow students to receive both a master’s degree in population health and a medical degree during their four years.

Students will be selected for the program through a separate admission process from the annual Med School admission process and participate in a different four-year curriculum, said Edward Wing, dean of medicine and biological sciences.

Instead of attending large lectures, students in the program will learn some material online before attending focused small-group sessions, said Ira Wilson, professor of health services, policy and practice and a member of the advisory board that helped develop the program. This format, made possible by the program’s small size, was driven by the notion of the “flipped classroom,” in which students learn basic concepts on their own and then engage with one another to study specific cases and further develop their knowledge, Wilson said. Students will begin studying population health during the first year of medical school, and their clinical years will be formatted differently from those of the majority of medical students in the country, Wilson said.

The advisory board, composed of deans and professors of the Med School and Public Health programs as well as representatives from the medical community in Providence and Rhode Island, is led by Professor of Family Medicine Jeffrey Borkan, according to a press release about the program. The board is split into four committees focused on curriculum, admissions and financial aid, resources for the program and fourth-year advanced scholarship — including a possible master’s degree, said Philip Gruppuso, associate dean for medical education and professor of pediatrics. In recent months, the board has formed a clearer, more detailed picture of what the program might entail, Gruppuso said.


Uniquely Brown

While some schools have established dual degree programs that allow students to obtain a medical degree and master’s degree in five years, Brown is paving the way with the possibility of a four-year dual degree, Wing said.

The program will “attract people to Brown because it’s new and different,” Wilson said.

The separately-admitted cohort with different curricular activities will differ from schools that have a primary care track and make Brown’s curriculum “almost a one-of-a-kind program in the country,” said Provost Mark Schlissel P ’15.

“We’ve envisioned the program as a dual degree, but we’ve had only very preliminary meetings as to how a dual degree would work,” Gruppuso said. The main additional requirement the committee has proposed is a thesis focused on a topic in population health, he said.

“Because we’re designing a program from the ground up, this is a tremendous opportunity for innovating in medical education,” Gruppuso said.

The Med School’s curriculum must be full of general courses to meet the needs of all its students, and there is no room for population health topics to be added to existing courses, Gruppuso said. The small program allows for an alternate pathway through the school with a focus on primary care, he said.

The new program will have “a very forward-looking curriculum that will provide something unique to a set of our students,” Schlissel said.

The program will expand the University’s growing emphasis on population health and health care delivery, which is already “a prominent part of the landscape at Brown,” Gruppuso said. The University has a prominent Program in Public Health and a new School of Public Health slated to receive accreditation in 2015. Though the Primary Care and Population Health program will be housed in the Med School, it will be reliant on the School of Public Health faculty, Wing said.

“I think the school definitely has (population health and primary care) as a core facet of its culture,” said Peter Kaminski MD’15, one of several students serving on the advisory committee. The program will provide structure and resources for the many students who are already interested in the field, he said.

Many Med School students have expressed interest in a program that incorporates both public health and primary care, and some already conduct individual projects emphasizing the two areas of study, Kaminski said.

The new program received a “wealth of support” from a recent survey of Med School students, according to preliminary reports, Kaminski said. As planning goes forward, student input will be vital “to make sure (the program is) in line with the identity of the Med School and Brown at large,” he said.


Fixing the system

The important development for the University comes at a critical time for the nation’s healthcare system, Grupposo said. “We’re simply responding to what is a very loud national call.”

“We have a very expensive and relatively unproductive healthcare system,” Wilson said. The U.S. spends somewhere between 50 and 100 percent more than any other country in the world on health care, he said, and one would “hope and expect that kind of investment would produce health outcomes that would dwarf other countries that spent less.” In most of the measures that can be used to compare health outcomes across different countries, including infant mortality and access to health care, the U.S. is ranked in the lowest 25 percent of developed countries, Wilson said.

While healthcare professionals disagree nationally about the cause of the country’s poor results, Wilson said, many people at the University agree it has to do with the lack of primary care doctors.

“In the U.S., a healthcare system has evolved that is really wildly specialist focused,” Wilson said. In most high-value, low-cost healthcare systems, there are approximately two generalists for every specialist, Wilson said, while in the U.S., the numbers are “reversed or worse.”

“Many people believe — and I do — that a healthcare system with more generalists and fewer specialists would be better and less expensive,” Wilson said. Rhode Island does not have a shortage of primary care doctors, he said, but the balance of specialists to generalists is “not optimal.”

Not only are more primary care doctors needed, Wing said, but a different kind of primary care doctor is needed — one who understands the community in which a patient lives.

“System-based medicine really demands that we think broader,” requiring a better understanding of the patient’s community and the healthcare system, Borkan said.

“It’s not about whether the doctor who sees you is smart. It’s about the system that the doctor is a part of,” Wilson said. The program will aim to give special emphasis and attention to primary care and population health skills needed in the system, like building relationships with patients and using information, technology and electronic medical records to manage larger populations of patients effectively, Wilson said.

“These new generalists, primary care doctors, will be able to take care of individuals, families and communities,” Borkan said. If a pregnant 15 year old enters one of their offices, graduates of this integrated primary care program will not only care for the individual but also think about providing appropriate birth control and sexual health education on a statewide level, he said.


Community engagement

Students will spend their third and fourth years in the program learning how to fully understand the communities in which they work.

The third year will be a clinical year, but instead of rotating from internal medicine to pediatrics to surgery in month-long or several month-long rotations — as traditional medical students do — population health and primary care students will be assigned a panel of patients to follow throughout the year, Wing said. Over the course of the clinical year, students may follow a pregnancy, see a baby born and follow the course of certain diseases.

This model — which Wilson called a “longitudinal clerkship” — has been used at several other institutions, including Harvard Medical School, Wing said. Care for different patients will run in parallel instead of consecutively and allow for a more real-world experience, Wilson said.

The University’s Master’s of Public Health Program takes two years to complete, but the proposed curriculum merges the master’s and medical degrees into four years by layering public health courses into the first and second years to lay a foundation for individual research in the fourth year, Wilson said.

The community-focused research in which students engage in the fourth year will help build the relationship between the Med School and the state, said Wilson, who sits on the committee for advanced scholarship.

“When we send people out for scholarly activities, some will want to be in the Department of Health,” Borkan said.

“We hope that among other things, some of the people that go through the program might be Rhode Island residents and stay here for that reason,” Wilson said.

People need to think about care as a “really complex team effort,” he said. The team should include social workers, nurses, various kinds of care managers and housing experts, he said, and students will need to connect with these key players in the broader community.

“(The Med School) is dedicated and committed to the state of Rhode Island, and I think this will cement that further,” Kaminksi said.

Those on the committee from outside of Brown are supportive of the program, Wilson said. “I have every expectation that those parties’ enthusiasm and engagement will only grow.”


An ‘outstanding’ legacy

“The planning process has been going great, because there’s been a lot of interest and a lot of willingness to invest time and effort,” Gruppuso said.

Admitting students for the 2015 academic year means the committee must be prepared for an admissions cycle that begins in July 2014. Not every detail of the syllabus and courses needs to be planned at that point, but a thorough plan for the program will be completed, Gruppuso said. He added that they would like to figure out a mechanism for Program in Liberal Medical Education students to be admitted.

There are no final plans for how students will be chosen, but the application process will be international and competitive, Schlissel said.

The program will look for students “who want to essentially devote their life not only to clinical practice of medicine but the systemic issues behind it,” Kaminski said. Admits to the program will likely be more devoted to community causes and may either have more world experience or could be coming straight from college with a passion for community health, he said.

The program expects to draw students who are scientists but are also interested in the social sciences and humanities, particularly social advocacy, Borkan said. “We think a lot of Brown students will be interested.”

The 24-student class size will allow for more participatory learning, but the small class size also allows for more curricular experimentation within the program. “This is a chance for us to try some things out on a smaller group and then maybe move to a larger group,” Borkan said.

Students will be charged the same tuition as regular Med School students, Schlissel said. He added that the University is hopeful Rhode Island may have an interest in supporting the program in return for assurance that graduates of the program will stay and practice in Rhode Island.

Wing will be stepping down at the end of the year, and the development of this program “will be one of (his) most outstanding legacies,” Schlissel said.

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