WCUCOM: College Update and Overview of the Physician Preceptor Program MPHCA 25 th Annual Conference Tunica, MS September 22, 2011 Darrell E. Lovins, D.O., M.P.H. Dean, WCUCOM
Where we are going aka Objectives A short history of the osteopathic profession How WCUCOM came to be University vs. Community-based training One Minute Preceptor Where WCUCOM is now
A Short History of Osteopathic Medicine
What is Osteopathic Medicine? - American profession - Grew from a need and a question - Brought a new way of thinking and a new tool to modern Western medical practice - Built on the following premises: - Unity - Structure and function are related - Homeostasis - Rational care related to first three
Comparisons To find health should be the object of the doctor. Anyone can find disease. He should make the grand round among the sentinels and ascertain if they are asleep, dead or have deserted their posts, and have allowed the enemy togetintotheircamps their camps AT Still, MD, DO, Philosophy of Osteopathy, 1899.
Characteristic M.D. D.O. sons s paris omp Co Unrestricted License All Medical / Surgical Specialties Educational Accrediting Agencies Comprehensive pre-doctoral education Additional musculoskeletal training - Primary Care Emphasis * Holistic, Patient-centered Philosophy * Training i Hospitals University i Based Community Based
Obligatory Dates 1828 Birth of ATS 1973 MS Law 1874 Banner 1892 ASO 1896 - Vermont 1917 ATS Death 1962 California 1975 Sen. Javits 1983 1 st 1983 1 st DO Flag 1996 1 st DO SG 2004 Planning 2010 COM Opens 1966 Viet Nam 2011 2 nd Class
First Class
How we came to be the need!
Physician Shortage
Why a new school? CDC Health Indicators State s Rank Statistic* MS LA AL AR % of Births to Unmarried Mothers 1 3 29 9 C-Section Delivery Rate 3 3 8 10 Pre-Term Birth Rate 1 3 2 13 Teen Birth Rate 3 12 11 4 Low Birth Weight 1 2 3 10 Infant Mortality Rate 1 2 32 8 * CDC NCHS Data 2004-2006 Data
Causes of Death - US Top Ten Statistic* State s Rank MS LA AL AR Heart Disease** 1 5 2 8 Cancer** 4 3 7 5 Stroke** 6 8 1 3 Chronic Lower Respiratory Diseases** 13 31 17 15 Accidents 2 1 11 16 Diabetes** 30 1 8 13 Alzheimer's Disease** 20 3 4 30 Influenza / Pneumonia 10 9 18 1 Kidney Disease** 2 1 3 7 Septicemia 4 1 7 8 * CDC NCHS Data 2004-2006 Data * * Chronic Diseases
Mississippi Statistics 11/82 counties meet/exceed COGME stds 1 PCP per 1429 patients 56% of physicians i practice in 4 urban areas 12% physicians practice in the Delta 19% MS population in Delta 51/82 MS counties underserved Crossman, et al 2005 Mississippi Health Policy Research Center
How did we get here? Physician surplus in 1980 s GMENAC No medical school enrollment change for 20 yrs BBA 1997 changes financing rules for GME Demographic change in medical school Generational change in work ethic
Shortages and Supply Supply = Demand had the increases been allowed. 400 Had residency programs continued to expand in 1997 at 500/year, the US would not now be facing severe shortages tion 000 of populat ians per 100,0 Physici 380 360 340 320 300 280 260 240 220 Supply with +500/year continuing after 1997 200 1970 1980 1990 2000 2010 2020 2030 2040 Year Demand Supply Cooper: March 2008 Bulletin of the American College of Surgeons; Figure 9
WCUCOM Planning Pre Hurricane Katrina Post Hurricane Katrina January 2008 November 2009 August 2010
The PCSOM Model
WCUCOM MISSION STATEMENT The Mission of William Carey University College of Osteopathic Medicine is to prepare men and women to become osteopathic physicians through an emphasis on primary care, lifelong l learning and scholarly activity. By using a community based training model, it will produce graduates who are committed to serving the health care needs of the medically under-served and diverse populations p of the state, region, and mission field.
Hub Sites Students move to their respective hub sites Remain in the area for two years Integrate into the community Work, Schools, Churches, Little League, Scouts, etc Perhaps from the area originally Enculturated to local medical community
Hub Sites Qualifying Criteria Community Based Curriculum Hub Site Criteria: Support all required rotations 2-Family Practice 2-General Surgery 2-Pediatrics 2-General Internal Medicine 2-ER 1-Women shealth 1-Community Behavioral Medicine* 4- Medical Surgical Selectives 4- electives Taught By Practicing Clinicians Inpatient & outpatient experience W/in 60 minutes of a central location Preceptors must be: Licensed Certified Malpractice Hospital Privileges
AHEC and Hubsite Regions State MS AR LA AL Actual Total Number 90 126 / yr 5 / yr 5-10 / yr 25 35 / yr 275 / yr (MS)
Training Models
Clinical Training Community Based Model -Initially for professional survival - Now - Meets mission - Personal attention ti - More economical - Excellent training i
University Model Johns Hopkins Model Flexner Report 1910 Prior to 1910 Apprentice Model University Medical School University Hospital VA Hospital Women s & Children s Hospital Cancer Hospital Community Hospital
University Model Large Medical Complexes State and Private Faculty Large Research Dollars Great Doctors Teaching Echelons Attending Fellows 4 th year+ resident 3 rd year resident 2 nd year resident 1 st year resident (intern) 4 th year medical student 3 rd year medical student
Community-Based Model Medical School Community Hospital Community Hospital Community Hospital Community Hospital Community Clinics
Community-Based Model Various Sizes of Medical Campus Private and contracted medical staff + / - Research dollars Great Doctors One-on-One teaching May have teaching echelons
Myth Buster Myth: You have to train at the large university center because of the volume and the you need to see it all and do it all. Truth(s): No doctor ever sees it all and does it all. Most medicine is practiced in the community hospitals Greater opportunities to see undifferentiated patients Greater likelihood of having trainees remain in area Easier for community-trained trained physician to function in larger hospital than vice versa
Myth Buster Myths: I don t have time to teach. Show me a BMS who only triples my work and I will kiss his feet. It s the university's responsibility to teach. Truths: The One-Minute Preceptor Medical students do not need to see every patient Efficient use of medical students If not us, then who? If not now, then when?
Post-doctoral Training All fields of study open ACGME training AOA training Dually approved training
Clinical Training Community Based Model -Initially for professional survival - Now - Meets mission - Personal attention ti - More economical - Excellent training i
Philosophical Re-orientation Therefore, at UK, we plan on changing g culture creating one that is patient centered and not illness based. I am proud to say that beginning this fall our medical students will begin to experience this new culture as we launch the first in a series of new medical courses designed to enhance our curriculum to develop more well-rounded, caring physicians for our future. As outlined on pages 4 and 5, a new course focused on the continuity of care is targeted to teach our students the importance of becoming a compassionate medical caregiver to their patients. Most importantly, explaining that they are not treating an illness they are treating a patient. Jay Perman, M.D., Dean College of Medicine, Vice President for Clinical Affairs, University of Kentucky U K Medicine Fall 2007
A Precepting Tool
Goals and Objectives Goal To enhance efficacy and efficiency in clinical teaching Understand the community-based training model Adopt the mindset of a teacher Objective To provide teachers with an effective and elegant teaching tool
Background Clinical teaching: settings of busy clinical outpatient and inpatient practices. Teachers desire succinct and cogent presentations from learners. Learners desire clear and effective instruction from the teacher.
The Problem How to achieve the teacher s and learner s desires in an efficient manner. A Solution Utilize the principles outlined in The One- minute Preceptor 1
The One-Minute Preceptor - Overview First introduced by Neher, Gordon, Meyer and Stevens in 1992 Five step process Get a commitment Probe for supporting evidence Teach general rules Reinforce what was done right Correct mistakes
Get a commitment. After the presentation make the learner commit to a decision (in a non Example: What do you think is going on? What would you like to do? (in a non-threatening way) Try to get the learner to make commitments just out of their comfort zones
Probe for supporting evidence. These questions probe fund of knowledge and allow the teacher to assist the learner in connecting the dots. Examples: What led you to your decision or diagnosis? What else did you consider?
Teach general rules. Teach one or two points from the patient at hand and then extrapolate to other patients. Do not try to teach everything off on one case. Learners vary: Learners with less clinical knowledge need to be addressed differently from those with more. Be alert to the maturity of the learner
Reinforce correct thinking and action Strategies: Ask learners what they did right. Ask what they did wrong. Ask at the beginning of the rotation how they would prefer to receive feed back.
Correct mistakes. Feedback needs to be: Timely Case specific Expected Bh Behavior focused Descriptive rather than evaluative language
References 1. The One-minute Preceptor: Shaping the Teaching Conversation Jon O. Neher, MD; Nancy G. Stevens, MD, MPH (Fam Med 2003;35(6):391-393) 393) 2. Neher, JO, Gordon, KC, Meyer, B, and Stevens, N. A Five-step "Microskills" Model of Clinical Teaching. Journal of the American Board of ff Family Practice.. 5:419-424, 1992.
To Ponder Docere Latin root for doctor to teach Educare Latin root for educate to care for and nurture; to bring up
Wherewearenow now
Numbers GPA = 3.4 MCAT = 24.6 2014 2015 APPLICANTS = 1064 REGIONAL FOCUS 110 STARTED 107 CURRENTLY GPA = 3.4 MCAT = 26 APPLICANTS 1704 REGIONAL FOCUS EXPECT 108 START
First Class
FACULTY Biomedical Science Complement Clinical Science Compliment On-campus faculty Off-campus faculty
Training Network
Student Activities Heart Walk Tutwiler Clinic Women s Health Clinic i Food Drive $$ Drive Disaster Relief SGA & Club Activities DO Day on the Hill West Point Clinic i
How can we help each other? Clinical Clerkship opportunities 3 rd and 4 th year Participate in Hub Site Plant the seed for residency training Visiting lecturers Recruit qualified applicants (Sponsor qualified applicants?) Other
Questions? Comments / questions may be addressed to: Darrell E. Lovins, DO, MPH, FACOFP WCUCOM dlovins@wmcarey.edu 601-318-6552
Thank You!