University of South Alabama Influencing the “Hidden Agenda” in Medical School through a Longitudinal Experience in Ambulatory Practice” University of South Alabama College of Medicine Carol Motley, M.D., Craig Bogar, Ed.D., Christine Bogar, Ph.D., Mary Harpen, B.S.,MS-3

Disclosures We have nothing to disclose.

The Hidden Curriculum transition of knowledge through attitudes, values and behaviors The social environment and academic discourses in AHC support subspecialty choice over Family Medicine One study estimated that 8% of total variation in students choosing careers in PC was due to school-level factors. * “You don’t make any money.” i.e. you can’t pay off your debt “ FM works too many hours – other specialties have better lifestyles” “You won’t see any complicated or challenging cases – only specialists see these patients.” “The people who go into family medicine are the ones who have difficulty with their grades or board testing.” i.e. they aren’t smart *EricksonCE, Danish S, Jones KC, Sandburg ST, Carl W AC. The role of medical school culture in primary care career choice. Acad Med. 2013;88:1919-1926

Ways to combat the Hidden Curriculum Early and sustained exposure to family medicine role models Pre-medical Programs- the pipeline High school College Medical School Mission of the school: Social Responsibility: to graduate the type of physicians our nation needs Presence of FM in positions of power to raise prestige FMIG GME funding

Our intention: to expose pre-clinical medical students to primary care clinics early in their training to combat the hidden curriculum. USACOM USACOM Primary Care US Specifically listed as Primary Care 35% 3.5% 12% 19% 1.9% 1.3% 5% 3.75% 2.1%% 2.5% 1.8% 6% 8.9% Primary Care Internal Medicine Pediatrics IM /Peds Family Medicine National Surveys: Percent of Graduates planning to pursue Subspecialty Training: Internal Medicine- 80-90% Pediatrics – 20-25% IM/Peds – 50%

Longitudinal Experience in Ambulatory Practice LEAP Longitudinal Experience in Ambulatory Practice MS1 and MS2 students placed in primary care clinics First clinical exposure Orientation; LEAP Handbook. 8-10 sessions in a year/student with the same primary care clinician Basic training in clinical skills, Universal Precautions and HIPPA training is a prerequisite. Clinical Faculty MD CRNP/PA/Other Family Medicine 16 Family Medicine 6 Medicine 5 Medicine 4 Pediatrics 2 Pediatrics 3 Geriatrics 1 PT 1

Challenges Faculty Competition for preceptors with clerkship and new DO schools High turnover rate in public health organizations Little incentive for faculty Some students drive to distant clinics without reimbursement for travel. HRSA does not fund incentives or food for lunch meetings for preceptors LEAP course is non-credit. Although it is required it does not show on the student’s transcript. Clinical Faculty MD CRNP/PA/Other Family Medicine 16 Family Medicine 6 Medicine 5 Medicine 4 Pediatrics 2 Pediatrics 3 Geriatrics 1 PT 1

Student Comments: Themes LEAP Student Comments: Themes Positive Reinforced what was learned in the classroom. Improved understanding of collaboration and Team-based care New exposure and opportunity to work with the under-insured Overall a rewarding experience Opportunity for Clinical Skills Acquisition Learned new communication skills Negative Not enough patients or clinical experiences

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Preliminary Data Results How likely is it you will choose a primary care specialty? Very Likely Likely Not Sure Unlikely Very Unlikely

Very Likely Likely Not Sure Unlikely Very Unlikely It appears that we have moved interest based on historical (past years) but it is early. The M3 class who completed the full 2 year of the program show a decrease in the “not sure” with in increase in “likely” and also “very unlikely.” . Flattening of the curve with fewer people unsure. Very Likely Likely Not Sure Unlikely Very Unlikely

Why is family medicine a distinct specialty? “It is different because of the focus on prevention and screening, which is different from reactive medicine.” “It is also rare in medicine to manage all the different aspects of care and help the patient coordinate all their health needs, you essentially get to be their guide through the system.” “I can’t help but think that if more people visited their primary care doctor (at least on an annual basis) then many of the problems we face in healthcare (particularly cost) would improve.” “It interacts, laughs, grieves, and shows compassion in the context of the patient and their families, effectively caring.” -- M3 Students Class of 2016

Preliminary Conclusions The data is inconclusive with respect to the impact of the LEAP program on student specialty selection in particular toward choosing primary care. The LEAP program was well received by students and was of value to students. Unclear if the Hidden Curriculum was impacted.

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