Steve Crossman, MD, Department of Family Medicine, Virginia Commonwealth University, MCV Campus
Having recently attended the New Horizons in Medical Education: A Second Century of Achievement Conference sponsored by the American Medical Association and the Association of American Medical Colleges, I was heartened to hear speakers from both Canada and the United States stress the need for interprofessional education in the health professions and for emphasis on the social responsibility of medicine as a profession.1,2 These national-level calls parallel local efforts at many of our institutions. At Virginia Commonwealth University, the Departments of Family Medicine (School of Medicine) and Pharmacotherapy and Outcomes Science (School of Pharmacy) have partnered with CrossOver Ministry, a local free clinic, to create the Enhanced Teaching Practice (ETP).
The ETP has one central aim: to provide excellent interprofessional health professions training while also providing excellent care to underserved patients in our community. All medical students in the ETP are also members of our International/Inner City/Rural Preceptorship (I2CRP) program, which provides special didactic and experiential learning for medical students who are dedicated to serving the underserved. Students must apply to and be accepted into the I2CRP program during their M1 or M2 year. The pharmacy students are chosen by the program’s pharmacy faculty from a pool of applicants hoping to participate in this special teaching clinic. The ETP clinic operates on Monday and Tuesday evenings each week during the fall and spring semesters and on a more limited schedule during the summer. On each clinic night, students operate in teams of two (each team with one medical and one pharmacy student) to interview, examine, and develop a plan of care for their patients. The student teams are supported by senior medical students, pharmacy residents, and both medical and pharmacy attendings. After conducting the patient visits, student teams present their findings to either the medical or pharmacy attending (utilizing existing collaborative practice agreements) but often to both attendings jointly. The senior medical students and pharmacy residents serve as junior preceptors and greatly facilitate the efficiency and flow of each night’s work.
We are lucky to have received support for this project from many places. To begin with, we have support from departmental leadership, in the form of 10% FTE time for the two family physicians who are the primary medical attendings. Both the university and health system support the project as well, by providing funds via a community engagement grant (University) and by providing professional interpreter support (the Health System). Further, physicians from our local medical community volunteer to staff each ETP clinic night in the role of the second medical attending. While this support is very important, it is the dedicated clinical and educational faculty in both schools and leaders at CrossOver ministry who are the major key to its success, serving as the project champions and cheerleaders.
The relationship between the academic medical center and the community partner is crucial: missions, personalities, and priorities must align, and communication channels need to be open and clear. Placing the ETP in an existing full-scope free clinic setting enables ETP patients to receive continuous care even during non-ETP hours. The ETP has also been a well-received method enabling CrossOver to respond to recent dramatic need to expand access (40% more patients seeking services). Student selection is also critical, and we select ETP participants purposefully, choosing only from a pool of students who self-identify as interested in this particular project and dedicated to serving medically underserved populations. This combination of a strong academic-community partnership, dedicated faculty and community champions, and focused and eager learners has worked well for us.
1. Berwick DM, Finkelstein JA. Preparing medical students for the continuing improvement of health and health care: Abraham Flexner and the new “public interest.” Acad Med 2010;85:S56-S65.
2. Hodges BD. A tea-steeping or i-doc model for medical education? Acad Med 2010;85:S34-S44.
Education Column Editor: Beat Steiner, MD, MPH, Department of Family Medicine, University of North Carolina