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C O L L E G E O F C O M M U N I T Y H E A LT H S C I E N C E S UNIVERSITY OF ALABAMA SCHOOL OF MEDICINE • TUSCALOOSA REGIONAL CAMPUS

building the

PATIENTCENTERED MEDICAL HOME

DR. PAUL GRUNDY

Global Director of Healthcare Transformation, IBM


| DEAN'S MESSAGE

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OR A CHANGE, LET’S NOT TALK ABOUT the Affordable Care Act, expansion of Medicaid, regional care organizations or anything else that’s controversial in health care. (This could be a short conversation.) Instead, let’s talk about something about which most people would agree: Despite having the best hospital facilities, the best technology and the best trained doctors and health care professionals, our current health care system leaves a lot to be desired in the way it’s organized and delivers care, especially given the poor population health outcomes we get. You with me so far? No dissension?# OK. Good. Let’s try another one: The evidence from across the world at every level—from city to county to state to national to country-by-country comparisons—irrefutably indicates that investment in a robust primary care infrastructure is an essential feature of the best performing health systems. We still good? Great.‡ Then, as an aside, let me point out that in the United States, we have an absolute deficiency of primary care docs. Most of the world’s high performing health systems have 50 percent or more of their doctors in primary care (family medicine, general internal medicine and general pediatrics). In the United States, we are at 30 percent and dropping. I say “dropping” because only some 20 percent or so of our graduating medical students are choosing residencies likely to launch them into primary care careers. Do the math. Going from 30 percent now to 40 percent to 50 percent in the future will require more than 20 percent of new grads to choose primary care. Underlying the fact that we can’t attract enough physicians into the primary care fields, as above, we know that the income of primary care physicians (PCPs) is disproportionately low compared to that of subspecialists, creating a significant disincentive. And, further, our academic health centers don’t help. Despite a “social contract” to serve the needs of the public given their public funding, prospective primary care physicians find themselves dissuaded and discouraged by the so called “hidden curriculum” (a discouraging set of unwritten norms and attitudes about primary care that faculty impart, often but not always passively, to their students) that is all too common in our medical schools.

Workforce needs aside, here’s something else that pretty much every U.S. primary care doc, even those who love their careers and their work, as do I, agree upon: There is a huge need for improvement of primary care practice.

“Despite having the best hospital facilities and the best trained doctors, our health care system leaves a lot to be desired, especially given the poor outcomes we get.” It’s tough, maybe impossible, to be a really complete PCP these days. There’s simply too much to be done in the time available in a day. For one thing, the current fee-for-service payment mechanism is all wrong to allow the busy PCP to: • coordinate care effectively, including with hospitalists and subspecialty providers; • comprehensively address chronic disease management; • have the time and resources to do effective lifestyle counseling; • effectively discuss and offer all the recommended preven- tive services; and • address the innumerable social needs that impact patients and their health. All this will only get worse as the population ages and more and more individuals live longer with multiple chronic conditions. So, something needs to change. Remember the old adage? Systems are perfectly designed to achieve the results they get. Put another way, if we want better results out of our primary care system, it’ll take more than just more primary care docs; it’ll take a new system of primary care. The American Academy of Family Physicians recognized this as it concluded a major project back around 2000 called “The Future of Family Medicine.” The project’s intent was to “develop a strategy to transform and renew the discipline of family medicine to meet the needs of patients in a changing health care environment.” At the time, the AAFP leadership

# If so, email me and we can discuss! But, it’s hard to argue that the most expensive system in the world (by far!), which achieves such poor population health, which allows 40 million or more to go without health insurance and hence access to care and thousands of individuals to go bankrupt each year, which is characterized by unthinkable inequities and disparities, and that wastes nearly a quarter of every dollar spent on health care on overhead rather than care, is “desirable.” ‡ If not, read this, then call me: Starfield, B, Shil Mackino J. Contribution of Primary Care to Health Systems and Health. MilbankQ. Sep 2005; 83(3):457-502. % http://www.pcpcc.org/about/medical-home & https://www.pcpcc.org/guide/benefits-implementing-primary-care-medical-home * Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood) 2008;27:759–69.

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correctly articulated that fundamental flaws in the fragmented U.S. health care system would be improved “through the integrative, generalist approach” that characterizes good primary care. To this end, along with other activities and recommendations, the FFM project identified what was labeled “The New Model” of practice. This was to be a patient-centered, team approach embracing all the principles found in the Starfield evidence—a focus on quality and outcomes, enhanced and alternative financing, robust use of information systems and redesigned and more functional patient access and physician offices. Key to this model were the concepts of a personal physician-led, interprofessional team approach to care, and of patient-centeredness (Nothing about me without me).

“If we want better results, it’ll take more than just more primary care docs; it’ll take a new system of primary care.” The concept was timely. The underlying principles of the New Model were entirely consistent with the evidence on the effectiveness of primary care from around the world, and gave a framework around which widespread consensus could be built on how to change the U.S. system of primary care. Fortunately, because the name “The New Model” lacked pizazz, someone remembered that the pediatricians had created a term, “the medical home,” some three decades earlier, referring to a primary care practice that partnered with families and specialists in caring for chronically ill children. With the permission of the American Academy of Pediatrics, the term was borrowed, and the “New Model” became “The Patient-Centered Medical Home.” In 2007, all the major primary care physician organizations signed on to endorse the Joint Principles of the Patient Centered Medical Home%—an unprecedented consensus.

Today, some years later, the PCMH concept has been critiqued, challenged, perhaps disparaged and tested. Dozens of trials and pilots, however, are encouraging and show that the model reduces overall costs and spending by reducing inpatient visits, emergency department use and hospital readmissions without sacrificing, and in some cases while improving, quality.& Today in the United States, the PCMH model may be on the verge of a tipping point. Hence, this was the reason for our PCMH conference this past summer, as discussed starting on page 5. In 2013, I wrote of our College’s “goal of improved population health, the means to it and of our organizational responsibility to contribute.” In caring for patients in our own practice, and in preparing physicians for future practice, we need to look forward toward best practices, toward models that deliver the “triple aim” (enunciated by Berwick* as another way to articulate the new direction needed in our health system): improved health, lower costs and a better patient experiences. We also look to furthering a conversation in our community about better approaches to health care organization and delivery. We need to be an organization of connectors, mavens and salesmen. For us to do so, we all needed to understand more about the PCMH. Some 200 community and CCHS members (docs, nurses, medial assistants, business clerks, academic secretaries— people in every type of role within CCHS) participated in the conference last July, which brought national leaders to Tuscaloosa to share their experience and insight into the PCMH. Our journey as an organization, and as a country, headed toward a better way of doing primary care, toward the Triple Aim, has started.

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| CONTENTS

FALL 2014 • VOLUME 22 • NUMBER 16

Deanʼs Message Dr. Richard Streiffer

Building the Patient-Centered Medical Home

Brett Jaillet, MA

10 Years of Building

Leslie Zganjar, MPA

Community Learning

Kim Eaton Linda Jackson Andrew Richardson Amy Saxby

Connor Simpson

Miriam Brant Jeff Hanson Zachary Riggins Matthew Wood

Medical Students Match UASOM Dean Speaks at Senior Convocation Caring for Patients in Ghana Rural Medical Scholars Honored at Convocation Chief Residents Residents Graduate University Medical Center Expands Access to Care Using Telemedicine to Provide Asthma Education CCHS Leads Flu Shot Campaign Rural Health Conference Focuses on Early Childhood

On Rounds is a semiannual publication of The University of Alabama College of Community Health Sciences. Please send address changes and correspondence to Leslie Zganjar, College of Community Health Sciences, The University of Alabama, Box 870326, Tuscaloosa, AL, 35487-0326 or lzganjar@cchs.ua.edu.

Project Earns Award for Community Engagement Research Round-up Accolades Faculty and Staff

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| COVER STORY

THE BEGINNING OF A JOURNEY THESE ARE THE WORDS DR. Richard Streiffer uses when he talks about transforming how patient care is delivered at University Medical Center. By transformation he means delivering care using the patient-centered medical home (PCMH) approach. In broad terms, the PCMH model provides care that is patient-centered, accessible, continuous, comprehensive and coordinated, and that focuses on quality and safety. It’s not a place but rather a philosophy of providing care. Streiffer, dean of The University of Alabama College of Community Health Sciences and a family physician by specialty, hopes the work that CCHS is doing to change the way patient care is delivered at its own practice will motivate other medical practices in

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the area to embrace this model of care. University Medical Center, the largest community practice in West Alabama with 63,000 patient visits last year, provides primary care focused health services in family medicine, internal medicine, pediatrics, women’s health, psychiatry, geriatrics and sports medicine. UMC also forms the base for a clinical teaching program at CCHS, which also functions as the Tuscaloosa Regional Campus of the University of Alabama School of Medicine. “As a College, we are interested in not only transforming our own practice into this patient-centered medical home approach but also in helping to further the transformation of medical care in our area,” Streiffer says. “That’s our mission. It’s about moving forward.”

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ost agree that fundamental changes are needed in the nation’s healthcare system. The system ranks 37th in quality, despite spending more per capita on health care than any other nation in the world, and 2.4 times more than most other developed countries, according to the World Health Organization. Three-quarters of U.S. health care expenses can be attributed to chronic disease care. Still, the system’s emphasis is on reactive care—not prevention, wellness or coordination of care. Proponents of the PCMH model say the system’s current provision of poorly coordinated episodic care must be replaced with a care delivery team, led by a primary care physician, that provides coordinated and integrated care with the patient at the center of the health care experience.


Dr. Paul Grundy, third from left, meets with Arnelya Cade, a fourth-year medical student and Rural Medical Scholar, Dr. Richard Friend, director of the College's Family Medicine Residency, and Dr. Jared Ellis, assistant professor of Family Medicine and associate director of the Collegeʼs Family Medicine Residency.

The physician, nurse, health educator, pharmacist and other caregivers have new roles to play in this team-based approach—a shared responsibility for the patient’s health. Rather than just providing episodic care, the team is proactive in providing preventive, wellness and chronic illness care. Health information management systems play an important role in the PCMH; electronic health records can be used to improve quality and efficiency and to monitor chronic diseases. The PCMH is also about enhanced access, such as after-hours care and use of multiple channels of communication, including email or a web-based portal through which patients can make appointments, have prescriptions refilled and access laboratory results. Early PCMH pilot projects have shown success in improved care quality, greater patient compliance and more effective use of health care services, including reductions in unnecessary or avoidable hospitalizations and use of emergency rooms for primary care. The PCMH has also been shown to help patients more successfully manage chronic health conditions. But for the PCMH to succeed, proponents say, the current payment system must be reformed so that physicians are compensated for health promotion and disease prevention and rewarded for continuity and patient-centered care. In addition, education for clinicians must include such critical topics as team-based care and the use of health information technology to improve care quality and to incorporate evidence into practice. “Health care hasn’t always responded to advances in technology,” says Dr. Paul Grundy, global director of Healthcare Transformation for IBM. “It’s still a mom-and-pop industry because the core product being provided is stored in a doctor’s head.”

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BM is among dozens of the nation’s large employers, including Boeing, Intel, Safeway and Lockheed Martin, that now offer employees advanced primary care and PCMH benefits, according to the January 2014 report “The Patient-Centered Medical Home’s Impact on Cost and Quality,” published by the Patient-Centered Primary Care Collaborative (PCPCC). In the public sector, beneficiaries are receiving patientcentered primary care through 25 state Medicaid programs, Medicare and the Veterans Administration. In addition, more than 90 commercial and not-forprofit health plans are leading initiatives grounded in the philosophy of patient-centered care and the PCMH, according to the report. The PCPCC is a national coalition IBM helped create that advocates adoption of the PCMH as a way of transforming the nation’s healthcare system. In the report, the PCPCC details COLLEGE OF COMMUNITY HEALTH SCIENCES

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studies that examined PCMH initiatives and found that use of the PCMH model demonstrates improvements across a number of metrics: decreases in the cost of care; reductions in emergency department visits and hospital readmissions; improvements in population health indicators such as better controlled blood glucose, blood pressure and cholesterol levels; increases in preventive services such as screening and immunization rates; improvements in access to care and to primary care clinicians; and improvements in patient satisfaction. In Pennsylvania, with 160 PCMH practices, there has been a 44 percent reduction in hospital costs, a 21 percent reduction in overall medical costs and the number of patients with poorly controlled diabetes had declined by 45 percent. In Michigan, PCMH physicians and practices helped patients avoid emergency room visits and hospital admissions by providing evening-hour, weekend and same-day appointments.

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s the PCMH model moves toward center stage in proposals for redesigning the U.S. healthcare system, the College of Community Health Sciences is moving its efforts in tandem. In partnership with MedNet West, a patient-centered health network in Tuscaloosa that provides coordinated care to Medicaid patients, University Medical Center is using care managers to identify high-risk patients and remove barriers to their care, and is incorporating quality improvement measures into medical practice, particularly in the target areas of diabetes, asthma and emergency room overuse. In the UMC Family Medicine Clinic, providers have divided into four care teams, and each team has a patient panel and is responsible for the care of those patients. The teams are currently collecting data about diabetic patients and creating a registry to help maximize efforts in managing this chronic disease. The registry provide alerts and reminders when screening and follow-up appointments are needed, helping to increase compliance with recommended care. In addition, a health educator has been hired to work with UMC patients. “If one team is doing better, we look at how we can standardize that practice,” says Dr. Richard Friend, interim chair of the College’s Department of Family Medicine. “Providers are talking with each other and with the other teams about how to better care for diabetic patients. We are learning from each other.” Also toward this end, the College this summer hosted a two-day gathering of CCHS and UA faculty and staff, along with health care providers from Tuscaloosa and across the state, to study and discuss the PCMH model. The goal of the conference, “Building the Patient-Centered Medical Home: Inspiration and Tools to Help Transform Your Practice,” was to educate physicians and other health care providers about how to incorporate the PCMH model into their medical practices. “The conference was a tool for us internally, as well as at the community level, to increase awareness, create dialogue and learn from experts with experience in this transformative process,” Streiffer says.


Top: Beverley Johnson, president and CEO of the Institute for Patient- and Family-Centered Care in Bethseda, Md., delivers a keynote address at the College's conference, "Building the Patient Centered Medical Home: Inspiration and Tools to Help Transform Your Practice," which was held in July. Below: An evening event after the first day of the conference featured a panel discussion including (from left) Dr. Kathleen Bowen, medical director of BlueCross BlueShield of Alabama; Dr. Melly Goodell, chair of Family Medicine at MedStar Franklin Square in Baltimore Md.; and Dr. Robert Moon, chief medical officer for Alabama Medicaid. Across left: Dr. Richard Streiffer, dean of the College, explains the patient-centered medical home at the conference. Across right: Dr. Paul Grundy, global director of Healthcare Transformation at IBM, delivers a keynote speech.

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he conference featured experts in the concept of the PCMH and its business side, implementers of PCMH pilot programs and leaders in family- and patient-centered health care. One of the speakers was Grundy, who, through his work with IBM and the Patient-Centered Primary Care Collaborative, develops strategies to shift health care delivery toward consumer-focused, primary-care based systems through the adoption of new philosophies, primary care pilot programs, new incentive systems and information technology. He described the PCMH as a home for data. “Data is now made available (through electronic health records and health IT) and it has to be acted on,” he said. “Acting on that data means that every patient has a health care plan that is managed by a team of providers, which, overall, leads to promoting a healthy population.” Beverley Johnson, president and CEO of the Institute for Patient- and FamilyCentered Care in Bethesda, Md., said the PCMH represents a cultural shift in health care. “It’s about the work you’re going to do together to profoundly change the culture of health care organizations.” Dr. Melly Goodell, chair of the Family Medicine Department at MedStar Franklin Square in Baltimore, MD, oversaw the 2011 achievement by MedStar’s Family Health Center of Level III NCQA Patient-Centered Medical Home status and the center’s acceptance as one of the 50 statewide practices into Maryland’s three-year PCMH Pilot Program. She spoke about the process of changing into a PCMH. “You really do need to have an approach and some guiding principles around change,” she said. Dr. Michael Canfield, associate chief of staff of ambulatory care for the Central Alabama Veterans Health Care System in Montgomery, Ala., has worked as a family physician and was a partner with Palmetto Primary Care Physicians in Summerville, S.C. Palmetto is an organization of more than 90 physicians and clinical and support staff who practice primary and specialty care at 32 offices in seven South Carolina

counties. He spoke about the business side of the PCMH and outlined the keys to success for Palmetto. “Ancillary income was the main driver to (physician) buy-in for Palmetto,” he says. Ancillary services include after-hours clinics and laboratory and X-ray services. Canfield said the income generated by these services meant physicians could see fewer patients, spend more time with them, and spend more time with care managers to promote patient prevention and wellness strategies. “This is the patient-centered medical home,” he said. Other conference speakers included: Dr. Mary Coleman, professor and chair of Family Medicine and director of Rural Education in Community Health at Louisiana State University School of Medicine, who spoke about population and patient-care management; Dr. Melanie Tucker, assistant professor of Health Education at CCHS, who spoke about leading patients to better health through health coaching; and Sylvia Brown, executive director of Gulf Coast Patient Care Network, who spoke about innovative care delivery. The conference also included a public event that featured a discussion by the conference speakers and Dr. Kathleen Bowen, medical director of BlueCross BlueShield of Alabama, and Dr. Robert Moon, chief medical officer for Alabama Medicaid. The event gave community members and leaders an opportunity to hear and engage in conversation with the speakers. “We hope the conference served as a step toward moving the process and the culture and the understanding of the model of the PCMH and its underlying principles,” Streiffer said. “Our intent was to motivate and inspire and inform some of the docs, along with their staff, including our own, and help them to get started thinking about and acting toward practice transformation. We want to make this a movement.” Brett Jaillet contributed to this report. COLLEGE OF COMMUNITY HEALTH SCIENCES

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| COVER STORY

PAUL GRUNDY, MD, MPH

A HOME FOR DATA > The patient-centered medical home

GLOBAL DIRECTOR OF HEALTHCARE TRANSFORMATION, IBM

In this role with IBM, Grundy develops and executes strategies that support IBM’s healthcare industry transformation initiatives. Much of his work is directed toward shifting health care delivery around the world toward consumer-focused, primary-care based systems through the adoption of new philosophies, primary care pilot programs, new incentive systems and the information technology required to implement such changes. He is a member of the Institute of Medicine and recipient of the 2012 National Committee for Quality Assurance Quality Award. He is known as the “godfather” of the patient-centered medical home.

isn’t a literal home for patients, but rather a home for data, said Dr. Paul Grundy, global director of Healthcare Transformation for IBM. “Data is now available, and it has to be acted on,” he said. “Acting on data means that every patient has a health care plan that is managed by a team of providers, which, overall, leads to promoting a healthy population.” Grundy, who is also founding president of the PatientCentered Primary Care Collaborative (pcpcc.org), said information technology is essential to manage high-quality, coordinated, proactive and evidence-based care. And it’s IT mostly driven by an electronic health record system. An EHR supports a preventive approach—mining data and identifying which patients are due, or past due, for screening and diagnostic tests, immunizations and follow-up care, as well as disease-specific care. An EHR tracks patient referrals to specialists and other clinicians and captures the incoming results. All these activities are fundamental to a PCMH. “With a PCMH, practices are redesigned to manage populations, and when you manage a chronic population, you see returns quickly,” Grundy said. Medical practices may need other IT-related capabilities in order to be patient-centered, such as online appointment scheduling, e-prescribing, quality reporting and patient portals to facilitate patient e-visits and provider-to-provider communication for care coordination. Grundy acknowledges that producing high-quality, measurable and cost-effective outcomes for a population across the care continuum demands an enormous amount of information synthesis, often in real time. And he understands the frustration health professionals currently experience with EHRs and other forms of health IT. “But that’s where you are in dealing with data. It’s very early, very primitive, but it will change.” He compared the current situation to a time when automobiles were new and drivers had to stop every few miles to fix their cars. “We couldn’t have gone to the moon without a computer, and we can’t manage a diabetic patient without a computer,” he said. “We need to deliver value with an infrastructure that can deliver meaningful data.”

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PARTNERS IN CARE > Information technology can

accumulate vast amounts of information, but there’s an equally important type of knowledge that no computer printout can provide and it comes from engaging physicians, patients and families in care, said Beverley Johnson, president and CEO of the Institute for Patient and FamilyCentered Care. “These people—patients and families—have so much to share and they may not realize it,” she said. “They can be partners with you in improving care.” Some of the key concepts of the patient-centered medical home are information sharing, collaboration, and participation in care and decision making. “We get the best clinical outcomes when patients and families are actively engaged in their care,” Johnson said. This transformation is not just on the physician’s shoulders.

Johnson said patients and families must be involved in change at the practice level. “Patient- and family-centered care needs to get attention from the leadership because this puts patients and families in real roles of influence to drive change,” she said. “The patient and the family need to be respected as part of the care team. In hospitals, we have been disempowering patients and families, and families are part of the health care team.” Johnson understands the importance of health IT and a reformed payment system to the PCMH but argues that patient- and familycentered care can enhance these components. “We have to talk about money, but we can use patient- and family-centered care as a business model. We have to get much more creative in how we use technology. The computer needs to be part of the conversation— sharing pictures and information. Documentation systems need to capture the thoughts and goals of patients and their families.” Ultimately, patient- and family-centered care “is about culture change and the work you will do to profoundly change health care delivery. But people find this is a better way to practice,” Johnson said. “And the satisfaction piece is not just patients and families. Workers are satisfied. “It brings joy.”

BEVERLEY JOHNSON PRESIDENT AND CEO, INSTITUTE FOR PATIENT- AND FAMILY-CENTERED CARE (BETHESDA, MD.) In her role with the Institute for Patient- and FamilyCentered Care, Johnson has worked to advance the practice of patient- and family-centered care to more than 250 hospitals, health systems, federal and state agencies, military treatment facilities and community organizations. She is a member of the Patient-Centered Primary Care Collaborative board of directors and a recipient of the 2011 Dorland Health People Award for leadership in the area of patient- and family-centered care.

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| COVER STORY

MELLY GOODELL, MD

CHAIR OF FAMILY MEDICINE, MEDSTAR FRANKLIN SQUARE (BALTIMORE, MD.) As chair of the Department of Family Medicine at MedStar Franklin Square, Goodell oversaw the 2011 achievement by MedStar’s Family Health Center of Level III NCQA Patient-Centered Medical Home status, and the center’s acceptance as one of the 50 statewide practices into Maryland’s three-year PCMH Pilot Program. The Family Health Center provides care to more than 10,000 patients in the Baltimore area.

LEADING PRACTICE CHANGE > The Family Health Center at Med-

Star Franklin Square has been on the patient-centered medical home journey for three years, and that journey has involved every employee of the practice, said Dr. Melly Goodell, who oversaw achievement by the center of NCQA Patient-Centered Medical Home status. The team approach to practice transformation is just as important as the team approach to providing patient care that the PCMH calls for, Goodell said. “This is not just about the leader leading practice change. Everyone in the practice has a leadership role,” she said. “Every person has a piece of leading this change.” In addition to leadership, practice change needs to be planned, Goodell said. “You need to have an approach and guiding principles around change.” Her advice? First, create a climate for change. “Create a sense of urgency. Develop a change vision and strategy. Build the team. Staff at all levels must agree that transformation is needed.” Second, engage and enable the organization. “Empower others.” Third, implement and sustain the change. “Don’t let up. Be relentless. Sustain the change and it becomes the culture.” Goodell said the Family Health Center, which provides care to more than 10,000 patients in the Baltimore area, began its PCMH journey by dispelling misconceptions about the model and effectively communicating for PCMH buy-in, concentrating efforts on skeptical or hesitant employees. Resources were effectively utilized to begin to make changes. A “team environment” was created where everyone’s opinion is sought and respected. “No one person has all the expertise,” she said. Goodell said the practice has learned that change requires employees to be adaptable – to cross train and cross cover, to respond to urgent situations and to be flexible, and most of all to respect the input of everyone and to encourage different viewpoints. “You have to make this change fit you,” she said. “It has to be based on your patients’ needs, your community and your staff skills. And it requires ongoing attention to detail. You have to constantly reflect—does your team have what it needs?”

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ASSOCIATE CHIEF OF STAFF OF AMBULATORY CARE, CENTRAL ALABAMA VETERANS HEALTH CARE SYSTEM (MONTGOMERY, ALA.)

As associate chief of staff of Ambulatory Care for the Central Alabama Veterans Health Care System, Canfield is responsible for ambulatory care for 40,000 veterans on six campuses, as well as for 35 physicians and mid-level providers. He also supervises occupational health services, diabetes care clinics, patient education and women’s health services.

MICHAEL CANFIELD, MD

A BUSINESS MODEL > Before he came to Montgomery, Ala., Dr. Michael Canfield was one of a handful of physicians who founded Palmetto Primary Care Physicians in Summerville, S.C. Today, Palmetto is an organization of more than 90 physicians and clinical support staff who practice primary care and specialty care at 32 offices in seven South Carolina counties. Palmetto has also earned NCQA Patient-Centered Medical Home status. Today, Canfield, a family physician, is associate chief of staff of Ambulatory Care for the Central Alabama Veterans Health Care System in Montgomery, where he is responsible for the care of 40,000 veterans on six campuses, as well as for 35

physicians and mid-level providers. At the conference, he spoke about the business side of the PCMH model, using Palmetto as a case study, and he outlined the keys to success for Palmetto. Canfield said the founding partners started by identifying physicians who were “early adopters” of the PCMH model, and then put small, model teams together. “The main driver for physician buy-in early on,” he said, “was ancillary income.” Ancillary services include such activities as laboratory and X-ray services, preventive screenings like colonoscopies and mammograms, and after-hours clinics. Canfield said the income generated by these services and screenings allowed physicians to see fewer patients but spend more time with them, and spend more time with care managers to develop prevention and wellness strategies for patients. Continually seeking ways to be innovative, Canfield said Palmetto extended the concept of after-hours care to include a 24-hour nurse triage service that allowed nurses, though they had to work at night, to work from home. A Wellness Center was built to promote prevention strategies with patients. “This is the patient-centered medical home,” Canfield said. “We created a system that puts the patient at the center.” COLLEGE OF COMMUNITY HEALTH SCIENCES

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MARY ANN COLEMAN, MD, PHD

PROFESSOR AND CHAIR OF FAMILY MEDICINE, DIRECTOR OF RURAL EDUCATION, COMMUNITY HEALTH, LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE A professor and chair of Family Medicine and director of Rural Education in Community Health at LSU School of Medicine, Coleman is working to develop an LSU network of primary care health clinics that conform to the patient-centered medical home model.

How do you begin to implement a patient-centered medical home model within your practice? “It’s not all that hard if we start small,” said Dr. Mary Ann Coleman, a professor of Family Medicine and director of Community Health Clinics at Louisiana State University School of Medicine. “Take 20 to 30 patients and one disease.” She explained: Create a disease registry for diabetic patients. Select an evidence-based plan of care to address their diabetes and to determine health outcomes. Identify a health-care team that will provide care and monitor the progress. “You have to engage patients in their personal care,” Coleman said. “You have to help patients self-manage their chronic conditions through team care and health coaching. Ask questions that allow patients to become an active participant in their care. Help patients develop an action plan. Make follow-up phone calls to see how they are progressing with their action plan.”

MELANIE TUCKER, PHD ASSISTANT PROFESSOR OF HEALTH EDUCATION, COLLEGE OF COMMUNITY HEALTH SCIENCES

Dr. Melanie Tucker is an assistant professor of Health Education at UA’s College of Community Health Sciences. She provides clinical health coaching to University Medical Center patients with chronic diseases, working directly with individual patients and patient groups to set behavior change goals and to help motivate them through the process. She is also developing and implementing a health education and health communications curriculum for the College’s medical students and family medicine residents.

Patients dealing with chronic illnesses need more than a visit to the doctor and a patient information brochure when they leave the office. “They need guidance and support,” said Dr. Melanie Tucker, an assistant professor of Health Education at UA’s College of Community Health Sciences. Consider the statistics: > 40 to 80 percent of the medical information patients receive during the doctor visit is immediately forgotten. > 30 to 50 percent of patients leave doctor visits without understanding the treatment plan. > 25 percent of patients don't fill their prescriptions. > 25 percent of patients don't take their prescriptions even after they are filled. > Only 9 percent of patients participate in their health decisions. “What we’re doing isn’t working,” Tucker said. She provides clinical health coaching to University Medical Center patients with chronic diseases, working directly with individual patients and patient groups to set behavior change goals and to help motivate them through the process. That’s what a health coach is, she said, a behavior change specialist who works directly with patients. Who can be a health coach? Nurses, social workers, medical assistants, health educators and community health workers—with training. Tucker describes a health coach as “the bridge between the clinician and the patient,” serving as the patient’s liaison and ensuring that the patient understands and agrees with the health plan.

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“The health coach helps to empower the patient and to make sure the patient’s voice is heard,” she said. “This transformation allows the patient to participate in his or her own care.” Tucker says the current paradigm must change. Instead of the physicianpatient relationship, where the physician is the authority and tells the patient what to do, “we need to ask patients what changes they are willing to make. Incorporate a health coach into the care team to elicit the patient’s agenda and to build on what the patient is doing that is already working,” she said. “Transform the conversation, and you transform the care.”


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SYLVIA BROWN

EXECUTIVE DIRECTOR, GULF COAST PATIENT CARE NETWORK (MOBILE, ALA.)

Sylvia Brown is executive director of the Mobile, Ala.-based Gulf Coast Patient Care Network, a non-profit organization that provides a system of coordinated care, including care management and pharmacy services, for Medicaid patients in the area suffering from chronic diseases or mental illness. The network is based on an existing patient-centered medical home initiative within the Alabama Medicaid program known as Patient 1st.

By the second quarter of 2014, that rate had dropped to 21 percent. Brown attributes the trickle down to the coordinated care and home visits post hospitalization provided by the GCPCN. She said sometimes simple efforts can eliminate a trip back to the hospital. “Why is that person at the hospital? Because they don’t have an air conditioner in their home. So we get them an air conditioner. “What we’re doing is working,” Brown continued. “It will take time to get data and really see how we’re doing. We want to really drill down on that data to see why people aren’t going to a primary care doctor.” In addition to hospital readmissions, the GCPCN works with “rising risk patients so they don’t end up as high risk,” Brown said, targeting such health issues as asthma, diabetes, mental health and HIV. Previously, when Brown served as executive director of MedNet West, a nonprofit, community-based care network in Tuscaloosa, the network discovered that many of the hospital readmissions in the city were newborns. “There was a system problem,” she said. When parents, having selected a pediatrician, were discharged from the hospital, they found they couldn’t get an appointment with the pediatrician when they got home. So they ended up back in the emergency room for care. “MedNet West helped solve that issue by helping them get appointments,” Brown said. “Once we get a handle on these system issues, and on the behavioral health piece, a lot of chronic conditions and other issues will take care of themselves.”

The year-old Gulf Coast Patient Care Network in Mobile, Ala., is a collaborative of hospitals, mental health facilities, care management services, pharmacies and the Alabama Medicaid program. The network serves 64,500 patients in the Mobile area, which has among the state’s highest hospital readmission rates. “We work to bring all care under the scope of primary care providers,” said Sylvia Brown, executive director of GCPCN. “We identify gaps in the system and try to remove the barriers. We connect the dots with the goal of reducing readmissions.” The hospital readmission rate for Washington County, of which Mobile is the county seat, was 25 percent in 2013.

> TOTAL NATIONAL HEALTH CARE EXPENDITURES: $2.7 TRILLION

> UNINSURED AMERICANS: 45.2 MILLION OR 16.9% OF THE U.S. POPULATION

> PER CAPITA NATIONAL HEALTH CARE EXPENDITURES: $8,680

> UNINSURED ALABAMIANS: NEARLY 800,000

(chronic diseases account for about 75% of expenditures)

> LEADING CAUSES OF DEATH IN U.S. � HEART DISEASE � CANCER � CHRONIC LOWER (other industrialized countries spend an average of 9 percent) RESPIRATORY DISEASE � DIABETES > PERCENT OF NATIONAL HEALTH CARE EXPENDITURES FOR > LEADING CAUSES OF DEATH IN � HOSPITAL CARE: 31.5% ALABAMA � PHYSICIAN AND CLINICAL � HEART DISEASE SERVICES: 20% � CANCER � CHRONIC LOWER > AMERICANS WITHOUT SUFFICIENT RESPIRATORY DISEASE ACCESS TO A PRIMARY CARE � STROKE PHYSICIAN: 56 MILLION > TOTAL NATIONAL HEALTH CARE EXPENDITURES AS A PERCENT OF GROSS DOMESTIC PRODUCT: 17.9%

(primary care oriented countries have better health at lower costs)

Sources: The U.S. Centers for Disease Control and Prevention, 2011; Arise Citizens' Policy Project; Alabama Department of Public Health.

> PERCENTAGE OF AMERICANS AGE 20 AND OLDER WHO ARE: � OBESE: 31.5% � OVERWEIGHT: 69% > PERCENTAGE OF ALABAMIANS AGE 18 AND OLDER WHO ARE: � OBESE: 32.2% � OVERWEIGHT: 69% > PERCENTAGE OF AMERICAN ADOLESCENTS AND CHILDREN WHO ARE OBESE: � 12 TO 19 YEARS: 18.4% � 6 TO 11 YEARS: 18% � 2 TO 5 YEARS: 12.1% > PERCENTAGE OF ALABAMA ADOLESCENTS AND CHILDREN WHO ARE OBESE: � GRADES 9 TO 12: 13.5% � 2 TO 5 YEARS: 14.1% COLLEGE OF COMMUNITY HEALTH SCIENCES

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| COVER STORY

PERSONAL PHYSICIAN

Each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.

PHYSICIAN-DIRECTED MEDICAL PRACTICE The personal physician leads a team of individuals at the practice level that takes responsibility for the ongoing care of patients.

ENHANCED ACCESS TO CARE

is available through systems such as open scheduling, expanded hours and new options for communication between patients, their personal physician and practice staff.

WHOLE PERSON ORIENTATION

The personal physician is responsible for providing for all the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life—acute care, chronic care, preventive services and end-of-life care.

CARE IS COORDINATED AND/OR INTEGRATED

across all elements of the complex healthcare system (subspecialty care, hospitals, home health agencies, nursing homes) and the patient’s community (family, public and private community-based services). Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it and in a culturally and linguistically appropriate manner.

PAYMENT

appropriately recognizes the added value provided to patients who have a PCMH.

QUALITY AND SAFETY are the hallmarks of the PCMH.

The National Committee for Quality Assurance Patient-Centered Medical Home recognition is the most widely-used way to transform primary care practices into medical homes. The NCQA recommends that a medical practice wanting to become a PCMH transform its operations in accordance with the Patient Centered Primary Care Collaborative’s Joint Principles of the PCMH (above).

RECOGNITION 16

THE UNIVERSITY OF ALABAMA


VALUE-BASED PURCHASING IN HEALTH CARE By Leslie Zganjar

N

ot long ago, IBM posed this question to its employees in regard to the health care coverage it purchased and the care they received—Are we providing you something of value? More than half of employees responded that they couldn’t access a primary care doctor, and 26 percent said they couldn’t get after-hours care. “They wanted access, convenience, a relationship of trust and communication with their doctor. We weren’t doing any of that,” says Dr. Paul Grundy, global director of Healthcare Transformation for IBM. “We concluded that we weren’t giving them anything of value.” IBM also concluded the company wasn’t getting value from the health care it purchased. To illustrate, Grundy often uses this example: “I can buy the kind of care that allows me to get pretty good amputation for my diabetics, but I can’t buy the kind of comprehensive, integrated care that prevents my diabetics from needing an amputation.” Value-based purchasing, quickly becoming the catchword in the business community, brings together information about the quality of health care, including patient outcomes and health status, with data on care costs. It focuses on managing the healthcare system to identify and reward the best-performing providers, and aligning payment with quality and efficiency. This represents a fundamental shift from the current system of volume and profitability of services provided—physician visits, hospitalizations, procedures and tests. Now, each time a patient gets sick, the doctor gets paid; physicians aren’t monetarily incented to keep patients well. IBM in 2006 began a journey to find ways to infuse value in the health care coverage it provides employees. “We thought, ‘Should we build our own health care? We concluded that we should build the mechanism,” Grundy says. “So we asked: How do you create a foundation upon which you can build something of value?” The answer involved IBM reaching out to other large employers. Forty-seven Fortune 500 companies came along and the Patient-Centered Primary Care Collaborative was formed. The group met with primary care organizations and developed the Joint Principles of the Patient-Centered Medical Home. Today, more than 600 organizations are part of the PCPCC, including hospitals, national health plans, consumer groups, medical specialty groups and employer associations, and they advocate adoption of the PCMH as a way of transforming the nation’s healthcare system. “It’s a large group that’s fundamentally trying to drive

$AVINGS SNAPSHOT INTEGRATED DELIVERY SYSTEM PCMH MODELS:

Group Health Cooperative of Puget Sound: > 16% reduction in hospital admissions > 29% reduction in emergency room use Geisinger’s Health System ProvenHealth Navigator PCMH Model (serving Medicare patients in rural Pennsylvania) > 18% reduction in hospital admissions > 7% reduction in total PMPM costs

PRIVATE PAYER SPONSORED PCMH INITIATIVES:

BlueCross BlueShield of South Carolina - Palmetto Primary Care Physicians: > 36% reduction in inpatient days > 32.2% reduction in emergency department visits BlueCross BlueShield of North Dakota – MeritCare Health System > 6% reduction in hospital admissions in PCMH group from 2003 to 2005 > 24% reduction in emergency department use in PCMH group from 2003 to 2005 > Total costs per member per year $530 lower than expected in 2005

change toward more comprehensive primary care,” Grundy says. Pilot projects have been designed and implemented around the PCMH model. In North Dakota, a coordinated approach to the care of diabetics resulted in an annual savings of $500 per patient, which was shared with the practices. In North Carolina, a focus on better care coordination by the state and Community Care North Carolina has resulted in a 44 percent reduction in the number of patients hospitalized for asthma. “For those who say they were hired under the old system of productivity, well, the only way to herd a cat is to move the food. Your practice needs to change to population management, and I have to find out how to pay you for that,” Grundy says. Most agree that making the PCMH a reality will require a change in the reimbursement structure. Now, physicians and other providers are paid per patient encounter. The more patients they see and the more procedures performed, the more they are paid. Under a PCMH model, physicians are paid to manage patients’ care. Some payment is tied to performance, some to patient encounter and some to managing the health of a population using services like group visits and disease registry monitoring. Physicians are paid for using electronic health records, and reimbursed for patient encounters via email and telephone consultations. “Primary care transformation can only be achieved through change to both systems—organizing and paying for care,” according to the Milbank Memorial Fund report, “Aligning Payers and Practices to Transform Primary Care.” “One reason the patient-centered medical home model is taking hold and spreading is that the business community increasingly ‘gets it’—much more so than with prior efforts like managed care and HMOs,” says Dr. Richard Streiffer, dean of the College of Community Health Sciences and a family medicine physician. “Business is starting to demand that the old dynamics, and economics, of health care change.” Poorly managed chronic diseases affect worker productivity, and the cost of health care negatively impacts the global competitiveness of American companies, according to the Milbank report. U.S. employers provide health insurance to 60 percent of the nonelderly population. “Sixty percent of our costs at IBM are hidden costs—sickness, absenteeism,” Grundy says. “You have to change from episodic care, and there is no longer the master builder—the physician—but the team. Culture change is the hardest part.”

MEDICAID SPONSORED PCMH INITIATIVES

Community Care of North Carolina > 40% decrease in hospitalizations for asthma > 16% lower emergency department visit rate > Cumulative savings of $974.5 million from 2003 to 2008 Colorado Medicaid and SCHIP > Children enrolled in PCMH practices had lower median annual costs ($2,275) than those not enrolled ($3,404)

*per member per month Source: Patient-Centered Primary Care Collaborative report, "Outcomes of Implementing Patient Centered Medical Home Interventions: A Review of the Evidence from Prospective Evaluation Studies in the United States," 2010. pcpcc.org.

OTHER PCMH PROGRAMS

Johns Hopkins Guided Care PCMH > 24% reduction in total hospital days > 15% fewer emergency room visits Genesee Health Plan (Michigan) > 50% decrease in emergency room visits between 2004 and 2007 > 15% fewer inpatient hospitalizations between 2006 and 2007

COLLEGE OF COMMUNITY HEALTH SCIENCES

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| TEN YEARS

1o Years COLLEGE MARKS DECADE IN NEW BUILDING

T

HIS FALL MARKS 10 YEARS SINCE THE College of Community Health Sciences opened the doors of its building on Fifth Avenue East. Construction finished on the 72,000-squarefoot building in 2004, which was designed to provide an optimal environment for teaching, patient care, research and community outreach. Groundbreaking took place 12 years ago in late November 2002, and an open house was held for the College in August 2004. When the College started occupying the building, University Medical Center became the name for the only primarycare focused multi-specialty practice in Tuscaloosa (it had previously gone by Capstone Medical Center) and the largest community practice in West Alabama. Upon its opening, UMC was equipped with a state-of-the-art medical information system—an electronic medical record that served a twofold purpose: the system allowed for better education of medical students (The College educates a cohort of third- and fourthyear medical students of the University of Alabama School of Medicine.) and residents of The College’s Family Medicine

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THE UNIVERSITY OF ALABAMA

Residency. It also improved clinical efficiency while providing care to patients. Before the new location opened, Capstone Medical Center served as the training site for more than 300 graduates of the College’s Family Medicine Residency and more than 450 medical students. Now, nearly 800 students have completed their third and fourth years of medical school at the College, training at UMC, and more than 430 graduates of the Family Medicine Residency are spread throughout 29 states, with the majority practicing in the South. UMC reported 63,753 patient visits in 2013, and provides services in family medicine, women's health services, sports medicine, psychiatry and behavioral health, pediatrics, internal medicine and geriatrics. UMC offers on-site lab and x-ray services, and provides psychiatric care, diabetes education and asthma education to rural communities through telemedicine. The building cost $13.5 million to construct, and it succeeded in consolidating nearly all CCHS faculty, staff, residents, medical students and health care services into one building.


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Opposite page, from left: The Family Practice Center, a 30,000-square-foot facility, opened in 1975, just three years after the College was formed; the Family Practice Center was expanded and renamed the Capstone Medical Center in 1982. Clockwise: A groundbreaking ceremony for the new building took place in November 2002, with Sen. Richard Shelby present; the College’s new building was constructed on a site at Fifth Avenue East and University Boulevard; digital renderings show the plans for the building, which has a clinical and academic side; the College’s clinical side serves as the entrance to University Medical Center; the College’s academic side houses classrooms, administrative offices, the Health Sciences Library, Residency and Medical Education administration and the Institute for Rural Health Research.

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24 M E D I C A L S T U D E N T S 33 R U R A L H E A LT H P R O G R A M S 36 F A M I LY M E D I C I N E R E S I D E N C Y 40 F E L L O W S H I P S

Community Learning M E D I C A L S T U D E N T S F O L L O W PAT I E N T S T H R O U G H O U T CARE IN NEW PROGRAM. By Kim Eaton

THIRD-YEAR MEDICAL STUDENTS AT THE College of Community Health Sciences have an opportunity to follow a patient over time through the health care system as part of an innovative new program being piloted this year. The Tuscaloosa Longitudinal Community Curriculum, or TLC², is a program that covers medical students’ third-year curriculum. Third-year medical students learn about pediatrics, internal medicine, surgery, family medicine, psychiatry, neurology and obstetrics/gynecology by working with physicians in clinic settings. The traditional rotation schedule consists of seven eightweek rotations through the various specialties, but through TLC², students spend most of their third-year working with a community physician and following patients throughout the diagnosis or disease. For example, a student may gain competency in obstetrics during a patient’s visit to her OB/GYN, help deliver the baby, 20

THE UNIVERSITY OF ALABAMA

then follow the newborn through well-baby checks. Or a student might see an adult patient at an initial visit, accompany him or her to specialty consults, assist in surgery on the patient, then see the patient back in the primary care doctor’s office for follow-up visits, says Brook Hubner, CCHS program director of Medical Education. “Many of the patients we treat, especially in Alabama, have multiple chronic diseases for which they need treatment,” says Kay Rainey, a third-year medical student at the College who is participating in the pilot program and currently working in Dr. Vernon Scott’s practice in Tuscaloosa. “With that comes the need to see multiple specialists, and patients are required to navigate between all of the specialists, receiving different medications and instructions from each one,” Rainey says. “I think that this new integrated curriculum will make a lasting impression on me about how patients and our healthcare system


Third-year medical student Elizabeth Junkin examines a patient under the supervision of Dr. Julia Boothe at her practice in Reform, Ala.

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| E D U C AT I O N

Left: Drs. Vernon Scott (left) and Erica Day-Bevel of Alabama Multi-Specialty Group in Tuscaloosa serve as preceptors for third-year medical student Kay Rainey. Right: Rainey (left) examines a patient.

interact, as a whole. I see it as an opportunity to see more of ‘the big picture’ of health care.” While longitudinally integrated clerkships have been part of medical education for some time, medical schools are beginning to create these programs as evidence of their effectiveness and benefits accumulates. Medical students who have participated in these clerkships say they feel better prepared to care for patients, and studies show that the students perceive better clinical education and access to patients. The length of the experience also allows time for students to become involved in the community; complete a community scholarly project; develop trusting and respectful relationships as a team member with physicians, clinic and hospital staff and patients; learn about the business of providing health-care services; and appreciate the rewards and challenges of primary care. “We encourage students to become involved in the community by attending ball games, religious services and otherwise becoming part of the town in which they are living,” Hubner says. “In other areas of the country where similar programs have been in place for years, communities view the student experience as a recruiting opportunity to attract physicians to the area.” Third-year medical student Elizabeth Junkin is working closely with Dr. Julia Boothe in Reform, Ala., through the 22

THE UNIVERSITY OF ALABAMA

TLC² program. Junkin says the biggest thing she has learned from her experience with the program is the “art of communicating with the patients.” “From convincing a patient to stop smoking to telling a family that their daughter is not going to wake up, there is an art to how to get your point across to a patient while providing the support they need to accept the news or make a change,” she says. “A lot of this art comes with experience, but it also comes with truly knowing your patients. My hope is that I will be able to develop my own art of communication through the longterm personal relationships that I will develop with my patients in the TLC² program.” The program will have other special curriculum components in primary care leadership, community engagement and population health that will be delivered through onsite and teleconferenced seminars throughout the nine-month experience. Admission to TLC² is through a competitive selection process. After piloting the curriculum, the College would like to admit a full cohort of students who would participate in the longitudinally integrated curriculum, Hubner says. “We know that this type of program will prepare future physicians with vigorous general professional clinical training,” says Dr. Richard Streiffer, dean of the College.


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By Leslie Zganjar

t

he College hosted Dr. Kathleen Brooks in April as a consultant to assist in the development of the Tuscaloosa Longitudinal Community Curriculum (TLC²)—an innovative program that enables third-year medical students to have clinical education and experiences in community settings over a period of months under the supervision of experienced primary care physicians. Brooks, the director of the Rural Physician Associate Program (RPAP) and an assistant professor in the Department of Family Medicine and Community Health at the University of Minnesota Medical School, serves as a national consultant to medical schools interested in implementing longitudinal integrated clerkship (LIC) models. She defines LICs as a model of medical education that allows students to participate in the comprehensive care of patients over time, maintain continuous relationships with patients and clinicians and meet the clerkship requirements. The RPAP at the University of Minnesota, a nine-month LIC for third-year medical students that began in 1971, demonstrates that students who complete the program enter primary care at a rate higher than traditional students. Seventy-six percent of the 1,400 students who have completed the program are currently practicing primary care; two-thirds of those are practicing family medicine and

half practice in rural settings. While LICs have been part of medical education for some time, medical schools are beginning to create these programs as evidence of their effectiveness and benefits accumulates. “The conclusion of many studies shows that we no longer need to do equivalence studies on longitudinal integrated curriculums. The students do well,” Brooks says. Dr. Richard Streiffer, dean of the College, said at an April meeting with Brooks and the CCHS Board of Visitors that the College’s strategy is to have a model like the RPAP over time, including an admissions component. A pilot of the College’s LIC, TLC², began in May with two students enrolled. “Right now, the pilot is looking like the University of Minnesota’s program but will continue to evolve,” says Streiffer. The College’s LIC initiative is a direct product of a strategic plan that determined, in part, that the majority of CCHS stakeholders agree that an integrated, longitudinal program would provide a more effective education to medical students. In addition to meeting with the CCHS Board of Visitors, Brooks also met with the College’s Medical Student Education Planning Committee, the TLC² Planning Committee, the College’s preceptors and clerkship directors and medical students. The Board of Visitors is a group of 32 volunteers whose purpose is to affect a close working relationship between the providers and consumers of health care and the College, to act as an advisory Dr. Kathleen Brooks talks with two medical students via Skype before they began piloting the Tuscaloosa Longitudinal Community Curriculum (TLC²) in May. group to the dean and to influence the advancement of CCHS. During her visit, Brooks was able to talk, via Skype, with the two students who began piloting TLC² in May and answer many of their questions. Brooks also spent some time at the University of Ala-

bama School of Medicine's main campus in Birmingham, where she met with the school’s administrators to discuss the logistics of starting a new curricular track. The College, which also functions as a regional campus of the University of Alabama School of Medicine, provides the third and fourth years of medical education and clinical experiences for a cohort of School of Medicine students, emphasizing education that aligns with the College’s mission to improve the health of Alabama’s population and provide primary care physicians for the state. But TLC² is not just for students interested in primary care. “We know that this type of program will prepare future physicians with vigorous general professional clinical training,” Streiffer says, along with skills in community engagement, leadership and population health, enabling them to be highly qualified for residencies and future practice in fields in addition to primary care, including emergency medicine, pediatrics, general surgery, OB/GYN and psychiatry.

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Drs. Daniel Partain and Paige Partain celebrate their match into residencies at the Mayo School of Graduate Medical Education in internal medicine and pediatrics, respectively.

Medical Students Match T W O F O U R T H - Y E A R M E D S T U D E N T S M AT C H I N T O T H E C O L L E G E ’ S F A M I LY M E D I C I N E R E S I D E N C Y.

By Amy Saxby TWENTY NINE MEDICAL STUDENTS AT THE COLLEGE OF COMMUNITY HEALTH SCIENCES, ALONG with others across the country, learned March 21 through the National Residency Match Program where they will train for the next three to seven years for their graduate medical education. The fourth-year medical students completed their clinical education at the College, which also functions as a regional campus of the University of Alabama School of Medicine, headquartered in Birmingham. The students entered into the Main Residency Match and received residency placements. Two students—Drs. Brittney Anderson and Justin Vines—matched into the College’s Family Medicine Residency. The remaining students placed across 12 different states. The NRMP Main Residency Match provides an impartial venue for matching medical students’ preferences for residency positions with the preferences of residency directors across the country. Last year, 40,335 applicants competed for positions, and the NRMP reported about 94 percent of senior students matched to first-year positions. Each year, approximately 31,000 applicants compete for approximately 24,000 residency positions. Medical residencies provide in-depth training in a specific medical specialty. Successful completion of residency training is a requirement to practice medicine in many jurisdictions.

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THE UNIVERSITY OF ALABAMA


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NAME

matched

matched

Brittney Anderson

Family Medicine — The University of Alabama Family Medicine Residency, Tuscaloosa, Ala.

Michael Wes Love

General Surgery — Greenville Hospital System/University of South Carolina, Greenville, S.C.

Teresa Backes

Pediatrics — University of Alabama Medical Center, Birmingham, Ala.

Brandon Heath Mitchell

Anesthesiology — Virginia Commonwealth University Health System, Richmond, Va.

Kent Burton

Otolaryngology — Louisiana State University Health Sciences Center, Shreveport, La.

Daniel Partain

Internal Medicine — Mayo School of Graduate Medical Education, Rochester, Minn.

Samuel Douglas

General Surgery — Baptist Health System, Birmingham, Ala.

Paige Partain

Pediatrics — Mayo School of Graduate Medical Education, Rochester, Minn.

Michael Dumas

Emergency Medicine — University of Tennessee College of Medicine, Chattanooga, Tenn.

Pratik Patel

Radiology‐Diagnostic — University of Florida College of Medicine‐Shands Hospital, Gainesville, Fla.

Luke Farmer

Internal Medicine — Carolinas Medical Center, Charlotte, N.C.

Benjamin Todd Raines

Orthopedic Surgery/5 Yr — University Hospital, Columbia, Mo.

Reese Feist

Ophthalmology — University of Utah Affiliated Hospitals, Salt Lake City, Utah

Holland Reaves Pierce

Emergency — Medicine New York Methodist Hospital, Brooklyn, N.Y.

Samuel Ford

Orthopedic Surgery — Carolinas Medical Center, Charlotte, N.C.

Danielle Franklin

Pediatrics — University of Alabama Medical Center, Birmingham, Ala.

Sarah Gammons

Pediatrics — University of Texas Southwestern Medical School, Dallas, Texas

Richard Slama

Emergency Medicine‐Navy — Naval Medical Center, Portsmouth, Va.

William Hampton Gray

Thoracic Surgery — University of Southern California, Los Angeles, Calif.

Surgery (1) Alexander Smith

University of North Carolina Radiology‐Diagnostic — Medical University Hospitals (Chapel Hill, N.C.) of South Carolina, Charleston, S.C.

David Hardin

Internal Medicine — Baptist Health System, Birmingham, Ala.

Justin Vines

Family Medicine — The University of Alabama Family Medicine Residency, Tuscaloosa, Ala.

Andrew Klinger

Pediatrics — University of South Alabama Hospitals, Mobile, Ala.

Mary Katherine Leonard

Psychiatry — University of Alabama Medical Center, Birmingham, Ala.

Gregory Little

Internal Medicine — Baptist Health System, Birmingham, Ala.

NAME

Brittany Richardson Physical Medicine and Rehabilitation (1) Benjamin Roberts

Pediatrics — Baylor College of Medicine, Houston, Texas Mt. Sinai Hospital (New York, N.Y.) Anesthesiology — University of Alabama Medical Center, Birmingham, Ala.

Surgery Baptist Health MATCH UP: Medical students learnedGeneral on March 15, — 2013, through Jerald Residency Payden Wallace System, Ala. the the National Match Program where theyBirmingham, would spend next stage of their graduate medical — University education and training. “It was a tight Radiology‐Diagnostic match but the best year everof Adam Zelickson Virginia,says Charlottesville, for the [UASOM] Tuscaloosa Regional Campus,” HeatherVa. Taylor, MD, assistant director of Medical Student Affairs for the College.

Dr. Heather Taylor, an associate professor in the College’s Department of Pediatrics, has been named director of Medical Education for the College. The position was formerly held by Dr. Cathy Gresham, a professor in the Department of Internal Medicine, before her retirement. As director of Medical Education, Taylor is the College’s principal liaison for the University of Alabama School of Medicine student affairs matters that relate to the College’s medical students. The College provides clinical education and experiences for a portion of the School of Medicine’s third- and fourth-year students. Dr. Harriet Myers, an associate professor in the Departments of Family Medicine and Psychiatry and Behavioral Medicine, has been named assistant dean for Medical Education for the College. In this role, Myers will integrate common functions across the College’s educational activities for medical students, residents and faculty, including academic support and performance improvement, faculty development, assessment and evaluation and inter-professional education. Brook Hubner, an administrative specialist in Medical Education, has been named program director of Medical Education and senior registrar for the College. In this role, she will provide administrative oversight for the College’s medical students, coordinate the medical student curriculum for other health professional student interactions in the College and assume the registrar functions for the College. COLLEGE OF COMMUNITY HEALTH SCIENCES

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| E D U C AT I O N

Lending a Hand F I R S T- Y E A R M E D I C A L S T U D E N T S G E T T O K N O W C O L L E G E , T U S C A L O O S A T H R O U G H C O M M U N I T Y S E R V I C E . By Brett Jaillet FIRST-YEAR MEDICAL STUDENTS, WHO WILL receive their third and fourth years of clinical education at the College of Community Health Sciences, spent a day in late August getting to know each other and Tuscaloosa by way of community service. About 40 students spent the day sprucing up the grounds of the Arc of Tuscaloosa County, an agency that serves adults with intellectual disabilities, for First Year Fun Day, a part of the students’ medical school orientation. One of the College’s functions is serving as the Tuscaloosa Regional Campus for the University of Alabama School of Medicine, headquartered in Birmingham. All medical students complete their first two years of medical school in Birmingham, and then a cohort of students move to Tuscaloosa for their clinical education. In addition to trimming hedges and gardening outside the building, the students painted much of the interior. One of their biggest projects was covering a large activities room in a bright blue hue, which Donna Callahan, interim director of the Arc of Tuscaloosa, says will serve as the base for an aquariumthemed room to be completed by a local artist. Callahan says that while the day is beneficial for the consumers at Arc of Tuscaloosa, she hopes it will impact students, too. “Some people come in here who have not been exposed to people with intellectual disabilities before, and we want them to see that they can be funny or serious or clown around, just like you and I can,” Callahan says.

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This is the second year that first-year medical students have completed a day of community service at the Arc of Tuscaloosa, and the experience is meant to help them understand the importance that serving the community will play in their careers as physicians, says Brook Hubner, program director of Medical Education at the College. “Connecting the students with the breadth of the Tuscaloosa community is very important to our mission and is a key component of their Patient, Doctor and Society course,” Hubner says. After completing their projects, students mingled with College faculty over lunch and enjoyed a performance by Sounds of Joy, the Arc of Tuscaloosa choir. Dr. Heather Taylor, director of Medical Education at the College, says getting to know the faculty is an important part of orientation, too. “Working at the Arc gave the students an opportunity to get to know us and each other while helping out a great organization,” she says. The students’ orientation and first class culminated with the White Coat Ceremony on Sunday, Aug. 17, inside the University of Alabama at Birmingham Alys Stephens Performing Arts Center. The ceremonial presentation of white coats to medical students, created by the Arnold P. Gold Foundation in 1993, includes the signing of the oath of commitment to patient care that reminds incoming students of the dedication necessary to complete a medical education and underscores the responsibilities inherent in the practice of medicine.


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First-year medical student Stephanie Norwood paints a wall at the Arc of Tuscaloosa as part of First Year Fun Day. Norwood will complete her third and fourth years of clinical education at the College. COLLEGE OF COMMUNITY HEALTH SCIENCES

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Medical Students Attend Orientation at College By Leslie Zganjar

THIRTY-ONE UNIVERSITY OF ALABAMA SCHOOL of Medicine students who will complete their third and fourth years of medical school at the College of Community Health Sciences attended an orientation session in Tuscaloosa in May. “Our mission drives who we are and what we do, and our core values are the principles upon which we operate,” Dr. Richard Streiffer, dean of the College, told the students. “What drives our medical education is social accountability.” The College, which also functions as a regional campus of the School of Medicine, provides clinical education that is oriented toward primary care, while also providing exposure to and experience in other specialties. “We have to have everything, but we have too many specialists and not enough primary care physicians in Alabama,” Streiffer said. The College’s mission is to improve and promote “the health of individuals and communities in Alabama and the region.” Medical students complete the first two years of basic sciences courses at the School of Medicine’s main campus in Birmingham, and then complete the third and fourth years of the medical school curriculum at either Birmingham or one of the school’s regional campuses in Tuscaloosa, Huntsville and Montgomery. During their orientation in Tuscaloosa, the medical students also learned about the College’s clerkships and electronic medical record, and participated in CPR and training in the use 28

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of defibrillators. They toured DCH Regional Medical Center and met with Dr. Ken Aldridge, chief medical officer. “You’re about to begin an interesting part of your medical training,” Aldridge told them. “It’s a wonderful time for you and I hope you find it rewarding. And I hope all of you set up private practice in Tuscaloosa. We need all the bright young doctors we can get.” Medical students practice CPR to the tune of “Stayin’ Alive” by the Bee Gees as part of their orientation. Above: Medical student Missy Ma gets fitted for a defibrillator.


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Students Present at Research Society Dinner TW ICE A YEAR, M ED IC A L STU D EN TS AT T HE College of Community Health Sciences get the chance to present their research and scholarly activity to CCHS faculty at the Larry Mayes Research Society Faculty and Student Dinner. A dinner was held April 10 at Cypress Inn, and medical students Jamie Powell and Chelsea Cernosek presented. A second dinner was held Nov. 17 at Surin of Thailand, and students Melanie Wooten and Cory Smith presented. Powell presented her research on using a DVD as intervention for parents and caregivers of children hospitalized for respiratory illnesses to improve knowledge and reduce second-hand and third-hand tobacco smoke exposure. Third-hand tobacco smoke exposure is the residual smoke that remains on clothes, hands and hair after smoking. “This is a very low-cost type of intervention,” Powell said. She also said participants in her study demonstrated retention of knowledge, and some reported a decrease in smoking. Cernosek presented her scholarly activity on sickle cell trait and wound healing and the use of epinephrine in breast reduction procedures. Wooten presented her ongoing research on empathy, and whether or not exposure to a humanities-based extracurricular activity affects empathy changes in third-year medical students. Her study has included monitoring CCHS third-year medical students’ attendance of the Art of Medicine series presented by the College and its Health Sciences Library, and then testing for empathy. Smith presented the beginning stages of the evaluation of a catalytic oxidoreductant to protect the brain after a concussion. He said his experience playing football and suffering from multiple concussions and post-concussion syndrome spurred his interest in this research. “Concussions are still happening despite efforts to prevent them, so what can we do on the clinical side to treat them?”

Melanie Wooten presents her research at the most recent Larry Mayes Research Society Faculty and Student Dinner.

Dr. Heather Taylor, director of Medical Education, says these events give students a chance to practice formally presenting their research before giving oral presentations at conferences. Cernosek, for example, presented her research again in June at an international plastic surgery conference. “So this was a valuable opportunity for her to practice and see what kinds of questions she needs to prepare for,” Taylor says. The overall goal of the dinner is to support and encourage student scholarly activity, says Taylor. The objective of the Larry Mayes Research Society is to expose medical students to research being conducted at The University of Alabama and encourage them to engage in research with the College and the University. “It gives the students and faculty a chance to hear about the projects our students have been working on and often stimulates ideas for future projects,” Taylor says.

Medical Students Selected for Honor Societies FOUR UNIVERSITY OF ALABAMA SCHOOL OF Medicine students who are receiving their clinical education at the College of Community Health Sciences were elected members of the Alpha Omega Alpha Honor Medical Society. The students are Chelsea Cernosek, Duncan Harmon, Jamie Leigh Powell and Nathan Wilbanks. Alpha Omega Alpha is a professional medical organization that recognizes excellence in scholarship as well as outstanding commitment and dedication to caring for others. The top 25 percent of a medical school class is eligible for nomination to the honor society, and up to 16 percent may be elected. “These students were elected based on their outstanding academic achievements, character, community service and leadership,” says Dr. Heather Taylor, director of Medical Education at the College. In addition, eight medical students completing their clinical

education at the College were inducted into the Gold Humanism Honor Society. The students are: Stevie Bennett, Anna Choe, Jacquelynn Parks, Shweta Patel, James Raley, Amber Beg, John Killian Jr., and Paul Sauer Jr. The society is a signature program of the Arnold P. Gold Foundation and was established to recognize medical students, residents and faculty who practice patient-centered care by modeling the qualities of integrity, excellence, compassion, altruism, respect and empathy. Only 10 to 15 percent of each medical class may be selected during the third and four years. Students are nominated by their peers. In its role as a regional campus of the University of Alabama School of Medicine, headquartered in Birmingham, the College provides clinical education for a portion of third- and fourth-year medical students. COLLEGE OF COMMUNITY HEALTH SCIENCES

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UASOM Dean Speaks at Senior Convocation V I C K E R S G I V E S ' 5 C S ' O F B E I N G A G R E AT P H Y S I C I A N .

By Brett Jaillet GRADUATING MEDICAL STUDENTS RECEIVED sage advice from Dr. Selwyn Vickers, dean of the University of Alabama School of Medicine, at the annual Senior Convocation hosted by the College of Community Health Sciences and held at the Indian Hills Country Club in Tuscaloosa on May 16. The College provides clinical education and experiences for a cohort of third- and fourth-year medical students enrolled at the School of Medicine, which is headquartered in Birmingham. The 29 students honored at the convocation were among the more than 160 students who graduated from UASOM during a ceremony in Birmingham on May 18. Vickers delivered the convocation keynote address and presented his “5 Cs” of being an excellent physician: care, competence, character, courage and collaboration. Having a caring attitude in examining patients will be of the utmost importance, Vickers said to the students. “You have to be all in, all the time.” He said that while the students have been highly trained 30

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at the College, they will need to be lifelong learners. “At the end of the day, your patient needs someone who is competent and willing to go that extra mile to make sure the patient is taken care of.” Vickers said at some point in their careers, students’ characters will be put to the test, and when that happens they’ll need to exercise courage.“It will take courage on your part to always put your patient first, even when it seems like it may cost you.” His final “c,” collaboration, often goes hand-in-hand with communication, he said. “That collaborative spirit and ability to communicate is important for your success and for the outcome of your patient.” Vickers said the faculty, students’ family and friends and the students themselves should be proud of their hard work and accomplishments. “If you look at the spectrum of everything you can do in the world, there really is nothing like waking up and knowing you can make a difference every day in someone’s life.”


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Robert F. Gloor Award in Community Medicine Dr. Paige Partain Family Medicine Award Dr. Brittney Anderson Family/Rural Medicine Preceptor’s Award Dr. Julia Boothe William W. Winternitz Award in Internal Medicine Dr. Justin Vines Neurology Award Dr. Richard Feist, Jr. Pediatrics Recognition Award Dr. Brittany Richardson Pediatrics Service Award Dr. Sarah Gammons Peter Bryce Award in Psychiatry Dr. Mary Thrower

Larry Mayes Research Society Scholar Dr. Brittney Anderson

Finney/Akers Memorial Award in Obstetrics and Gynecology Dr. Justin Vines

Larry Mayes Research Society Members Dr. Daniel Partain; Dr. Paige Partain; Dr. Brittany Richardson

William R. Shamblin, MD, Surgery Award Dr. Samuel Ford

Student Research Award Dr. Benjamin Raines

Faculty Recognition Award (Junior Year): Dr. Heather Taylor

Most Likely to Wear a Suit to Clinic Dr. Zachary Farmer

Patrick McCue Award Dr. A. Robert Sheppard

Most Likely to Wear Heels to Clinic Dr. Danielle Franklin

Resident Recognition Award Dr. J.D. Engelbrecht

Most Likely to Leisurely Read JAMA Dr. Daniel Partain

James H. Akers Memorial Award Dr. Justin Vines

Most Likely to be Seen on Television Dr. William Gray

Most Likely to Make You Laugh During Morning Report Dr. Samuel Douglas

Most Likely to be Late for Work on July 1 Dr. Zachary Farmer

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Caring for Patients in Ghana F I R S T- Y E A R R E S I D E N T, F O R M E R C C H S M E D I C A L S T U D E N T S H A R E S E X P E R I E N C E S W O R K I N G I N W E S T A F R I C A . By Leslie Zganjar

DR. BRITTNEY ANDERSON RE-

members patients arriving before dawn, health records in hand, at the Ankaful Leprosy/General Hospital in Kuntanase, Ghana, in West Africa. And they would wait. The hospital did not make appointments, and it would be noon or later before some of the patients would be seen by a doctor. There were no air-conditioned waiting rooms, but Anderson says there were no complaints. “I kept a journal, and every day I would start with, ‘Today was awesome,’ and every day I would end with, ‘This was the best day.’ This was one of the best experiences I’ve ever had,” she said. Anderson, now in the first year of her family medicine residency at the College of Community Health Sciences, was a fourth-year medical student at CCHS when she traveled to Ghana in January 2014 to complete an international elective as part of the Larry Mayes Memorial Scholarship she was awarded. It was her second trip to Ghana; she visited the West African country for nine weeks in 2007 while an undergraduate student at Duke University. During the four weeks she spent at the Ankaful Leprosy/General Hospital, Anderson cared for patients with leprosy, with chronic conditions, and those in the maternity ward. She remembers one maternity patient suffering with pre-eclampsia, but the hospital had only enough magnesium sulfate for 12 hours and no other medication to help bring down the patient’s blood pressure. “This was a really rough day because I knew there were things that could be done, but there wasn’t the medicine there,” Anderson says. The patient was transferred to another hospital, but this experience, and others, helped Anderson to “learn to trust my medical judgment and stethoscope before I rushed to do a test.” Anderson also spent time at the nearby Elmina Urban Health Center, which provides primary and preventive care. “We saw a lot of chronic back pain, high blood pressure and elevated sugar levels. We did immunizations,” she says. “My favorite part was the wound clinic.” She relayed these experiences to the CCHS Board of Visitors during a spring meeting and thanked members for making the scholarship for 32

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international medical experiences available to medical students at the College. The Board of Visitors is a group of 32 volunteers whose purpose is to affect a close working relationship between the providers and consumers of health care and the College, to act as an advisory group to the dean and to influence the advancement of the College. “The funding you provide for these international experiences for students who aren’t from rural areas will make them think about one day practicing in rural areas,” she said. Rural is already where Anderson’s heart is. After her residency training, she plans to practice family medicine in a Black Belt county of Alabama, close to her home in Autauga County, where her family has lived on a farm since the Great Depression.


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Rural Medical Scholars Honored at Convocation K E Y N O T E A D D R E S S G I V E N B Y C O L L E G E A L U M N A D R . S A N D R A L H U L L E T.

By Leslie Zganjar

MEMBERS OF THE COLLEGE OF COMMUNITY Health Sciences’s Rural Medical Scholars class of 2013-2014 and Rural Community Health Scholars were recognized April 25 at the annual Rural Health Scholars Convocation. The 18 students also earned certification in Rural Community Health. The Rural Medical Scholars Program is exclusively for college seniors or graduate students from rural Alabama. It is a five-year track of medical studies that leads to a certificate or master’s degree in Rural Community Health in the first year, and a medical degree from the University of Alabama School of Medicine. The first year of the program focuses on rural primary care and community medicine and gives students experiences in rural settings through field trips, service projects, research and shadowing of rural physicians. The Rural Community Health Scholars Program is for graduate students and trains future health care providers to become community health leaders. The training prepares them to develop and maintain community health centers and other health-care

practices and to engage in community affairs that advance community health. The 11 Rural Medical Scholars honored at the convocation, held at the Hotel Capstone on the The University of Alabama campus, began their first year of medical school this summer at the School of Medicine’s main campus in Birmingham. They will return to the College, which also functions as a regional campus of the School of Medicine, during their final two years of medical school. “The mission of the Rural Medical Scholars Program is to produce physicians for rural Alabama who are leaders of health in their communities,” said Dr. John Wheat, founder and director of the program. The convocation keynote address was given by Dr. Sandral Hullett, a graduate of the College’s Family Medicine Residency and a national expert in rural health. “I felt it was important to be a family doctor,” she told the students. “The number one thing is for people to have a doctor COLLEGE OF COMMUNITY HEALTH SCIENCES

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who will care for them and listen to them.” Hullett was also presented with The University of Alabama Rural Medical Scholars Program Distinguished Service Award. “She has made her mark everywhere she’s been,” Wheat said when presenting the award to Hullett. “She grew to national importance and advised people about what we should do as a country about rural health care.” After her residency training, Hullett took a position with Green County Hospital in Eutaw, Ala., where she stayed for 23 years, also serving for many of those years as medical director of West Alabama Health Services

and as a preceptor for a large number of medical students and residents. She served as a physician and director for the nonprofit Family Health Care of Alabama, where she supervised 24 primary health care facilities serving 20 rural counties. She later served as CEO and medical director of Cooper Green Mercy Hospital in Birmingham. She is the principal investigator of the National Institutes of Health Transdisciplinary Collaborative Centers for Health Disparities Research. Hullett has received numerous honors, including induction into the National Institute of Medicine, a unit

of the National Academy of Sciences. She was named Rural Doctor of the Year by the National Rural Health Association in 1988, and was elected to Alabama’s Health Care Hall of Fame in 2001. College Dean Dr. Richard Streiffer also spoke to students at the convocation. “Rural is always a neglected area, and that’s still the case. So our work continues,” he said. Whitney Hudman, a Rural Medical Scholar from Jemison, Ala., said, “Coming from a modest background, the Rural Medical Scholars Program was made for people like me. It will help me succeed in medical school.”

Dr. John Wheat, director of the Rural Medical Scholars Program, presents The University of Alabama Rural Medical Scholars Program Distinguished Service Award to Dr. Sandral Hullett, College alumna and keynote speaker at the convocation.

By Linda Jackson

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r. Remona Peterson of Thomaston, Ala., who was named the College’s first Black Belt Rural Medical Scholar, says she, “has always been passionate about returning to the rural Black Belt of Alabama.” Now a resident in the College’s Family Medicine Residency, Peterson says she will return to Greene County after she completes the three-year program and her goal is to “empower the communities mentally, physically and emotionally to be more proactive about their health,” she says. Her focus will be preventive care—she wants to focus on health care disparities among African-American communities. “Remona has shown extraordinary determination and perseverance in reaching her goal of becoming a physician to serve her home community,” says Dr. John Wheat, professor of Community and Rural Medicine and the director of the Rural Medical Scholars program. Peterson graduated summa cum laude from Tuskegee University with a bachelor’s in biology. She earned her master’s degree in rural and community health from The University of Alabama as part of the Rural Medical Scholars program, where she played a role in introducing the Alabama Agromedicine Program

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to minority farmers across the state, earning her an Excellence in Community Engagement award from the UA Center for Community-Based Partnerships in 2010. Peterson completed two years of medical school at Saba University School of Medicine on the Caribbean Island of Saba, then returned to the College for an externship in rural community health working with the Rural Medical Scholars program before spending her third year of medical school at Texila American University in Guyana, South America. She completed her fourth year of medical school in collaboration with the College, which also functions as the Tuscaloosa Regional Campus of the University of Alabama School of Medicine.


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Hale County Health Scholars Recognized at Annual Ceremony THE SECOND GRADUATING CLASS OF THE HALE County Health Scholars program was recognized at a luncheon ceremony at Moundville Archaeological Park on Aug. 13. The luncheon was hosted by the Rural Health Leaders Pipeline, which is operated by the College of Community Health Sciences. The Pipeline is a sequence of programs that seek to recruit and mentor rural students who are interested in becoming physicians and health professionals and practicing in rural Alabama. Studies have shown that rural students are more likely to return to rural areas to work and live. The Pipeline was chosen by the National Rural Health Association last year as the 2013 Rural Program of the Year. As part of the Hale County program, students participated once a month in activities related to health careers, including visits to local health care facilities, agromedicine field trips to farms and seminars with local health professionals. Local and state officials joined the students and their parents

to commend the students and urge them to keep working toward becoming health professionals and leaders for the community. Ron Sparks, director of rural development in Gov. Robert Bentley’s office and former commissioner of agriculture and industries for Alabama, spoke on Bentley’s behalf. “You need to realize how important you are to your community,” he said “You are part of economic development.” The Hale County program, which began in 2011, was the ARC-funded pilot program for the West Alabama Health Scholars Program. The West Alabama Health Scholars has since expanded to include Fayette County Health Scholars and Pickens County Health Scholars. Ridge Payne, a senior at Hale County High School, said the program was a life changing experience. “It has opened my eyes to the possibilities that await me,” he said. “It has also opened my eyes to the needs of rural communities in Alabama. It’s a key that will open the door for my future success.”

Students from across the state visited Bryan Whitfield Memorial Hospital as part of the College of Community Health Sciences’s Rural Health Scholars program. They are shown with Dr. Jim Leeper, a professor in the College’s Department of Community and Rural Medicine. The Rural Health Scholars program allows 25 rising high school seniors from rural counties to live on-campus for five weeks during the summer, taking two classes for college credit and exploring career opportunities in health care. COLLEGE OF COMMUNITY HEALTH SCIENCES

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Chief Residents

By Amy Saxby

RESIDENTS SELECTED BY PEERS FOR CLINICAL, LEADERSHIP SKILLS.

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THREE RESIDENT PHYSICIANS IN THE COLLEGE OF COMMUNITY HEALTH SCIENCES’S FAMILY Medicine Residency were selected as chief residents for the 2014-2015 academic year. They are Drs. Hunter Russell, Sarah Mauthe and Kelly Shoemake. The chief residents were elected by their peers for being outstanding clinicians and for demonstrating leadership skills throughout the first two years of their residency training. Their nominations were approved by faculty and the residency director, Dr. Richard Friend. The residency is a three-year program that provides specialized training in the discipline of family medicine. It is among the oldest and largest such residencies in the nation. The chief residents will take the place of recently graduated chief residents Drs. J.D. Engelbrecht, Jonathan Parker and Mark Christensen. “I think these residents will offer excellence in leadership and management of the residency team,” Friend says. “We have great expectations that the new chief residents will continue the wonderful work done by our outgoing chiefs.”

Medical School Saba University School of Medicine After Graduation Plans to work as a hospitalist in Alabama “The role of a chief resident is to advance the residency, always working toward improvement. But it’s also about acting as a representative for the 45 residents in our program and ensuring they receive the education they have worked hard for.”

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Medical School University of Alabama School of Medicine (Tuscaloosa Regional Campus) “I chose the College’s Family Medicine Residency because I felt it offered the best opportunity for me to become a great physician.”

Medical School University of Mississippi After Graduation Plans to pursue a oneyear fellowship in obstetrics and women’s health then return to Mississippi to practice in a rural area “I chose this residency partially because of the vast amount of OB/GYN experience I’d receive, but also because, at its heart, the residency provides quality care to the underserved patients of West Alabama.”


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Residency Fills 2017 Class FIFTEEN NEW RESIDENTS WERE WELCOMED into the College of Community Health Sciences’s Family Medicine Residency class of 2017 on March 21 through the National Residency Match Program. One new resident was welcomed into the class of 2016. The residency, which is a three-year program and one of the largest of its kind in the country, was able to fill all the positions through the match process. Two of the residents who joined the class of 2017 were third- and fourth-year medical students at the College: Drs. Brittney Anderson and Justin Vines. (The College also functions as the Tuscaloosa Regional Campus for the University of Alabama School of Medicine.)

“We are very excited to announce our intern class,” says Dr. Richard Friend, director of the residency. “This is a talented group of physicians that will work hard and do well.” The College’s residency has been undergoing an expansion in recent years. To address the growing demand for primary care physicians in Alabama and nationwide, the residency recently applied for and received eight additional residency slots, bringing its total approved and funded slots from 36 to 44. One in seven family physicians practicing in Alabama has graduated from the College’s Family Medicine Residency. Of the total 435 graduates of the residency, 231 are practicing in Alabama in 48 of the state’s 67 counties, and most of the rest are practicing in the Southeast.

Dr. Shawanda Agnew University of Mississippi

Dr. Michelle Pike American University of the Caribbean

Dr. Brittney Anderson University of Alabama School of Medicine (Tuscaloosa Regional Campus)

Dr. Aisha Pitts Southern Illinois University

Dr. Joe Brewer Lincoln Memorial University Dr. Carrie Coxwell University of Alabama School of Medicine Dr. Blake DeWitt Texas Tech University Dr. Eric Frempong American University of the Caribbean Dr. Keri Meschman University of Alabama School of Medicine

Dr. Brooke Robinson Meharry Medical College Dr. Keirsten Smith American University of the Caribbean Dr. Stephen Smith American University of the Caribbean Dr. Justin Vines University of Alabama School of Medicine (Tuscaloosa Regional Campus) Dr. Courtney Weaver University of Mississippi Dr. Maysoon Hamed (Class of 2016) University of Cairo

Dr. Remona Peterson Texila American University, Guyana South America

Applications to the College of Community Health Sciencesʼs Family Medicine Residency totaled 1,600 for the current recruiting season, which began in October and continues through the spring. That’s up significantly from 2013. Of the 1,600 applicants, 110 have been invited for interviews. They include 89 graduates of U.S. medical schools.

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The 2014 graduates of the Collegeʼs Family Medicine Residency with the residencyʼs administrative leadership

Residents Graduate P H Y S I C I A N S A N D F E L L O W S R E C O G N I Z E D AT G R A D U AT I O N C E R E M O N Y A F T E R S P E C I A L T Y T R A I N I N G I N F A M I LY M E D I C I N E .

By Leslie Zganjar

TWELVE PHYSICIANS GRADUATED FROM THE COLLEGE OF COMMUNITY HEALTH SCIENCE’S Family Medicine Residency on June 22 and have started practices in Alabama, Georgia and Tennessee. The residency provides physicians with three years of specialty training in family medicine. Fellows were also recognized at the graduation ceremony, which was held at the South Zone in Bryant Denny Stadium. The College offers one-year fellowships in sports medicine, hospitalist medicine, obstetrics, behavioral health and rural public psychiatry. The fellowships provide additional training for family medicine physicians in other specialty areas. “This will be an exciting time for you, and there will be some anxiety as you enter the new world of practice,” Dr. Richard Streiffer, dean of the College, told the graduates. “In five or 10 years our discipline is going to be very different than it’s been during your residency, and I think it will be better. We’re seeing how we are being asked to be players in the healthcare system. At last the country is waking up to the fact that what we do as family medicine physicians is essential.” Dr. Robert Ireland, who recently retired from the College’s Department of Family Medicine after 22 years, was the graduation keynote speaker. He said connecting and building trust with patients is key. “Over the last three years, we’ve given these young doctors an opportunity to develop their medical skills, but after the science, it’s all about how we treat people,” Ireland said. “Even with all the advances in medicine, it’s still pretty much observational in primary care, and connecting with patients as only we in primary care can do. Be confident that you are prepared for that responsibility.” 38

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Dr. Megan Bullard Muscle Shoals, Ala.

Dr. J.D. Engelbrecht Buchanan, Ga.

Dr. Mark Christensen Marshall County, Ala.

Dr. Danielle Henson Columbia, Tenn.

Dr. William Clifford NATO peace-keeping mission in Kosovo

Dr. Maury Minton Gadsden, Ala.

Dr. Jeffrey Colburn Dalton, Ga.

Dr. Cynthia Mouton Demopolis, Ala.

Dr. Alisha Congress Hueytown, Ala.

Dr. Jonathan Parker Muscle Schoals, Ala.

Dr. Tamer Elsayed Tuscaloosa, Ala.

Dr. Saman Razzak Villa Rica, Ga.

William R. Willard Award Dr. Sirisha Chada (Class of 2016) Internal Medicine/Intern Award Dr. Sirisha Chada Internal Medicine/Best Resident Dr. Jonathan Parker, Dr. J.D. Engelbrecht Pediatrics Award Dr. Maury Hinton Psychiatry Award Dr. J.D. Engelbrecht Psychiatry/R3 Award Dr. William Clifford Obstetrics & Gynecology Award Dr. Jonathan Parker Rural Medical Scholar Graduates Dr. Jeffrey Colburn, Dr. Mark Christensen, Dr. Megan Bullard Rural Training Track Recognition Dr. Jeffrey Colburn, Dr. Megan Bullard Research/Scholarship Award Dr. Megan Bullard, Dr. J.D. Engelbrecht, Dr. Tamer Elsayed Dr. Robert Ireland, who recently retired from the College, delivered the keynote address at graduation. Above: Chief residents Drs. J.D. Engelbrecht, Jonathan Parker and Mark Christensen with Residency Director Dr. Richard Friend.

Society of Teachers in Family Medicine Teaching Award Dr. Jonathan Parker William F. deShazo, III Award Dr. Maury Minton

Dr. Scott Boyken Sports Medicine

Dr. Bhavik Patel Hospitalist Medicine

Dr. Friederike Fischer Hospitalist Medicine

Dr. Shelley Waits Obstetrics

Dr. Bruce Lovins Hospitalist Medicine COLLEGE OF COMMUNITY HEALTH SCIENCES

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College Welcomes New Fellows N E W F E L L O W S J O I N O B S T E T R I C S , H O S P I TA L I S T A N D SPORTS MEDICINE FELLOWSHIP PROGRAMS.

By Amy Saxby FIVE NEW FELLOWS WERE WELCOMED IN JULY TO THREE OF THE COLLEGE OF COMMUNITY Health Sciences’s fellowship programs: Dr. Lauren Linken, joined the Obstetrics Fellowship; Drs. Mutka Kapdi and David Aymond joined the Hospitalist Fellowship; and Drs. Blake Perry and Jeremy Coleman joined the Sports Medicine Fellowship. These fellowships, along with a Behavioral Health Fellowship in Family Medicine and a Rural Public Psychiatry Fellowship, make up the College’s post-residency training programs and provide family medicine residency graduates with training and expertise in a selected sub-specialty. The Obstetric Fellowship, a year-long training program, is aimed at addressing the overwhelming need for obstetric care in rural and remote areas. As the attrition of OB/GYNs in the United States exceeds the number of physicians completing OB/GYN residency programs and entering general OB/GYN practice, programs training family physicians to provide quality obstetrical care will continue to grow in importance. Linken is a graduate of the University of Alabama School of Medicine and recently completed a residency in Family Medicine and Community Health at the University of Massachusetts Medical School. A program of both the Department of Internal Medicine and the Department of Family Medicine at the College, the Hospitalist Fellowship is designed to assist family physicians in obtaining the skills necessary to provide inpatient care appropriate to the existing and future needs of urban, rural and underserved areas. This 12-month training program will be joined by Kapdi, a graduate of Grant Medical College in Mumbai, India, who completed her residency at State University of New York Upstate Family Medicine Residency Program at St. Joseph’s Hospital Health Center in Syracuse, N.Y., and a geriatric fellowship at University of Pittsburgh Medical Center. Aymond, who received his medical degree from Ross University School of Medicine and completed a family medicine residency at Rapides Regional Medical Center in Alexandria, La., where he was chief resident in 2013, will also join the program. Perry, a graduate of the University of Alabama School of Medicine who received his clinical education at the College, recently completed the Wake Forest Baptist Family Medicine Residency. Coleman completed his medical degree at Duke University School of Medicine in Durham, N.C., and his residency in family medicine at Louisiana State University in New Orleans. Both Perry and Coleman come to the Sports Medicine Fellowship with significant experience in sports medicine that will benefit them as they work through the year-long training program. “Fellowships are an important component of our graduate medical education offerings, and something we hope to expand in future years,” says Dr. Richard Streiffer, dean of the College. “These fellowships will prepare family physicians to better serve a need in their community or practice, to provide leadership in that area or to prepare them for a future academic role.” 40

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50 O U T R E A C H 54 41 U N I V E R S I T Y M E D I C A L C E N T E R 42 T E L E M E D I C I N E 44 F L U S H O T C A M P A I G N 45 F O R Y O U R H E A L T H

University Medical Center Expands Access to Care E V E N I N G A P P O I N T M E N T S N O W O F F E R E D F O R N E W, E S TA B L I S H E D PAT I E N T S T U E S D AY S A N D T H U R S D AY S .

UNIVERSITY MEDICAL CENTER, WHICH IS OPERATED BY THE COLLEGE OF COMMUNITY HEALTH Sciences, has expanded its evening hours to include scheduled patient appointments. The center has been open on Tuesday and Thursday evenings, from 5:30 to 8 p.m., for established patients needing urgent or walk-in care. Now those patients, and new patients, can schedule appointments to see doctors for routine services, including minor procedures, women’s health care, well-child visits and sports physicals. “Night clinic has allowed greater access for our patients and more educational opportunities for our residents,” says Dr. Richard Friend, director of the College’s Family Medicine Residency. “We will continue to look for opportunities to better serve our patient population.” University Medical Center provides comprehensive, patient-centered care to the University and the West Alabama community. Patients of all ages can receive care for the full spectrum of needs—from preventive care and wellness exams, to management of chronic conditions, to treatment for acute illness and accidents. Laboratory and x-ray services are provided on-site. Nutrition counseling and mental health counseling for individuals and families are also available during daytime business hours. The center accepts BlueCross BlueShield of Alabama and other private insurance plans, Medicare and Medicaid. COLLEGE OF COMMUNITY HEALTH SCIENCES

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Using Telemedicine to Provide Asthma Education S C H O O L - B A S E D E D U C AT I O N P R O G R A M P R O V I D E S E L E M E N TA R Y S C H O O L S T U D E N T S W I T H A S T H M A K N O W L E D G E . By Leslie Zganjar

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A SCHOOL-BASED ASTHMA EDUCATION program was launched in DeKalb County in September by the College of Community Health Sciences. Seven elementary students at the Ruhama Junior High School in Fort Payne, Ala., which serves students in Kindergarten through the eighth grade, participated in the first session of the program on Sept. 18. Also participating were five parents, two school nurses and the school principal. The education program was conducted from CCHS via telemedicine by Dr. Karen Burgess, associate professor and chair of the Department of Pediatrics, and Beth Smith, a nurse practitioner in the Faculty-Staff Clinic at University Medical Center, which the College operates. This first group of participants will attend a total of four sessions, on consecutive Thursdays, from 1 pm to 1:30 pm. Then, a new group will participate, also on four consecutive Thursdays. The asthma education program is being funded with a $25,000 gift from BlueCross BlueShield of Alabama. According to the U.S. Centers for Disease Control and Prevention, an estimated 137,091 children in Alabama had asthma in 2007, a prevalence rate of 12.3 percent, which compares to the U.S. rate of 9 percent. CCHS has provided specialty health care via telemedicine across the state for a number of years, including: telepsychiatry services to the DeKalb County Youth Services; telepsychiatry services to West Alabama Mental Health Care Center, with sites in Marengo, Choctaw, Greene, Hale and Sumter counties; and diabetes education via telemedicine to a number of rural Alabama communities in Sumter, Pickens and Clarke counties.

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FIRST SESSION SEPT. 18: Seven students (Kindergarten - eighth grade) Five parents Two school nurses School principal

45 patients in Sumter, Pickens and Clarke counties in 2013. Efforts underway to expand to Lamar and Walker counties.

240 patients in DeKalb, Marengo, Choctaw, Greene, Hale and Sumter counties in 2013.


UMC Launches Wellness Walls For Art Program By Leslie Zganjar AREA ARTISTS HAVE JOINED TOGETHER TO bring the healing effects of art to University Medical Center through a new program­—Wellness Walls for Art. More than two decades ago, artists affiliated with The University Women’s Club at The University of Alabama began volunteering their time to keep the walls of the former Capstone Medical Center’s patient waiting areas filled with bright and vibrant paintings. Keeping in line with that initial concept, Deborah Hughes, a Tuscaloosa artist who serves as coordinator for Wellness Walls for Art, said she is committed to keeping the walls of University Medical Center, which replaced Capstone Medical Center in 2004, filled with art work. “I am excited that the Wellness Walls for Art program presents an opportunity to identify a rich array of art, bring it into focus and spotlight it in a public and accessible space,” she says. Dr. Richard Streiffer, dean of the College of Community Health Sciences, which operates University Medical Center, says the art displays not only enhance the environment for patients but also for College employees. He said art can play an important role in medicine and healing. “In addition to helping patients with dementia and Alzheimer’s,

art used as therapy has successfully helped people with anxiety, depression, chronic pain, high blood pressure and other health conditions,” he says. University Medical Center is located on the UA campus and provides comprehensive patient-centered care to UA and the West Alabama community in the areas of: primary care, including family medicine, internal medicine, pediatrics and geriatrics; psychiatry and behavioral medicine; women’s health, including obstetrics and gynecology; and sports medicine. On-site laboratory and X-ray services, nutrition counseling and mental health counseling for individuals and families are also provided. As part of Wellness Walls for Art, a new collection will be displayed every three months. Exhibits held in 2014 have included: a painting show featuring the work of The Tuscaloosa and University Painters group; “The Many Faces of Art in Adult Continuing Education,” which featured the work of residents of UA’s Capstone Village retirement community, UA’s OLLI program (Osher Lifelong Learning Institute) and Shelton State Community College’s Lifelong Learning Program; and “Quilting and Carving,” featuring quilts by the West Alabama Quilters Guild and Block Prints by Isadora Bullock. COLLEGE OF COMMUNITY HEALTH SCIENCES

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CCHS Leads Flu Shot Campaign T H E C O L L E G E VA C C I N AT E S T H O U S A N D S O F F A C U L T Y, S T A F F A N D S T U D E N T S B E T W E E N SEPTEMBER AND NOVEMBER 2014.

By Leslie Zganjar

T H E C O L L E G E O F C O M M U N I T Y H E A LT H Sciences led The University of Alabama campaign in 2014 to vaccinate faculty, staff and students against the flu. Nurses from the College’s University Medical Center, and the University’s Student Health Center and Capstone College of Nursing, traveled to sites across campus during September, October and November—including the Quad, University buildings and student dormitories—to provide the free flu shots. WellBAMA also participated in the flu shot campaign. Flu shots were also provided at the UA Employee Health Fair and the UA Student Health Fair, and at University Medical Center and its Faculty-Staff Clinic. By early November, approximately 8,200 shots had been given on campus. The goal of the campaign was to make getting a flu shot as easy and convenient as possible. This is the third year the College has led the University’s efforts to protect its employees and students against the flu. Last year, more than 8,000 vaccinations 44

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Nurses from University Medical Center, operated by the College, the University’s Student Health Center and the Capstone College of Nursing vaccinate students, faculty and staff against the flu on the Quad in October.

were given, and the College received the prestigious University of Alabama Sam S. May Commitment to Service Award for its leadership of the campaign. “Members of the No Flu Zone Campaign made the vaccine easier and more convenient to get by locating teams across campus,” UA President Dr. Judy Bonner said at the time. “Thousands of vaccines were given, which contributed greatly to stopping an outbreak of flu on our campus.” The U.S. Centers for Disease Control and Prevention recommends that everyone aged six months and older get a flu vaccine annually. According to the CDC, a flu vaccine is needed every year because flu viruses are constantly changing and it is not unusual for new flu viruses to appear. The flu vaccine is formulated each year to keep up with the flu viruses as they change. “Getting a flu vaccine is the first and most important step in protecting against this serious disease,” says Dr. Richard Streiffer, dean of the College. Risks associated with receiving a flu shot are extremely small, and the viruses in the flu shot are inactivated so they cannot cause the flu, according to the CDC.


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For Your Health P H Y S I C I A N S O F F E R H E A LT H A D V I C E I N U A H E A LT H C O R N E R V I D E O S E R I E S

THE COLLEGE OF COMMUNITY HEALTH SCIENCES WORKED with The University of Alabama during 2013 and 2014 to create a series of videos in which College physicians address various health topics and provide advice and guidance. The videos are posted to the University’s website (ua.edu) as part of UA Health Corner, where they can be accessed by the public. The health topics covered include: childhood obesity, breast health, flu vaccine, flu versus a cold, heartburn, managing stress, a healthy heart, asthma, prostate cancer screening, chronic fatigue syndrome, menopause, skin cancer, warts, colorectal cancer screening, ovulation, spotting teen depression, hypothyroidism, pap smears, medication side effects, erectile dysfunction, diabetes and measuring blood sugar, supplements and osteoporosis, exercise for the elderly, snoring, holiday depression and healthy New Year’s resolutions.

College of Community Health Sciences faculty contributed in 2013 and 2014 to UA Matters, a weekly website posting by The University of Alabama (ua.edu) that offers information and tips on consumer and health issues.

· What to know if breast

cancer runs in your family

· Ways to avoid heat stroke · Staying safe in the water · What is West Nile Virus? · Having a healthy spring break · Dealing with stress during the holidays

· Talking to your kids about sex · Preventing diabetes

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48 P R O J E C T U N I T E D 49 R E S E A R C H R O U N D - U P 51 R E S E A R C H D A Y 52 A A F P A N N U A L M E E T I N G

Rural Health Conference Focuses on Early Childhood 1 5 T H A N N U A L C O N F E R E N C E A T T E N D E D B Y H E A LT H C A R E P R O V I D E R S , C O M M U N I T Y L E A D E R S I N T E R E S T E D I N R U R A L H E A LT H .

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By Brett Jaillet

THE KEY TO FORMING HEALTHY COMMUNITIES and eliminating health disparities in rural areas is to start early —from birth to age 5. Early childhood development was the focus of the 15th Annual Rural Health Conference, held April 29 at The University of Alabama Bryant Conference Center. Hosted each year by the College of Community Health Sciences and its Institute for Rural Health Research, the conference is attended by health care providers, community leaders, researchers, government officials and policymakers interested in making an impact in rural communities. This year’s event, “Healthy Beginnings, Healthy Communities: The Early Childhood Experience,” featured keynote speakers Allison de la Torre, MA, executive director of the Alabama School Readiness Alliance, and Dr. Bernard Guyer, the Zanvyl Kreiger professor of children’s health, emeritus, at Johns Hopkins Bloomberg School of Public Health. De la Torre, who works with the ASRA to promote highquality, voluntary pre-kindergarten as a top statewide priority and has implemented state-based pre-K policy initiatives, spoke about the need for high-quality pre-K education in Alabama and led a discussion of the definition of “high-quality.” She said the most important window of a child’s education and brain development is before age 5: children who attended a higher-quality pre-K often have higher achievement test scores later on in life. “This is critical,” de la Torre said. “This is vital to our state’s economic future. The achievement gap that our teachers and policymakers work so hard to close begins as a school-readiness gap.” Guyer, who delivered the afternoon keynote address via videoconferencing (due to severe weather), spoke about how to link early child health to healthy communities as a whole.

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The more adverse events that occur during early childhood, the more likely adverse outcomes (like heart disease and depression) will be present later in life, even into the individual’s 50s, 60s and 70s, Guyer said. “How do we go about addressing early influences in adult life?” Guyer asked. “We’ve begun to realize that it isn’t just about medicine, that healthy life is created in homes, health care facilities, community facilities in neighborhoods, in day care, in a whole range of different kinds of settings.” Conference breakout sessions, many of which were led by speakers from the UA colleges of Nursing, Education and Human Environmental Sciences, focused on early child health care, development and education. Drs. Michele Montgomery and Paige Johnson, both assistant professors at the UA Capstone College of Nursing, spoke at the beginning of the conference and also in a breakout session about the Tuscaloosa Pre-K Initiative. Another breakout session was led by Dr. Maria Hernandez-Reif, director of pediatric development research for the UA College of Human Environmental Sciences, who spoke about common milestones in early childhood development. This year’s William A. Curry Award winner was Dr. Keri Merschman, at the time a fourth-year medical student at the Huntsville campus of the University of Alabama School of Medicine, for her research, “Report to the AAFP: Evaluating the Effectiveness of the Tar Wars Education Program.” The award, named after the former dean of the College of Community Health Sciences and founder of the Institute for Rural Health Research, honors a University of Alabama School of Medicine student who demonstrates an academic interest in rural medicine and is engaged in rural research or scholarly activity. Merschman began her residency training in July at the College’s Family Medicine Residency.


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Clockwise: Dr. John C. Higginbotham, director of the College’s Institute for Rural Health Research, introduces morning keynote speaker Allison de la Torre, executive director of the Alabama School Readiness Alliance; De la Torre leads a discussion about high-quality pre-K education in Alabama; Dr. Bernard Guyer, the Zanvyl Krieger professor of children’s health, emeritus, of Johns Hopkins Bloomberg School of Public Health, delivered the afternoon keynote address via videoconferencing due to severe weather; Dr. Maria Hernandez-Reif, director of pediatric development research for the UA College of Human Environmental Sciences, discusses early childhood development with another conference attendee. COLLEGE OF COMMUNITY HEALTH SCIENCES

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Project Earns Excellence Award for Community Engagement By Leslie Zganjar A R E S E A R C H P RO J E C T T H AT I S B R I N G I N G rural Alabama communities and University of Alabama researchers together to reduce obesity has received an Excellence in Community Engagement Award from UA. The project is called UNITED—Using New Interventions Together to Eliminate Disparities—and it is a partnership of UA’s College of Community Health Sciences and College of Communication and Information Sciences, and the Black Belt Community Foundation. The foundation is a nonprofit organization that works to improve the health and quality of life of citizens in the 12 Black Belt counties it serves. Project UNITED is funded by a three-year, $668,095 grant from the National Institutes of Health. The Excellence in Community Engagement awards were presented at a luncheon April 18 to UA faculty, staff, students and community partners whose research projects reflect excellence in community engagement. The award program, now in its eighth year, is sponsored by UA’s Center for Community-Based Partnerships. “Never doubt that a small group of thoughtful citizens and people can change the world,” said Dr. Samory Pruitt, vice president of the UA Division of Community Affairs, of which the Center for Community-Based Partnerships is a part. “We are indeed engaging communities and changing lives.” Dr. Katy Campbell, dean of the Faculty Extension at the University of Alberta, Canada, was the awards luncheon keynote 48

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speaker. She is a member of the board of directors of the Engagement Scholarship Consortium, and is an expert in learning and instructional design and faculty transformation. “We are involved in creating knowledge, not only in the hallways of universities but out there (in communities),” Campbell said. Prior to the awards luncheon, there was a presentation of UA research posters emphasizing community-university partnerships and successful civic engagement practices. The focus of Project UNITED is to improve the health of rural Black Belt communities in regard to obesity and related diseases. Through Project UNITED, research training programs have been created for community residents and UA researchers to build their community-based participatory research capacity. CBPR is research that is conducted as an equal partnership between researchers and community members and allows communities to participate fully in all aspects of the research. To date, four research projects involving various Black Belt communities and UA researchers have been developed. According to the U.S. Centers for Disease Control and Prevention, more than 32 percent of Alabama’s population is considered obese, above the national average of 27 percent. In some Black Belt counties, obesity rates range between 39 and 47 percent for adults and greater than 20 percent for school-age children. Obesity can lead to myriad of health problems, including heart disease, high blood pressure, diabetes and some cancers.


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Mindful Intervention EXAMINING THE INTEGRATION OF MINDfulness and yoga practice into the existing Coping Power preventive intervention for at-risk children and their families is the focus of a $700,000 grant awarded to Dr. Caroline Boxmeyer, an associate professor in the College of Community Health Sciences’s Department of Psychiatry and Behavioral Medicine. Boxmeyer, a clinical psychologist, is the grant’s principal investigator, along with Dr. Shari Miller-Johnson, a child clinical and research psychologist at Duke University. The grant’s co-PIs are Dr. John Lochman, professor and Saxon Chair of Clinical Psychology at The University of Alabama and director of the UA Center for the Prevention of Youth Behavior Problems, and Dr. Nicole Powell, a research psychologist at the center. Boxmeyer is also a research psychologist at the center. The researchers anticipate their study will show that integrating mindfulness and yoga practices with the Coping Power program will reduce children’s emotional impulsivity, increase parental warmth and mindful parenting, and prevent possible

later substance abuse and negative developmental outcomes. Boxmeyer and Miller-Johnson will test the effectiveness of yoga and mindfulness techniques with at-risk youth from 100 families and four schools. “We think we can enhance the Coping Power program’s effects on emotion regulation by incorporating these strategies, which have been proven to enhance self-regulation,” Boxmeyer says. “As a practicing clinician, I’ve seen the benefits of mindfulness, which is a way of focusing your attention on the present moment, noticing how your body is feeling and what is on your mind, and practicing awareness and acceptance of those thoughts and feelings rather than judging them. We’ll work on building that practice with children.” The research project began in September and will continue through August 2017. It is funded by the National Institute on Drug Abuse. The Coping Power program is a preventive intervention delivered to at-risk children in late elementary school and early middle school years and addresses key factors, including social competence, self-regulation and positive parental involvement.

Preventing Childhood Obesity FACULTY FROM THE UNIVERSITY OF ALABAMA and community members from Alabama’s Black Belt region have been awarded $45,000 to support a childhood obesity prevention plan through Project UNITED’s Intervention Pilot Program. The project will run through June 2015. UA faculty members on the project are Dr. Harriet Myers, associate professor and clinical psychologist in the College; Dr. Linda Knol, associate professor in the department of Human Nutrition and Hospitality Management in the College of Human Environmental Sciences; and Dr. Shelia Black, an associate professor of Psychology in the College of Arts and Sciences. Community members are Debra Clark, founder of the Health and Wellness Educational Center in Livingston; Darlene Robinson, a community health advocate in Eutaw; and Yawah Awolowa, founder of Mahalah Farm in Cuba, Ala. The project will focus on the home environment of children between the ages of 2 and 5 living in Greene and Sumter counties. According to data from the U.S. Centers for Disease Control

and Prevention, approximately one-fourth of all children in these counties are obese. The study first will use questionnaires to better understand the many aspects of the home environment as it relates to eating behaviors. With this information and previous intervention research as a guide, the research team will develop and implement a homebased, multi-generational program intended to teach eating mindfulness to children and their caretakers. The funding has been awarded through Project UNITED (Using New Interventions Together to Eliminate Disparities), a program that was developed by UA faculty and staff in partnership with the Black Belt Community Foundation to promote community-based participatory research to reduce and eliminate health disparities in Alabama’s Black Belt, an impoverished region originally named for its dark, rich soil. Project UNITED is supported by a planning grant from the Community Based Participatory Research Program of the National Institute on Minority Health and Health Disparities. COLLEGE OF COMMUNITY HEALTH SCIENCES

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Undiagnosed ADHD and Traffic Accidents SCREENING YOUNG DRIVERS FOR ADHD AND providing treatment may reduce car accidents, according to the findings of research by Dr. Thad Ulzen, professor and chair of the College’s Department of Psychiatry and Behavioral Medicine. Ulzen conducted the research in his native country of Ghana in West Africa. Road traffic accidents are consistently among the leading causes of mortality in sub-Saharan Africa, and in Ghana are the ninth leading cause of death. Ulzen explored the relationship between the presence of ADHD, as determined by the ASRS (ADHD Self-Report Scale), and the driving behaviors of young workers in driver’s unions.“In Ghana, many male school dropouts find employ-

ment by joining driver’s unions,” Ulzen says. The prevalence of ADHD in the control group was consistent with World Health Organization data on community prevalence of ADHD worldwide. But the higher prevalence rate of ADHD among unionized drivers in the sample suggests that drivers who are recruited after academic failure have a greater likelihood of ADHD, which has been shown to be associated with a significantly higher rate of road traffic accidents. “This is a big problem, even here in the United States,” Ulzen says. “Car accidents are a huge problem. We are just beginning to understand the possible link with ADHD. I think we’re on to something here.”

Combating HIV/AIDS Stigma CHURCHES COULD PLAY A BIG ROLE IN REDUCing both an individual and community-wide stigma of HIV/AIDS, according to research conducted by Dr. Pamela Payne-Foster, deputy director of the College’s Institute for Rural Health Research and an associate professor of Community and Rural Medicine. Foster is the primary investigator of Project FAITHH (stands for Faith-Based Anti-Stigma Intervention Toward Healing HIV/AIDS), which is funded by a $500,000 plus, multi-year grant from the U.S. Centers for Disease Control and Prevention’s Minority AIDS Research Initiative. The goal of the project is to conduct and evaluate an HIV/ AIDS anti-stigma-related intervention among congregations in rural Alabama. After a year and a half of recruiting, Foster was successful in getting the participation of 12 churches in Lowndes, Hale, Greene, Macon, Dallas and Montgomery counties (which are in the Black Belt) and Russell and Lee counties, with a total of 240 congregation members. To start, 50 persons living with HIV/AIDS completed surveys that Foster says will feed into the overall study. The preliminary data indicated a major gap in basic knowledge about HIV/

AIDS (such as facts about transmission of the disease), which Foster says has implications for clinicians to do a better job educating patients. Foster says a close tie was found between an individual or community stigma and a person’s choice to disclose that he or she is HIV-positive. “One of their greatest fears is that when they tell the pastor that they are HIV-positive, that information will spread throughout the congregation,” she says. “They feel it should be confidential, so they say, ‘If you want to keep a secret, don’t tell anybody in the church.’” Now, data is being gathered from those 12 churches and their congregation members on their knowledge of HIV/AIDS, their individual and community stigma and their religious and spiritual wellness. “We have completed pre- and post-assessments and interventions on three of the 12 churches,” Foster says. “We hope to complete the other churches by early 2015.” African-Americans make up only a quarter of Alabama’s population, but account for 75 percent of the state’s HIV cases, according to the CDC. Foster hopes that reducing the stigma will lead to better education about the disease and a higher level of care.

Caregiver and Child Perception of Weight WITH AN INCREASING TREND IN CHILDHOOD obesity in Alabama, Dr. Melanie Tucker, assistant professor of health education in the College’s Department of Family Medicine, and Dr. Karen Burgess, chair and associate professor of Pediatrics, wanted to take action with intervention efforts. But before they could do that, they needed to conduct a pilot study to see what percentage of the population was overweight or obese, determine perceptions of weight and gather basic demographic data. Their pilot study found that 69 percent of the caregivers of children 2 to 18 years old who were surveyed correctly perceived their child’s weight category and that 59 percent of the children correctly perceived their own weight. 50

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“However, the parents of overweight/obese children were correct 46 percent of the time with only 14 percent correctly identifying an overweight child and 72 percent identifying an obese child,” Tucker says. “This tells us that parents do not identify their child having a weight problem until the child is in the obese category.” Tucker says that this information can be used in planning interventions. “This tells us that we need to start talking to families early about the importance of proper nutrition, physical activity and weight management strategies—even before a child becomes overweight,” she says. “If we see a child trending upward on their weight, then we need to have a discussion with the parents, even if the child is not technically overweight yet.”


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College Hosts Research Day T H E C O L L E G E O F C O M M U N I T Y H E A LT H Sciences held its Sixth Annual Research Day on April 16. The annual event gives medical and graduate students, resident physicians, faculty and staff who are working on research projects the opportunity to display their findings. It is designed to show collaboration among CCHS departments and across The University of Alabama. “It was exciting to have another successful Research Day as scholarly activity is growing in the College,” says Dr. Lea Yerby, assistant professor in the Department of Community and Rural Medicine and the Institute for Rural Health Research, who coordinated the event. “This shows that faculty and students are placing increased value on research and working together to answer meaningful questions.” Two tied for first place in the faculty category for research: Dr. Dan Avery, professor and chair of Obstetrics and Gynecology, and his research, “The Economic Impact of Rural Family Physicians Practicing Obstetrics in Alabama,” was one of them. The project was also authored by Dr. Dwight Hooper, professor in Obstetrics and Gynecology; Dr. John McDonald, assistant professor in Obstetrics and Gynecology; Dr. Melanie Tucker, assistant professor in Family Medicine; Michael Love, a medical student; and Dr. Jason Parton, assistant professor in Information Systems, Statics and Management Sciences in UA’s Culverhouse College of Commerce and Business Administration. Avery says his research topic is important to the College’s mission so that physicians who are trained and placed in rural Alabama can provide economic growth in addition to good medical care. “These topics are what we are and what we do to make a difference in the health care of rural underserved Alabama,”

Dr. Caroline Boxmeyer, associate professor of Psychiatry and Behavioral Medicine at the College, explains her research to a Research Day attendee.

Avery says. “It is our mission.” The other victor in faculty research was Dr. Karen Burgess, associate professor and chair of Pediatrics, whose research “Caregiver and Child Perception of Weight,” was also authored by Dr. Melanie Tucker, an assistant professor of Family Medicine. “Childhood obesity has always been of interest to me since it was something I dealt with when I was younger,” says Burgess. “I hope providers understand the importance of addressing weight status with families at each visit and that providers won’t minimize overweight kids. Parents and children often don’t realize when the child is overweight.”

2014 WINNERS Faculty

The Economic Impact of Rural Family Physicians Practicing Obstetrics in Alabama. Daniel Avery, MD; Dwight Hooper, MD; John T. McDonald, MD; Michael W. Love, MSIV; Melanie Tucker, PhD; and Jason Parton, PhD.

Faculty

Caregiver and Child Perception of Weight. Karen Burgess, MD; Melanie Tucker, PhD.

Librarians Can Help: Resources for Occupational & Environmental Health for Rural Health Professionals. Suhua Fan, MA, MLIS.

Resident

Student

The Effects of Garden Exposure on Behavior and Achievement in Elementary School Children. Razel Remen, MD; Caroline Boxmeyer, PhD; Courtney Ricciardi, undergraduate.

Sickle Cell Trait and Wound Healing; Beware the Use of Epinephrine. A Report of Three Cases. Chelsea Cernosek, MSIII; Luis Vasconez, MD; Jorge de la Torre, MD.

Student

Does Irradiation of the Stem Cell Niche Change Prognosis in Glioblastoma? William Ennis, MSIII.

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Faculty Present at Annual Meeting PRESENTATIONS WERE MADE AT THE ANNUAL Alabama Academy of Family Physicians meeting by College of Community Health Sciences’s faculty. The meeting, held June 26 to 29 in Sandestin, Fla., provides networking opportunities and Continuing Medical Education to family physicians, physicians assistants, residents and medical students from across Alabama. An entire day of lectures was presented by the College on June 27, the third day of the conference. Faculty presented new information respective to their specialties. Presenting on autism screenings and the role played by family medicine physicians in early detection and intervention were Dr. Lea Yerby, assistant professor in the College’s Department of Community and Rural Medicine and Institute for Rural Health Research, and Dr. Angela Barber, assistant professor in communicative disorders at The University of Alabama. The prevalence of autism in Alabama per thousand is 5.7, while the national prevalence per thousand is 14.7, they said. The reason for the discrepancy is a screening issue, Yerby said, and the key to more screenings and early intervention is for family medicine physicians and autism specialists to work together. Ninety-two percent of parents of a child with autism first expressed concern to their primary care provider, Yerby said. “It takes two—screeners and family physicians. Neither of them can do it alone. But those two combined are really where we move forward, where more children are less likely to fall through the cracks.”

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he Alabama Academy of Family Physicians includes more than 900 members and more than 400 students and residents across the state, and serving as their leader for 2014 was College faculty Dr. Julia Boothe, assistant professor of Family Medicine. Boothe, a former Rural Medical Scholar who completed two years of medical school and her Family Medicine Residency at the College, is the 2014 president of the AAFP, which is year two of a threeyear leadership appointment. She was named presidentelect at the 2013 annual AAFP meeting, has served as president in 2014, and in 2015 she will be the chair of the Alabama Academy Board. Dr. Drake Lavender, assistant professor in Family Medicine at the

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College, was appointed as the 2015 president-elect. During this year, Boothe has traveled Alabama and the United States as a representative of the AAFP, cultivating relationships with leaders and other health-care providers. “Our Academy does a great job of championing the importance of primary care and our state leaders are familiar with our purpose,” she says. Boothe hopes to continue to share with other physicians and medical communities the importance of family medicine and primary care in the ever-changing landscape of health-care delivery. “We have evolved considerably in the last five years, and as the old saying goes, ‘You ain’t seen nothing yet,’” she says. “I see family physicians

Dr. Scott Arnold, associate professor and chair of the Department of Internal Medicine, presented new findings in adult medicine literature from 2013 to 2014. Some areas Arnold covered included diabetes prevention and care, treatment of heart disease, blood clotting, intracranial stenting, sepsis, Hepatitis C screening and treatment, low testosterone treatment, and lung, colon and cancer screenings. Dr. Jerry McKnight, a professor of Family Medicine, presented a clinical case study of 10 patients with one common etiology: hereditary hemochromatosis. The case study was presented in a typical grand rounds fashion, presenting the symptoms to the attendees of the patients and leading into the diagnosis. Following McKnight was Dr. Richard Friend, director of the College’s Family Medicine Residency, who wrapped up the day with a presentation on critical care and emergency room medicine for family physicians. Many physicians present indicated they work in some sort of emergency medicine capacity. Friend discussed the role of family physicians in the ICU, common trends and diagnoses in an emergency setting and various procedures such as intubating, performing a lumbar puncture and atrial fibrillation. “You have to have a heightened sense of awareness to [practice emergency medicine] and do it well,” he said. “The key is to really be aware of common procedures and to always practice evidence-based medicine.”

poised to answer many of the questions in current healthcare delivery, especially as we partner with different health care professionals and as we are already in such mass that we can be effective with any change very quickly.” Boothe says her varied experiences helped prepare her for the role: she’s worked in traditional family medicine (which includes inpatient care, clinical work, nursing homes and hospice work), in urgent care clinics, outpatient care, academic roles and solo private practice. Her diverse background lets her speak to the various faces of family medicine, she says. “Family physicians are the workhorse of our health care delivery,” Boothe says. “We hope to encourage these

dedicated people to join us on the journey to change the impact of family physicians in the direction of our health care delivery.”


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Dr. Susan Arnold, an assistant professor in the College of Community Health Sciences’s Department of Psychiatry and Behavioral Medicine, was recognized by the American Psychiatry Association with the status of Distinguished Fellow for her dedication to the profession of psychiatry. “Dr. Arnold has achieved distinction in special areas of psychiatry and possesses depth of knowledge and breadth of skills that are recognized and highly respected,” says APA Executive Director Jennifer Hancock. The designation of Distinguished Fellow is awarded to outstanding board-certified psychiatrists who have made significant contributions to the psychiatric profession in at least five of the following areas: administration, teaching, scientific and scholarly publications, volunteering in mental health and medical activities of social significance, community involvement and clinical excellence. It is the highest membership honor the APA bestows upon members. Arnold received her medical degree from the University of Alabama School of Medicine and completed a residency and fellowship in child and adolescent psychiatry at the Medical University of South Carolina. Her interests include traumatic stress and the prevention and treatment of disorders that present in the college student population.

Dr. Karen Burgess, an associate professor and chair of the College’s Department of Pediatrics, has been named medical director of MedNet West. The organization is a private, non-profit, communitybased care network in Tuscaloosa. MedNet West contracts with primary care providers and partners with hospitals, pharmacies, social services agencies and county health departments to improve health outcomes and reduce care costs in eight West Alabama counties—Bibb, Fayette, Greene, Hale, Lamar, Pickens, Sumter and Tuscaloosa.

Dr. Jennifer Clem, an assistant professor in the College’s Department of Family Medicine, was selected to participate in the Medical Student Educators Development Institute (MSEDI). The MSEDI is a year-long, comprehensive learning experience for those who educate medical students, particularly those who aspire to be clerkship directors or medical student education directors. Institute participants learn about curriculum development, student evaluation, recruiting and maintaining preceptor networks, providing career advice to students and submitting a scholarly project. The MSEDI is part of the Society of Teachers of Family Medicine, an association of nearly 5,000 medical school faculty, preceptors, residency program directors and faculty and others involved in family medicine education. The mission of STFM is to advance family medicine and improve health through a community of teachers and scholars.

True leader, compassionate and brilliant are all words used to describe Dr. Elizabeth Cockrum in her recent nomination for the XXXI, a women’s honorary organization recognizing exceptional leadership and service to The University of Alabama community. Cockrum, a professor of Pediatrics at the College, received her nomination from Margaret Johnson, a UA student and vice president of the XXXI, who met Cockrum through the University Fellows Experience during her freshman year. As part of the program, Cockrum served as a mentor to Johnson. “I have never met someone more willing to be involved in mentoring students,” Johnson says. “Not only is she an amazing mentor and helped guide my college career more than anyone else, but she is also an outstanding pediatrician and leader.” The University Fellows Experience is a community of elite scholars from diverse disciplines who share a similar passion to being change agents through commitment to leadership and service. “I had the privilege of shadowing Dr. Cockrum, and I have never seen a pediatrician connect so well with both her patients and their parents,” Johnson says. “Not only that, I also watched as she mentored the medical students during their pediatric rotation, and the amount of growth I saw in them over the six weeks was remarkable.”

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Amelia de los Reyes, RN, MSN, was elected to a leadership position with the Alabama Rural Health Association. She will represent Alabama’s rural population health needs as a Consumer Advocacy director. The Alabama Rural Health Association works to improve the health of the state’s rural citizens. De los Reyes is coordinator of the College’s Telemedicine Program. In that role, she oversees a telepsychiatry program that last year served more than 200 patients in DeKalb County and 240 patients of the West Alabama Mental Health Care Center in the rural counties of Marengo, Choctaw, Greene, Hale and Sumter. De los Reyes also oversees the portion of the College’s Diabetes Self-Management Education Program that teaches diabetic patients in rural counties, via telemedicine, how to better manage their disease. Last year, the program served 45 patients in Sumter, Pickens and Clarke counties. And she recently helped launch the College’s telemedicine asthma education for school children in DeKalb County.

The program provides leadership development for advanced practice nurses to enable them to effectively address the health needs of their communities, especially underserved populations. Program fellows are expected to be change agents within their practice settings and the evolving health care environment. University Medical Center, operated by the College, is the largest multi-specialty practice in West Alabama. It provides primary care to University faculty and staff and to West Alabama communities.

Dr. James Robinson (first row, third from left), the College’s endowed chair of Sports Medicine, was inducted into the Alabama High School Sports Hall of Fame in March.

From left: Michael Bzdak, executive director of Corporate Contributions, Johnson & Johnson; Angela Hammond, program fellow; and Anh Tran, director of Duke-Johnson & Johnson Nurse Leadership Program, Duke School of Medicine

Angela Hammond, CRNP, a nurse practitioner in the University Medical Center Faculty-Staff Clinic and an inaugural fellow in the Duke-Johnson & Johnson Nurse Leadership Program, successfully completed the one-year program in May. Program components included three leadership retreats as well as distance-based learning activities and a transformative health leadership project. The Duke-Johnson & Johnson Nurse Leadership Program is a partnership of Duke University School of Medicine, Duke University School of Nursing and Johnson & Johnson. 54

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Dr. James Robinson, the College’s endowed chair of Sports Medicine, was one of 12 major contributors to prep athletics in the state who was inducted into the Alabama High School Sports Hall of Fame during a banquet in Montgomery on March 17. Robinson was selected in the contributor category. A native of New Orleans, Robinson graduated from LSU School of Medicine in New Orleans and completed his residency at the College’s Family Medicine Residency. He serves as the co-chair of the Alabama High School Athletic Association (AHSAA) Medical Advisory Board and has played a key role in forming the AHSAA’s medical health and safety policies. He helped write the Concussion Law that now governs all athletic events in Alabama, and the AHSAA Pre-Participation Physical Exam Form used by all student-athletes. In addition to serving as The University of Alabama football team physician, Robinson serves as high school team physician for Tuscaloosa County, Hillcrest, Northside, Sipsey Valley and Tuscaloosa Central high schools and is a consultant for another dozen schools in the Tuscaloosa area. Robinson is an annual clinician at the AHSAA Summer Conference, where he has addressed member schools about the latest health and safety issues and good health and safety


FALL | practices. In addition to his role at the College, Robinson has a family medicine practice in Tuscaloosa, supervises athletic trainers for DCH Regional Medical Center and serves as medical director for DCH Sports Medicine. The Hall of Fame is located at the AHSAA office in Montgomery.

Dr. Cathie Scarbrough, an assistant professor in the College’s Department of Family Medicine and assistant director of the College’s Family Medicine Residency, was selected to the University of North Carolina Faculty Development Fellowship in Chapel Hill. This mid-career program for medical educators has a history of developing graduates for careers as leaders in family medicine education. The program is a one-year commitment, including six weeks in the Family Medicine Residency at Chapel Hill, and includes training and experiential projects in medical education, teaching, management and scholarship. Scarbrough started the program in June, joining the 36th fellowship class, which consists of a diverse group of educators coming from a variety of community, university and military family medicine programs. Dr. Jared Ellis, an assistant professor in the College’s Department of Family Medicine and associate director of the College’s Family Medicine Residency, recently completed the fellowship. “The opportunity to interact with and learn with leading peers from around the nation has been an incredible opportunity,” Ellis says.

Dr. Heather Taylor, an assistant professor of Pediatrics and director of Medical Education at the College, is continuing five years of service as the Alabama Early Hearing Detection and Intervention (EHDI) Chapter Champion. A Chapter Champion is responsible for leading and responding to health care provider concerns regarding newborn hearing screening in the state. Chapter Champions work on EHDI programs and activities with their state department of human services, department of public health staff and other state government agencies, as well as pediatric health care providers in the state. Champions also are involved in collaborating with their peers to influence state policy and programs related to children who are identified with hearing loss. Taylor also serves as the chair of the Alabama Newborn Screening Advisory Committee in addition to her service as EHDI Chapter Champion. She received a grant for hearing screening education through the American Academy of

Pediatrics and, as a result, initiated an outreach program in the Tuscaloosa community and surrounding counties to provide appropriate newborn hearing screening follow-up. At University Medical Center, the College’s multispecialty practice serving The University of Alabama and West Alabama, Taylor offers Automated Auditory Brainstem Response testing free of charge for her patients and others in the community. She has also contributed to the development of hospital guidelines to implement universal pulse oximetry screening in birthing facilities. “The newborn screening program is grateful to Dr. Taylor for her service to promote optimal outcomes for Alabama’s babies,” the Alabama Department of Public Health said in a recent newsletter. “She is an outstanding champion of the Alabama Newborn Screening Program.”

The University of Alabama School of Medicine received notification from the Liaison Committee for Medical Education (LCME) in October that the school has received the full eight-year accreditation, the highest level of accreditation a medical school in the United States can receive. The College also functions as a regional campus of the School of Medicine, headquartered in Birmingham, for the clinical education of a subset of third- and fourth-year medical students. The LCME commended the School of Medicine in two key areas: the diverse scope of medical electives students are encouraged to explore, and the present and anticipated financial stability of the institution. The accreditation came after an intensive site visit by the LCME in March. LCME accreditation is a voluntary, peer-review process of quality assurance that determines whether the program meets established standards and fosters institutional and program improvement. Accreditation by the LCME establishes eligibility for selected federal grants and programs, and most state boards of licensure require that U.S. medical schools be accredited by the LCME as a condition for licensure of their graduates.

Dr. Joe Wallace, professor and chair of the College’s Department of Surgery, and the Department of Obstetrics and Gynecology were named winners of the 2014 Argus Awards by the students of the University of Alabama School of Medicine. As a regional campus of the School of Medicine, which is headquartered in Birmingham, the College provides the clinical education for a subset of third- and fourth-year medical students. COLLEGE OF COMMUNITY HEALTH SCIENCES

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| ACCOLADES The Argus Awards, created in 1996 to recognize faculty members, give medical students the chance to honor their mentors, professors, courses and course directors for outstanding service to medical education. Faculty members are nominated by course evaluations, and students vote to select award winners in each category. Wallace was named Best Clinical Educator at the Tuscaloosa Regional Campus, while Drs. Dan Avery, Kristine Graettinger, Andrew Harrell, John McDonald and Heather Taylor were also nominated for the award. The OB/GYN Department was named Best Clinical Department at the Tuscaloosa Regional Campus. Also nominated were the Pediatrics and Surgery departments. A ceremony to honor Argus Award recipients and nominees was held on Sept. 5 in Birmingham.

Dr. Dan Avery, professor and chair of the College’s Department of Obstetrics and Gynecology, was presented with the Louis W. Sullivan, MD, Health Policy and Leadership Award by Dr. Louis Sullivan.

Dr. Dan Avery, professor and chair of the College’s Department of Obstetrics and Gynecology, was the 2014 recipient of the Louis W. Sullivan, MD, Health Policy Leadership Award, presented by the American Board of Physicians Specialists (ABPS). The award, named for Dr. Louis W. Sullivan, the former Secretary of the U.S. Department of Health and Human Services during the George H. W. Bush administration (1989-1993) and the founding dean of Morehouse School of Medicine in Atlanta, Ga., is presented to a physician who has served as a champion of major health policy changes and an advocate for health policy improvements. According to the ABPS, the award goes to someone who has made an outstanding contribution to improve the health status of an individual, a group of people or a population. The award was established in 2012 and was first presented to Dr. Omofolasade Kosoko-Lasaki, associate vice president of Health Sciences and professor of surgery 56

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(opthalmology), preventative medicine and public health at Creighton University School of Medicine in Omaha, Neb. She, in turn, nominated Avery for this year’s award. Avery worked with Kosoko-Lasaki at the American Academy of Surgery, and she nominated Avery for his work as a physician who also provides obstetrical care in rural areas, including Winfield, Ala., where he has practiced since he completed his residency and currently provides obstetrical care for about 4,000 patients. Avery also provides obstetrical care to the Demopolis community after its Bryan Whitfield Memorial Hospital closed its labor and delivery unit earlier this year. Kosoko-Lasaki also recognized Avery’s work with medical students who choose to practice family medicine in rural areas. Avery says that Kosoko-Lasaki also cited his work with the Alabama Family Practice Rural Health Board. “I am honored to have received this award,” Avery says. “The best part about it was that Dr. Sullivan came to the ABPS meeting and presented me with the award.” Sullivan, who is now retired, remains, according to Avery, “a champion for the rural, underserved and minority populations.” He is a public member of the ABPS Board of Directors and chair of the board of the National Health Museum in Atlanta.

Dr. Thad Ulzen, professor and chair of the College’s Department of Psychiatry and Behavioral Medicine, received the Postgraduate Training Award from the Ghana College of Physicians and Surgeons. He received the award in September during the Fourth Annual Medical Update for Ghanaian Physicians. Ulzen was a keynote speaker at the event. The award was given “in appreciation of your diligent and sustained effort that has enhanced the Medical Knowledge Fiesta and the practice of Medicine and Dentistry in Ghana.” The Medical Knowledge Fiesta is an annual Continuing Medical Education (CME) event organized by the Ghana Physicians and Surgeons Foundation of North America (GPSF), a non-profit entity of physicians of Ghanaian origin in the United States and Canada that supports postgraduate medical education in Ghana. Ulzen was president of GPSF in 2008 and worked to help establish the Medical Knowledge Fiesta in Ghana to provide updates in all specialties. The annual CME event is in its fourth year and is attended annually by approximately 300 physicians in practice in Ghana.


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Clem joined the College as an assistant professor in the Department of Family Medicine. She instructs resident physicians in the College’s Family Medicine Residency and cares for patients at UMC-Warrior Family Medicine, a satellite clinic of University Medical Center. Previously, Clem worked for Indian Health Service in a comprehensive health care facility in Chinle, Ariz., where she provided inpatient and outpatient care on the Navajo Nation. She earned her medical degree from the University of Alabama School of Medicine. As a medical student, she was selected by her classmates for the Gold Humanism Honor Society, a nationally recognized honor society comprised of individuals recognized for practicing patient-centered medical care by modeling the qualities of integrity, excellence, compassion, altruism, respect and empathy. Clem completed a residency at the University of Michigan Department of Family Medicine and is board certified in Family Medicine.

Conn, a certified medical technologist, joined the College as director of Laboratory and Radiology Services. She replaces Sherry Wedgeworth, who retired after 25 years of service. Previously, Conn served as the administrative supervisor of the Core Lab in Northport Medical Center, which is part of the DCH Health System. Conn has more than 30 years of experience in various lab settings and is a certified medical technologist through the American Society for Clinical Pathology, a professional membership organization for pathologists and laboratory professionals. The College’s Lab and X-Ray Department is part of University Medical Center, a multi-specialty practice operated by the College that serves The University of Alabama and the West Alabama community.

Elsayed has joined the College’s Department of Family Medicine as an assistant professor. In addition to participating in the clinical education of medical students and residents, he will also see patients in University Medical Center’s Family Medicine Clinic. The College operates University Medical Center. Elsayed completed his residency training at the College’s Family Medicine Residency, where he received the outstanding research award for an influenza vaccine acceptance study. He earned a master’s degree of internal medicine and a bachelor of science degree in medicine from the Medical School, Cairo University, Egypt, where he graduated with honors. He also received an Award of Excellence from the Kuwait Ministry of Health. Elsayed is a member of the American Academy of Family Physicians and the American Medical Association.

Gannon joined the College as an assistant professor in the Department of Pediatrics. Previously, Gannon practiced general pediatrics in Murfreesboro, Tenn., for eight years before moving to Owensboro, Ky., where he spent another six years in private practice. His interests include adoption, ADHD, multiple births and children with developmental delays. Gannon received his undergraduate degree from Vanderbilt University and his medical degree from the University of Tennessee School of Medicine. He completed a three-year pediatric residency at Saint Louis University’s Cardinal Glennon Children’s Hospital.

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Lavender joined the College as a faculty member in the Department of Family Medicine where he instructs medical students and residents in the College’s Family Medicine Clinic. He also sees patients at University Medical Center, which the College operates, and performs colonoscopies and colposcopies at Surgical Center in Tuscaloosa and at Pickens County Medical Center. Lavender spent nine years in private practice in Gordo, Ala., prior to joining the College. He earned his medical degree from The University of Alabama School of Medicine and completed his residency at the College’s Family Medicine Residency, serving as chief resident.

Rogers joined the College as director of Business Development, a new position created to expand and extend the College’s clinical footprint. Prior to coming to the College, Rogers was associate administrator at Nemours, one of the largest pediatric practices in the United States. In that role, she managed and coordinated all hospital ancillaries and social services at A.I. DuPont Hospital for Children in Wilmington, Del. As the College’s director of Business Development, Rogers is responsible for developing strategic business plans, serving as the primary contact for business development and building relationships with community physicians, particularly those in rural Alabama, to create a network of family physicians throughout the state. Rogers received her undergraduate degree from Washington University in St. Louis, Mo., and a master’s degree in hospital and health administration from the University of Alabama at Birmingham.

Skinner has joined the College’s Department of Family Medicine as an assistant professor. She worked at Pickens County Medical Center and Carrollton Primary Care before joining the College, and was a member of the Pickens County Medical Center’s Hospital Board and its Medical Staff Executive Committee. Skinner has served as a community professor for the College’s Department of Family Medicine, a volunteer preceptor for the College’s medical students and residents and as an assistant affiliate professor of Obstetrics and Gynecology. She completed an obstetrics fellowship at Austin 58

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Medical Education Program in Texas. She did her residency training at the College’s Family Medicine Residency. Skinner received her medical degree from the University of Alabama School of Medicine. She is a fellow of the American Academy of Family Physicians and a member of the Alabama Academy of Family Physicians and the Medical Association of the State of Alabama. She has received numerous awards from the University of Alabama School of Medicine, including Excellence and Dedication in Teaching, Outstanding Services in Obstetrics and Gynecology and Outstanding Research Award.

Friend, director of the College’s Family Medicine Residency and vice chair of the College’s Department of Family Medicine, has been named interim chair of the department. Friend will continue to serve as director of the residency, a position he has held since 2012. The College’s residency is one of the oldest and largest in the country. He replaces Dr. Chelley Alexander, an associate professor who served as chair of the department since 2006 and who earlier this year accepted the position of chair of the Department of Family Medicine at East Carolina University’s Brody School of Medicine in Greenville, N.C.

Tucker has joined the College’s Department of Family Medicine, where she was recently appointed an assistant professor of Health Education. Tucker has been with the College since 2005 as an assistant professor in the Department of Community and Rural Medicine and as director of Clinical Investigations. In her new role, Tucker will provide clinical health coaching to University Medical Center patients with chronic diseases. She will work directly with individual patients and patient groups to set behavior change


FALL | goals and to help motivate them through the process. Tucker will also develop and implement a health education and health communications curriculum for the College’s medical students and family medicine residents. Tucker will also work with the residents to complete their scholarly activity projects.

Gresham retired from the College after more than 18 years of service. Gresham was the director of Medical Student Affairs and a professor in the Department of Internal Medicine. In her role with Medical Student Affairs, Gresham fostered the professional and personal development of undergraduate and medical students, advocated for the students and helped guide them to their career of choice. She also served on the University of Alabama School of Medicine and Rural Medical Scholar admissions and interview committees, all while providing care to countless patients and teaching hundreds of medical students, residents and shadow students. The College hosted a retirement reception for Gresham in early April to celebrate and acknowledge her contributions to the College’s educational mission. The reception was coupled with the medical students’ Match Day celebration. “Remaining on the job through April was important to [Gresham], as she wanted to see the current year’s admissions process and Match for our fourth-year students through to the end,” says Dr. Richard Streiffer, dean of the College.

Ireland, a professor in the Department of Family Medicine, retired from the College in May after 23 years. Through the College’s Family Medicine Residency and the College’s role in providing clinical education to third- and fourth-year medical students of the University of Alabama School of Medicine, Ireland helped train more than 268 family medicine physicians. He has a passion for treating diabetic patients and was the founder of the College’s Diabetes Self-Management Education Program. “In my four years of medical school, three years of residency and one year of fellowship, I learned from Dr. Ireland, ‘You have to sell the shoes,’” says Beverly Jordan, a

graduate of the College’s Family Medicine Residency and family physician in Enterprise, Ala. “Dr. Ireland wanted us to teach our patients to understand and think the way we think.” Jordan and other graduates of the College’s residency gathered with Ireland and his family, friends and coworkers at a reception in May to honor him for his years of service and dedication to the College.

Wedgeworth, who served asdirector of the Lab and X-Ray Department at University Medical Center, which is operated by the College, retired in September 2013 after 25 years with the College. When Wedgeworth first took over the department, there were only five employees, two instruments and no computers. The department grew to 12 employees, eight analyzers and 12 computers. “I like to think that we’ve gone from a small lab to a lab that is known throughout the Tuscaloosa and University communities as a first-rate, high-quality medical laboratory,” says Wedgeworth. During her time with the College, Wedgeworth, a certified clinical laboratory consultant through the American Society of Medical Technologists, also contributed to resident and medical student education by establishing a lab rotation for residents, which certifies residents to serve as lab directors in private practice, and by providing training about medical lab essentials during the medical students’ Scholars Week.

Brandon accompanied the College’s Rural Medical Scholars to Washington, D.C., in February to the Medical Association of the State of Alabama (MASA) Governmental Affairs Conference. Students joined Alabama physicians from MASA and the Alabama Academy of Family Physicians (AAFP) for agency briefings, updates on issues, receptions to meet health leaders and elected officials, and meetings with the state’s congressional delegation about federal policies that affect medical practice and patient care. Brandon is medical director of the Rural Medical Scholars program, a five-year track of medical studies leading to a medical degree that focuses on rural primary care and community medicine. COLLEGE OF COMMUNITY HEALTH SCIENCES

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College of Community Health Sciences P.O. Box 870326 Tuscaloosa, AL 35487-0326 CHANGE SERVICE REQUESTED

A different perspective of the College of Community Health Sciences’s conference held in July, Building the Patient-Centered Medical Home: Inspiration and Tools to Help Transform Your Practice

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On Rounds Fall 2014  

On Rounds is a semiannual publication by The University of Alabama College of Community Health Sciences.

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