MPCC October 12, 2012

Drivers: Local needs/challenges Physician shortage current – perhaps 1,800 By 2020: 4,000-6,000 Closing the gap and the ongoing loss of physicians to their communities through retirement, etc. Distributional issue Recruiting to rural environment Retaining physicians in rural environment Who will come, who will stay? Pipelines-AHEC Inability to recruit and retain in central-north region Let’s start our own medical school!

Challenge: Criticality of retention Retain currently practicing physicians Retain our trainees Issue of access to care Physician supply: global, by specialty – general surgery, psychiatry, family medicine, internal medicine, pediatrics Physician distribution – geographic Distribution - specialties

Medicine’s Challenges/Drivers of change: (Reports: Macy, HHMI, AAMC) Accelerating pace of scientific discovery Calls for more public accountability The economy Rising cost of health care Shortfalls in health care quality: IHI call for care that is safe, effective, pt-ctrd., timely, equitable (personal, evidence-based, holistic) Racial/ethnic disparities Rising burden of chronic illness/disability (boomers)

Challenges/needs – improving medical education Re-define foundation sciences of medicine Psychology, social science, quality improvement, decision science, epidemiology, EBM… Social determinants of health/wellness CQI and Evidence-based practice Facilitate problem solving and self-directed learning skills Assure students experience continuity of care Emphasis on community-based education rather than the hospital (reality, retention)

Improving medical education Prepare students to work as team members (inter-professional teams) Increase knowledge of public health and non- biological determinants of health and disease CQI in practice Reporting publicly, and for MOC Develop teaching and mentoring skills of faculty – lecturing does not facilitate learning…

Improving medical education Proper learning environment Hidden curriculum and professionalism (Hafferty) Learning in simulated and actual clinical environment Simulation Patient presentation model (rich case model, digital presentation) Standardized, simulated patients Teaching OSCE – actual patients Computer simulations Integration of instruction Clinical relevancy of content

Carnegie 2010-Med Ed System Expectations Creates opportunities for integrative and collaborative learning Inculcates habits of inquiry and improvement Provides a supportive learning environment for professional formation (students and residents) Advances health of patients and populations Standardizes learning outcomes Integrate formal learning with clinical experience – community engagement Develops habits of inquiry and improvement into medical education at all levels Focuses on progressive formation of professional identity

The CMU plan Location of the college Holistic admissions process The curriculum The teachers and mentors The training sites Control debt AHEC

Mission Prepare exceptional physicians Improving access to individualized, essential care (health care delivery) Focus in rural and medically underserved regions of Michigan Rural/small community focus Differentiated skill set Generalist focus: (FM,IM, Peds, Gen Surg, Ob/Gyn, Psych, EM, PM&R)

Vision Excellence in instruction/active learning Team-based learning experiences Early patient contact Student-centered environment/program Patient-Centered care Residencies (new, distributed) Community-based, 11 affiliations thus far

Future Practice of Medicine Patient-centered care Patients as individuals and member of population to be cared for supporting health assessment, patient outreach, illness prevention strategies Systematic assessment and improvement of quality indicators for physicians, hospitals, systems, patient populations Coordinates and delivers care through organized systems Places value on cost-effective care Helps address constraints on health care resources Helps to define physician skill set for future

Formal Knowledge/ Courses embedded in: Clinical Experience (real and virtual), in an environment of: Inquiry, Discovery, Innovation Year IYear IIYear IIIYear IV Integrated Curriculum

Course Structure

Curriculum College culture: respect, compassion, inclusiveness, social responsibility, excellence, innovation, curiosity Integration of foundation and clinical science Anatomy, biochemistry, physiology, pharmacology… Psychology, decision science, continuous improvement… Early clinical experience Continuing foundation science education Schemata and Patient Presentation model, simulated patients and families (relevancy) Team-based learning (learning communities, in practices, in the hospital, friendly competition-game theory) Inter professional (PA, PT, et al.) Self directed learning/cognitive science

Curriculum years 1-2 Longitudinal clinical skills curriculum – integrated with anatomy, imaging, physical examination, interviewing Integrated content courses: Professionalism, Ethics Population & Community Health, Research, CQI, EBM Clinical and health services/delivery research Lean, process and quality improvement – including as research, at the practice and system levels Population health, epidemiology, community health Evidence-based medicine (proven practice) Health system, care delivery, business of medicine, financing… Assessments: to facilitate success for individual and team (simulations, mannequins, simulated patients, actual patients)

Curriculum – years 3-4 Longitudinal, integrated clerkship – PCMH, a member of the team Gradual transitions as skills/knowledge develop Focus on self assessment, lifelong learning, practice- based learning and improvement… Community engaged…learning in the community Clinical experience based there Community faculty as preceptors and facilitators GME community setting Patient Centered Medical Home (more later)

Affiliations Alpena Charlevoix Carson City Hancock Hospital McLaren (Central MI, Bay Regional, Northern MI) Mercy, Grayling MidMichigan (Midland, Gratiot, Clare, Gladwin) Saginaw (St. Mary’s, Covenant) West Branch West Shore

Predictors of specialty choice Indebtedness Lifestyle wants Married, female – Family Medicine Public medical school Primary care track Community training

Predictors of choosing rural practice Rural birth Interesting serving the underserved Interest in serving minorities Public medical school Males more likely than females Entering career plan: Family Medicine Training in the community Near final training location

Factors in retention Environment of training Location of training (100 mile radius) Institutional funding, culture and curriculum Context Experience (role models, happy generalists) Opportunities identified during residency… Linkage to home (grew up there) Scholarships to limit indebtedness Loan-repayment programs to address indebtedness

Environment/Institution Training in rural/small town communities Primary care more likely to choose rural Focus on primary care/generalism Public medical schools Based in primary care practices Role models who value primary care/generalism

Holistic admissions Application review – GPA, MCAT, home town, etc. Response to essay questions Personal statements, values Letters of recommendation Campus visit – MMI process Selection

25 CMU College of Medicine Office of the Dean 208 Rowe Hall Phone: (989) Web site: