Blog | Thursday, September 28, 2017

Defeating the implicit curriculum that discourages family medicine


This past February I retired as regional dean after 12.5 years. Our regional campus at the time had 25 3rd & 4th year students. Over the years we increased to 35 per year. Our campus has had a family medicine residency for over 40 years now. Yet, when I started, we did not have many students enter family medicine.

Prior to becoming a regional dean, I worked at large academic medical campuses. Any student interested in family medicine residency runs into persistent insults and harassment. When you talk to these students, they point fingers at residents in almost every speciality. Many attending physicians also berate students and try to convince them to do their specialty, while insulting family medicine.

Our state, and we are not unique, needs more family physicians. We know that family physicians improve the health of their communities. We need great medical students to serve our rural area, our urban areas, and even suburbia.

So early in my tenure at the regional campus I asked students about family medicine. At that time, the students went somewhat randomly to work with various family physicians in the area. These physicians varied greatly. Some students told me that some of these preceptors discourage them from considering family medicine.

At the same time, with a large family medicine department and 36 residents, the students knew the residents but did not know the faculty. While we did not have a negative implicit curriculum for family medicine, neither did we have a positive implicit curriculum.

So I asked the family medicine department to reinvent the family medicine/rural medicine 8 week block. My charge included involving our students with our faculty so that they would consider these important faculty equal to all the other specialties.

So they met, and developed a great plan. Our students spend 5 weeks with the family medicine department doing inpatient rounds with the family medicine team, outpatient clinic and nursing home rounds. They also spend 3 weeks with hand-picked family physicians (mostly graduates of our program). We have made these positions desirable and evaluate the preceptors carefully.

We made it clear to everyone on the campus that when a student stated that they were considering family medicine, we would emotionally embrace them and encourage them to include our program as a potential option. We invested in several programs to attract students from rural Alabama.

And we have succeeded. Our campus consistently has a higher percentage of students entering family medicine residencies. I strongly believe that the many interactions with both the family medicine faculty and our great cadre of hand-picked preceptors has helped us meet one of the important goals of a state medical school, producing physicians that serve formerly underserved areas of our state.

In too many medical schools, there does exist an anti-primary care and especially anti-family medicine curriculum. That curriculum is implicit and not in the best interest of our students or the public.

We can do better, but we will never do better unless we make family medicine a priority. Our country needs great family physicians and medical schools can do better. Our experience at one regional campus suggests that we can succeed.

6 years ago, we started a second residency at our campus – internal medicine. As an internist, I was and continue to love having an internal medicine residency. Some residents and family medicine faculty worried that this residency might hurt their residency. However, since starting the internal medicine residency we have had even more students enter family medicine residencies. We also have relatively large numbers entering internal medicine.

We have worked hard to have the two residencies cooperate and show mutual respect.

Success requires leadership from the Dean's office, the Departments and the entire faculty. We have worked hard to create an environment of mutual respect. We are very proud of the success of our family medicine program and the large number of students entering family medicine residency each year.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.