Creating Future Physicians for Hawaii 2021

CREATING FUTURE PHYSICIANS FOR HAWAI‘I

Creating Future Physicians for Hawai‘i | 1

Aloha, We extend a warm welcome to you for your interest in learning more about the John A. Burns School of Medicine at the University of Hawai‘i. Our medical school is among the most diverse in the nation, and our students consistently score above average in the U.S. Medical Licensing Exam, Step 1.

Our medical students learn through a unique “problem-based learning” and “learning communities” curriculum elements which emphasize intensive learning in small group sessions and hands-on clinical training. More than 2,000 applicants annually seek to become members of our next 77-person MD class.

JABSOM is committed to increasing the diversity of its student body. With programs such as the ‘Imi Ho‘ōla Post-Baccalaureate program and many outreach recruitment efforts, we have been successful in attracting, retaining and graduating students from underrepresented backgrounds and underserved areas in Hawai‘i and the Pacific Basin.

We also train 230 post-MD residents and fellows while they work toward licensure and board certification in 19 different specialty training areas. JABSOM works with medical staff in various teaching hospitals, clinics, and community health centers statewide to provide clinical experiences for our MD students, residents, and fellows. These community partnerships are essential to producing physicians who meet the unique needs of Hawai‘i’s diverse population.

As a medical school, our primary job is to produce MDs – and over half of the practicing physicians in Hawai‘i are employed by JABSOM or are graduates of the JABSOM MD or JABSOM sponsored residency programs. Some 80% of the “Best Doctors” identified in Hawai‘i every year have trained with us. We also confer graduate degrees in biomedical sciences and in the Allied Health programs of Communication Sciences & Disorders and Medical Technology.

Discovery is our island cultural tradition. Translating discoveries into practice is vital to Hawai‘i’s future. We seek to focus our research on the needs of our people which is a multi-ethnic, diverse community. Our Vision is health – not disease – focused. Please review the offerings on our website for additional details.

Aloha, Jerris R. Hedges, MD, MS, MMM Dean and Professor of Medicine Barry & Virginia Weinman Endowed Chair John A. Burns School of Medicine University of Hawai‘i at Mānoa https://jabsom.hawaii.edu/ https://jabsom.hawaii.edu/about-us/strategic-plan/

Dean’s Message .......................................................................................................................... 2 Vision & Mission ........................................................................................................................ 4 Physician Workforce ......................................................................................................................... 5 Road Map To Becoming A Physician ...................................................................................... 6 BEFORE MEDICAL SCHOOL – RECRUITING FOR DIVERSITY: School Health Education Program (SHEP)………………………………………….10 Hawaii State Loan Repayment Program…………………………………………….11 Science, Technology, Engineering & Math (STEM)…………………………………..12 Area Health Education Center (Pre-Health Corp, Teen Camp, Project ECHO)………...14 Continuing Medical Education…………………………………………………………..17 ʻImi Hoʻōla Post-Baccalaureate Program………………………………….18 Native Hawaiian Center of Excellence…………...…………………………………...19 Create & Navigate Opportunities in Education…………………………………………20 DURING MEDICAL SCHOOL – TRAINING IN DIVERSITY: Hawai‘i H.O.M.E. Project ........................................................................................................... 22 MD Curriculum Overview ........................................................................................................ 23 Rural Health Initiatives .....................................................................................................24 POST MEDICAL SCHOOL – CREATING A SPECIALIZED WORKFORCE: Graduate Medical Education ............................................................................................... 25 Affiliations & Partners .................................................................................................................... 28

Creating Future Physicians for Hawai‘i | 3

The John A. Burns School of Medicine (JABSOM) at the University of Hawai‘i at Mānoa is one of the leading medical education institutions in the United States.

JABSOM ranked #24 in the country in Primary Care in the 2021 “Best U.S. Medical Schools” list by U.S. News & World Report.

For the last three years, JABSOM has ranked #1 in National Institutes of Health research awards among community-based public medical schools (i.e., public medical schools without a university hospital) and ranked #1 in the nation by the Association of American Medical Colleges in retention of combined MD and Resident alumni practicing in-state.

Our Vision: A.L.O.H.A. Aloha is a cherished tradition in Hawai‘i, comprised of many layers which guide our way of life. At JABSOM, aloha embraces diversity. Aloha is also spelled out in our school‘s vision: Attaining Lasting Optimal Health for All — ALOHA.

Our Mission: JABSOM, as part of the fabric of Hawai‘i, is a diverse learning community committed to excellence and leadership in: •

Educating current and future healthcare professionals and leaders

•

Delivering high-quality healthcare

•

Conducting research and translating discoveries into practice

•

Establishing community partnerships and fostering multidisciplinary collaboration

•

Pursuing alliances unique to Hawai‘i and the Asia-Pacific region

•

Acting with forethought regarding right relationships, respect, and moral action. Pono

4 | Creating Future Physicians for Hawai‘i

Kelley Withy, MD, PhD Program Director withy@hawaii.edu (808) 692-1060

Physician Workforce Shortage JABSOM conducts the physician workforce assessment for the State of Hawaii.

Findings for 2021 are a shortage of 537 full time physicians (shortage is 732 when considering island and specialty specific needs).

Physician numbers by county are included below:

Table 1: Physician Shortage by County 2021 Oahu

Big Island

Maui County

Kauai

Statewide

Shortage

344

187

158

43

732

Percentage

15%

40%

40%

26%

22%

Table 2: Primary Care Physician Shortage by County 2021

Shortage Percentage

Oahu

Big Island

Maui County

Kauai

Statewide

115 15%

16 11%

32 17%

1 1%

163 15%

Creating Future Physicians for Hawai‘i | 5

Road Map

to becoming a physician

PRE-MED (Intermediate, High School & College) • Develop strong study habits & get involved with the community. Various pipeline programs & pathways are available to help jump start your interests (STEM, AHEC, NHH).

• Be sure to complete prerequisite science courses in biology, physics, general & organic chemistry, cell & molecular biology & biochemistry (JABSOM-specific requirements).

• Study hard to take the MCAT & prepare medical school application. Be sure to list all extracurricular activities, clinical & community service projects to demonstrate your experiences & attributes. http://jabsom.hawaii.edu/edprograms/

THE MATCH (During Final Year of Medical School)  Students choose a specialty on the basis of personal interests, clinical experiences & other factors & apply to residency programs.  Interview season begins! Most students are matched through the National Resident Matching Program (NRMP).  On “Match Day” in March, students learn where they will complete their residency training. http://jabsom.hawaii.edu/ed-programs/gme/

CERTIFICATION, LICENSURE, & CONTINUING MEDICAL EDUCATION (Ongoing after residency/fellowship)  Physicians must obtain licensure in the state(s) they will practice their chosen specialties.  Twenty-four specialty boards establish criteria that physicians must meet to be certified.  The rapid pace of change in medicine makes continuing medical education programs essential.  Specialty boards require recertification on a regular basis, a process called maintenance 1010/17* of certification. http://jabsom.hawaii.edu/faculty/cme/

6 | Creating Future Physicians for Hawai‘i

MEDICAL SCHOOL (4 years) • Years one & two provide service learning opportunities & preclinical skills courses with regular exposure to actual patient care-related learning activities.

• Students practice & develop their medical interviewing and physical examination skills while having the opportunity to be involved with clubs, interest groups & traditional annual events such as the medical school lūʻau & Halloween Extravaganza!

• Years three & four are clinical activities in hospitals & clinics which include clinical clerkships and electives under faculty & resident supervision. http://jabsom.hawaii.edu/ed-programs/mdprogram

RESIDENCY TRAINING (3-7years with additional years for Fellowship training)  Supervised, hands-on training that must be completed to be licensed, board certified and to practice independently.  Residents train as part of a patient care team alongside other health practitioners.  They are exposed to a variety of care settings, including community clinics; diverse patients and cases and cutting-edge research and care.  After completing their residencies, some residents choose to undertake a fellowship, which adds one to three years of study in a subspecialty area. http://jabsom.hawaii.edu/ed-programs/gme/

4 years

4 years

Undergrad Med School

3-7 years

1-3 years

Residency

Fellowship

Creating Future Physicians for Hawai‘i | 7

in the Road to Becoming a Doctor PRE-MED • The Title VII Health Careers Opportunity Program (HCOP) and Centers of Excellence (COE) support diversity “pipeline” programs that recruit minority and disadvantaged K–12 and college students into health education programs.

They also provide mentorship and support for enrolled health professions students.

MEDICAL SCHOOL • The Department of Education and other agencies offer financial aid options, including loan forgiveness and repayment programs.

Programs such as Public Service Loan Forgiveness (PSLF) and Title VII Scholarships for Disadvantaged Students (SDS) help ensure medical education is accessible to students from all backgrounds and offer incentives in targeted areas.

• Title VII Area Health Education Centers (AHEC) facilitate training opportunities in community health centers and other similar settings.

• Other Title VII programs, such as Primary Care Training and Enhancement and the Geriatrics Workforce Enhancement Program, support enhanced training in certain areas for medical students and other health professionals.

8 | Creating Future Physicians for Hawai‘i

THE MATCH • Medical schools have increased enrollment to help avoid physician shortages resulting from a growing and aging population. The Match likely will get more competitive as the number of graduates increases.

• Programs such as the Title VII training programs offer educational experiences in targeted areas, but ultimately a student’s specialty choice is a complex, personal decision.

RESIDENCY TRAINING • Medicare supports a portion of the direct costs associated with training physicians (for example, stipends and benefits for residents, salaries and benefits for supervising physicians, and overhead costs for GME offices). Medicare’s share of the costs is a hospital-specific amount that reflects each hospital’s Medicare volume. Since 1997, Medicare’s support for training residents has effectively been frozen.

• Teaching hospitals incur more than $17 billion in direct training costs each year. Medicare supports $3.5 billion of that total.

• More than 40,000 residents train at Department of Veterans Affairs facilities every year through more than 400 affiliations with medical schools and teaching hospitals.

Creating Future Physicians for Hawai‘i | 9

Ivy Nip Asano, MD, MAT/Ed

http://www.hawaii.edu/ome/shep/

Director of Admissions and Assistant Professor of Medicine inip@hawaii.edu (808) 692-0892

SHEP began in 2003 as a service learning partnership between JABSOM and the State of Hawaii Department of Education. The overall goals of SHEP are to inspire State of Hawaii Department of Education students to pursue higher education -- especially to pursue careers in science and the health professions. Medical students organize and plan innovative, interactive, and informative health education programs for high school and middle school students.

Activities include interactive/hands-on classroom lessons inclusive of: •

Anatomy Demonstrations

•

Cadaver Demonstrations

•

SimTiki Simulations

•

Clinical Skills

•

Suturing Workshops

•

Discussions About Native Hawaiian Culture and Plants

•

PBL Demonstrations

•

Discussions About College & Career Planning

During the 2016 – 2017 academic year, the medical students of SHEP were fortunate to interact with over 700 State of Hawaii Department of Education students. These included students from the islands of Kauai, Oahu, Maui, Molokai, and the Big Island of Hawaii.

10 | Creating Future Physicians for Hawai‘i

Kelley Withy, MD, PhD Program Director withy@hawaii.edu (808) 692-1060

Hawai‘i State Loan Repayment Program The Hawai‘i /Pacific Basin Area Health Education Center is pleased to announce the Hawai‘i State Loan Repayment Program (SLRP), a grant funded under the Patient Protection and Affordable Care Act of 2010. The SLRP offers primary care and behavioral health providers up to $40,000 a year in loan repayment to provide care at designated Health Professional Shortage Areas in Hawai‘i (HPSA).

Selected health care professionals are obligated to commit to at least 2 years of service at a public or non-profit private entity located and providing health services in a HPSA. In addition to caring for the community they serve; recipients are involved with work force development activities such as training and mentoring.

The SLRP will improve the number of primary care and behavioral health care providers in medically underserved areas of Hawai‘i and improve the retention of health care providers by decreasing the burden of debt. Such debt may prevent future doctors from choosing primary care or behavioral health careers in underserved areas.

But no longer!

Who’s Eligible?

• Physicians (Family Medicine, General Pediatrics, General Internal Medicine, Obstetrics/ Gynecology, Geriatrics, Psychiatry)

• Primary Care or Behavioral Health Nurse Practitioners, Registered Nurses, Nurse Midwives & Physician Assistants

• Health Service Psychologists • Licensed Clinical Social Workers • Licensed Professional Counselors and Marriage and Family Therapists

• Dentists, Pharmacists, Certified Substance Abuse Counselors

A total of 60 health care providers have taken advantage of this program to date.

Currently there are 26 active loan re-payers in underserved areas of Hawai‘i.

Of the program graduates, 63% are still working where they did their commitment and 83% remain working in Hawaii.

Partners In order to accomplish our goals, the Hawai‘i /Pacific Basin 20 undergraduate schools and 6 graduate schools including AHEC enjoys partnerships with 63 elementary and high schools, including the UH Nancy Atmospera-Walch School of Nursing, Social Work, Psychology, and the Department of Public Health Sciences and College of Education.

Additional partners include: 23 CHCs, the Hawai‘i Primary Care Association, the Hawai‘i Department of Labor, the HRSA regional office, NIH, the Hawai‘i State Rural Health Association, the Hawai‘i Department of Education, Papa Ola Lokahi, the Native Hawaiian Center of Excellence, Pacific Island Health Officers’ Association (PIHOA), Imi Ho‘ola Program, Health Occupations Students of America (HOSA) Health Careers Opportunity Program (HCOP) and the Hawai‘i Public Health Association.

Creating Future Physicians for Hawai‘i | 11

Rachel Boulay, PhD Director for Research & Specialist boulay@hawaii.edu (808) 692-0986

Mission: JABSOM’s mission is to educate its students to be high-quality physicians, biomedical scientists and/or allied health professionals. Our vision is to Maika‘i Loa: Attain Lasting Optimal Health for All (ALOHA). We encourage and support students to conduct research in biomedical and community health sciences with an aim to improve health outcomes, especially in heart disease, diabetes, cancer, in vitro fertilization, infectious diseases, mental health, respiratory diseases, and neurodegenerative disorders. We want to stimulate student interest early in pathways leading to biomedical and health science degrees and careers.

Examples of JABSOM’s Selected STEM Education Programs and Activities We invest in the next generation of biomedical and clinical scientists. Our stem education projects can be grouped under 3 broad areas: research training programs for students, educational outreach programs for youth, and professional development for teachers. We provide a few illustrations of each below and encourage you to learn about all of our other work to encourage the health science pipeline.

1. ResearchTrainingPrograms The Minority Health International Research Training (MHIRT) Program is based in the Department of Tropical Medicine, Medical Microbiology & Pharmacology which offers exciting opportunities for UH Mānoa students to perform research projects in international locations.

Other key research programs include: Hawai‘i’s statewide network of biomedical research excellence (INBRE), Pacific STEP-UP, Department of Native Hawaiian Health’s Summer Research Internship (SRI), and graduate student training in Cardiovascular Research.

2. Educational Outreach Programs for Youth The Hawai‘i Pacific Basin Area Health Education Center (AHEC), led by Dr. Kelley Withy, recently received three separate federal grants totaling about $5 million from individual departments within the United States Department of Health and Human Services (HHS). http://www.ahec.hawaii.edu 12 | Creating Future Physicians for Hawai‘i

AHEC’s Hawai‘i Pre-Health Career Corps is a free yearround program for high school and college students who are interested in pursuing careers in health. Its purpose is to increase awareness about health careers, provide mentoring, shadowing and research experiences, and provide exposure to health careers.

AHEC coordinates a speaker’s bureau, tours of JABSOM, Teen Health Camps, and more.

The Department of Native Hawaiian Health offers key educational programs such as their Native Hawaiian Pathway to Medicine and Nānākuli Pathways to Health programs. They connect with communities and support students with mentoring, service-learning, and training. Their efforts enable Native Hawaiian students to succeed in health professions and their research division aims to eliminate health disparities among Native Hawaiians.

3. Professional Development for Teachers Teachers in our Molecular Biology Professional Development Program make extra money during fall or summer break with paid stipends and travel assistance for neighbor islands. Teachers get access to online content materials, hands-on lab training, top biomedical and clinical scientists, and work with fellow science teachers. https://molecular-biology.coe.hawaii.edu/ Total Stem Enrollment Fall 2020: 116  68.1% Female  9.7% Native Hawaiian

STEM degrees awarded (2020-2021): 44  Bachelor's 7  Masters 31  Doctorate 6

Total Stem Enrollment Fall 2021: 109  66.1% Female  8.2% Native Hawaiian  (degrees data pending)

Creating Future Physicians for Hawai‘i | 13

Kelley Withy, MD, PhD AHEC Director withy@hawaii.edu (808) 692-1062

Hawai‘i/Pacific Basin AHEC The purpose of the Hawai‘i/Pacific Basin AHEC is to improve the health of the underserved through education. There are four main activity areas: 1.

Educating and recruiting students to health professions from K-12 schools.

2.

Educating health professions students in the rural and underserved communities of Hawai‘i, often in multi-professional teams.

3.

Recruiting health care professionals to rural and underserved areas and providing continuing education.

4.

Providing community-based and community-driven education for all underserved groups in Hawai‘i.

Why we need you?

Hawai‘i has a significant workforce shortage, mainly in primary care in rural areas. Rural areas need many medical and surgical subspecialty physicians to care for the most ill and vulnerable patients.

These shortages permeate almost every area of the state. Based on the number of providers trained, it is estimated that all medical school training must triple to meet local primary care needs!

We need assistance in finding housing for clinical trainees and faculty to train our students and residents in rural areas, so that they want to return to work in those areas after training.

Planning for your future!

The Hawai‘i Pre-Health Career Corps is a free program for High School and Undergraduate students who are interested in pursuing or learning about careers in health.

This includes those who are interested in medicine, nursing, social work, physical therapy, speech pathology, public health, medical technology, EMT, veterinary science AND MUCH MORE! 14 | Creating Future Physicians for Hawai‘i

JABSOM’s AHEC Office commits to help any student in Hawai`i pursue a career in healthcare!

Hawai‘i Pre-Health Career Corps - Planning for your future!

The benefits of becoming a Pre-Health Career Corps member •

Shadowing Healthcare Professionals

•

Participate in health-related workshops including CPR and HIPAA training

•

Visit the UH John A. Burns School of Medicine and other campuses

•

Gain valuable research experience

•

Receive FREE SAT test preparation, peer mentoring and help with the application process to health professions school

•

Receive a free Hawaii Health Career Navigator and Companion Guide

•

Gain Leadership and Mentoring Experience

•

Participate in Teen Health Camp, fun career orientation days and summer camps

•

Receive counseling from Health Career and College Advisors

•

Receive twice monthly Corps e-Newsletters with activities and member accomplishments

•

Celebrate accomplishments with a supportive group of peers!

Creating Future Physicians for Hawai‘i | 15

Teen Health Camp Teen Health Camps are day long activities for high school and college students to learn about health careers from health professions students.

Participants get to practice suturing on fake arms, spreading germs and seeing where they go under black lamps, calculating calories in food and placing casts on each other. These camps are offered six times a year across the State and are free to students. ahec@hawaii.edu

Project ECHO AHEC partners with the Hawaii State Rural Health Association to offer FREE case-based Behavioral Health and Pediatric interactive distance learning sessions at every lunchtime as part of the ECHO Hawaii program. Department of Geriatrics offers monthly case-based distance Geriatrics training on the second Wednesday of the month at noon. Information on both free offerings available at: http://echohawaii.org/ 16 | Creating Future Physicians for Hawai‘i

Brenda Wong Office CME Manager brendaw@hawaii.edu (808) 692-0900

The Hawaii Consortium for CME’s (HCCME) mission is “to support delivery of the highest quality of patient care by educating current healthcare professionals and physician leaders in Hawaii and the Asia-Pacific region”. A joint venture with the Hawaiʿ i Medical Association, HCCME is JABSOM’s provider of accredited continuing education required for the renewal of medical licenses.

HCCME facilitates JABSOM’s response through continuing education to issues such as the health and well-being of Native Hawaiian, Pacific Islander and homeless communities; public health concerns such as diabetes, hypertension, addiction and substance use disorders, melanoma and other cancers, treatment of HIV; and, most recently, the prevention and management of COVID in long-term care facilities.

HCCME was accredited with commendation by the Accreditation Council for Continuing Medical Education in 2016. It provides JABSOM with a means of assuring that there is a continuum of medical education for its faculty, alumni and all physicians and healthcare professionals serving our community.

HCCME designates 20 to 25 activities annually. These include series such as ECHO, Department Grand Rounds, conferences, workshops, symposiums, lectures, summits, hands on learning opportunities, faculty development, courses in the simulation center and activities conducted in collaboration with the School of Nursing and Dental Hygiene, Hawaii State Center for Nursing and the University of Hilo College of Pharmacy.

Creating Future Physicians for Hawai‘i | 17

Winona K. Lee, MD

http://jabsom.hawaii.edu/ed-programs/imi/

Director imihoola@hawaii.edu (808) 692-1030

The mission of the ʻImi Hoʻōla Post-Baccalaureate Program is to improve health care in Hawaiʻi and the Pacific Basin by increasing the number of physicians through a 12-month educational program in the Department of Native Hawaiian Health that addresses disadvantaged students’ academic needs. ʻImi Hoʻōla provides educational opportunities to students from disadvantaged backgrounds who are deemed capable of succeeding in medical school. Although ʻImi Hoʻōla is not limited to persons of Hawaiian, Filipino, Samoan, Chamorro or Micronesian descent, a large number of these students have demonstrated that they are from a disadvantaged background.

The curriculum emphasizes the integration of concepts and principles in the sciences and humanities and further develops students’ communication and critical-thinking skills.

Eligible individuals are from disadvantaged socio-economic and/or educational backgrounds and have demonstrated a commitment to serve in areas of need in Hawaiʻi and the U.S. Affiliated Pacific Islands. ʻImi Hoʻōla has expanded its outreach efforts and developed partnerships with local high schools, colleges, and community-based health organizations. These partnerships help to create an educational pathway for disadvantaged students to enter and graduate from college and pursue health and allied health careers.

‘Imi Hoʻōla contributes to diversity of the healthcare workforce and provides solutions to the physician shortage by increasing the representation of healthcare leaders from less privileged and/or rural communities who are committed to serving the people of Hawaiʻi.

18 | Creating Future Physicians for Hawai‘i

Winona K. Lee, MD Principal Investigator nhcoe@hawaii.edu (808) 692-1022

http://nhcoe.jabsom.hawaii.edu

The Native Hawaiian Center of Excellence (NHCOE) seeks to improve the health of Native Hawaiians through education, research, and community initiatives that enable Native Hawaiians to successfully pursue careers in medicine and other health professions.



 



   

Native Hawaiian Student Pathway to Medicine and Native Hawaiian Interdisciplinary Health Programs Nānākuli Pathways to Health Culturally responsive educational curricula for JABSOM medical students & residents Stewards of JABSOM Māla Lāʻau Lapaʻau (Native Hawaiian traditional healing garden) Academic support and mentoring for Native Hawaiian medical students Professional development workshops and Native Hawaiian Health resources Medical student clinical teaching in community clinics & health centers Health Career Exploration opportunities statewide

  

  

‘Ahahui o nā Kauka (Association of Native Hawaiian Physicians) Kīpuka Native Hawaiian Student Center (University of Hawaiʻi at Hilo) University of Hawaiʻi at Mānoa Office of Student Equity, Excellence and Diversity Papa Ola Lokahi (Native Hawaiian serving community organization) University of Hawaiʻi at Mānoa Myron B. Thompson School of Social Work University of Hawaiʻi at Mānoa Nā Pua Noʻeau (Center for Gifted and Talented Native Hawaiian children)

Creating Future Physicians for Hawai‘i | 19

Erica Davis Director of CANOE davise13@hawaii.edu (808) 692-1060

Create & Navigate Opportunities in Education CANOE: Create and Navigate Opportunities in Education (CANOE) is a navigating life, career & college success courses for disadvantaged youth in grades 9 through college. First piloted in March 2017 to July 2017, the 20 in-person sessions cultivate a cohort of students to become more employable for entry level positions in local health care facilities. Students in the pilot cohort include Title I public schools from across the island of O‘ahu. The on-going success of the pilot program on O‘ahu has sparked the birth of CANOE to take place on Hawai’i Island, Maui and Kaua‘i.

Words from former CANOE students: “When looking for a summer like no other, friends no matter how different from each other, and a clear view on the future ahead of you, the answer is CANOE” ~ Jade “CANOE allowed me to strengthen my character and experience new things” ~ Drew

20 | Creating Future Physicians for Hawai‘i

Certifications •

American Heart Association: CPR/First Aid/AED Certification

•

Health Insurance Portability and Accountability (HIPAA)

•

Occupational Safety and Health Administration (OSHA)

•

Youth Mental Health First Aid

The course includes an online curriculum and free lunch during in–person sessions!

A Career & College Success Course Students receive multiple certifications. They strengthen public speaking, leadership, STEM literacy, and teamwork abilities, as well as learn techniques to improve interview skills, professionalism, time management, and financial planning. CANOE provides students with the opportunity to successfully apply for employment, internships, research, and shadowing programs within their local communities.

Additionally, the course exposes students to the various careers in health and how to instill a life of balance, health, and wellness on their pathway to their aspirations through identity exploration and community building, while embracing adversity and diversity.

Creating Future Physicians for Hawai‘i | 21

Teresa Schiff, MD Director, Office of Medical Education schiff@hawaii.edu (808) 692-0932

Through the Hawai‘i H.O.M.E. (Homeless Outreach and Medical Education) Project, the John A. Burns School of Medicine (JABSOM) provides free health care services to O`ahu’s homeless populations. H.O.M.E. is administered by the Office of Medical Education (OME) and is staffed by medical students, faculty, and volunteer community physicians.

The goal of the H.O.M.E. Project is to improve access to and the quality of healthcare for Hawai‘i’s homeless. It also aims to increase student and physician awareness and understanding of the issues that face the homeless.

H.O.M.E. operates 5-6 student-run free clinics every week, at 9 sites across O`ahu, servicing both sheltered and unsheltered homeless individuals. Some additional sites have been suspended temporarily due to COVID-19 but we intend to return when conditions allow. Since the start of the clinics in May of 2006, H.O.M.E. Project has provided over 16,250 patient visits for homeless individuals for problems ranging from wound care to acute respiratory problems, to chronic problems like diabetes and hypertension.

Over that same time period, approximately 1,020 medical students at various stages of their medical education have participated in the health outreach efforts of H.O.M.E. Project and the many special events that the program provides for the homeless children and families that they work with.

22 | Creating Future Physicians for Hawai‘i

The MD Program is a four-year curriculum consisting of an initial two-year pre-clerkship portion followed by two years of clinical activities in hospitals and clinics. The curriculum is guided by the school’s educational philosophy and designed to help students achieve its graduation objectives.

The first two years are divided into eight instructional units, six of which are organized around problem-based learning (PBL) tutorials. Within each of these segments of the curriculum, students can look forward to active and engaging PBL tutorials, supplemented by lectures, labs, standardized patients, and advanced simulation experiences.

Throughout the first year, a Community Health course provides service-learning opportunities and information on valuable community resources. Across both the first and second year of the curriculum, a series of Clinical Skills labs and monthly experiences with Longitudinal Clinical Mentors in the community, provide students with regular exposure to actual patient care-related learning activities, and offer students the opportunity to practice and develop their medical interviewing and physical examination skills under the direct supervision of practicing physicians.

Electives in a variety of disciplines are also available to students. Clubs, interest groups, and traditional events like the annual medical school lū‘au complement the preclerkship academic experience at JABSOM. In the third year, students participate in longitudinal clinical “clerkships” consisting of a half-year of outpatient clinics based in a specific community both on O`ahu and the neighbor islands and half-year of inpatient blocks that immerse learners in the core clinical disciplines. Students participate in the care of patients under the supervision of medical school faculty and resident physicians.

The fourth year of medical school offers an opportunity for students to explore potential careers in medicine. In addition to required experiences in the fields of Emergency Medicine and Geriatrics & Palliative Care, students may spend up to 24 weeks in electives designed to explore various clinical and biomedical research disciplines.

Throughout all four years of the medical school curriculum, students participate in learning communities, which are intentionally set groups of faculty and students which allow interaction between students from each of the four classes, provide a 4-year longitudinal relationship with their mentor, and enhance the learning experience through exploration of the many dimensions of health care management which maximize student learning and professional growth.

The University of Hawai‘i John A. Burns School of Medicine is internationally known and respected for its outstanding educational programs. Combining an innovative problem-based learning (PBL) curriculum in the first two years with outstanding, community-based clinical training in the third- and fourth-years, JABSOM provides students with a highly-effective, thoughtfully-designed educational experience.

Creating Future Physicians for Hawai‘i | 23

Jill Omori, MD Director, Office of Medical Education jill.omori@hawaii.edu (808) 692-0932

Rural training opportunities are available and encouraged in every year of medical school.

Rural Health Training Initiatives: PBL on the Neighbor Islands 

Since 2011, we have been sending 1st year medical students to Hilo and Waimea on the Big Island for one of their curricular units.



They are mentored and trained by local physicians in those communities and participate in community health experiences that teach them about the local health care systems while providing a service to the community.



Starting in 2022, we will have this experience on Lanai and Kaua‘i islands.

Longitudinal Clerkship and other Rural Electives  The 3rd year longitudinal clerkship is divided into two parts: 6 months of mini-inpatient blocks and 6 months of ambulatory training. In addition to Oahu sites, students can complete their ambulatory semester in Hilo, Waimea, and Kona on Hawaiʻi Island, Maui, and Kauaʻi.  Approximately 25% of the 3rd year class completes their longitudinal clerkship on one of the Neighbor Islands.  Fourth year students have the opportunity to complete their required geriatrics and emergency medicine rotations on Hawaiʻi Island, Maui, or Kauaʻi.

 Students also have the opportunity to do electives in rural Hawaiʻi and

throughout the Pacific Basin during the summer between 1st and 2nd year and during their 4th year.

Rural Health Certificate of Distinction 

Students that have a special interest in rural health and that show a commitment to rural medicine can apply for the Dean’s Certificate of Distinction in Rural Health.



As part of this program, students participate in specific rural electives and rotations, attend rural health seminars, provide leadership for the rural health interest group, and participate in research or projects targeting rural health issues.

AHEC partners with the Hawaii Veteran’s Association to support 30 students a year to work in inter-professional teams in rural areas including Hilo, American Samoa, Guam, and Palau. Students from Medicine, Nursing, Social Work, Pharmacy and Public Health live and work together in clinical settings and perform a joint research project. For more information contact Dr. Kelley Withy at withy@hawaii.edu.

24 | Creating Future Physicians for Hawai‘i

Lee Buenconsejo-Lum, MD, FAAFP Associate Dean for Academic Affairs, Designated Institutional Official & GME Director lbuencon@hawaii.edu (808) 692-0989

What is Graduate Medical Education?

Graduate Medical Education or GME is the period of clinical training of a physician following receipt of the medical (or osteopathic) doctor degree and prior to beginning independent practice of medicine.

JABSOM is the Sponsoring Institution responsible for the training of residents and fellows in 19 GME programs conjunction with numerous partners.

Figure 1. Number of Medicare-funded training positions per 100,000 population, 2010. SOURCE: Institute of Medicine. 2014. GME that Meets the Nation’s Health Needs, Chapter 3

MISSION: To advance the health and well-being of the people of Hawai‘i • Outstanding Graduate Medical Education • Excellent training environments across clinical settings • Sustained quality patient care, health promotion, and academic excellence Despite extreme physician shortages and the expansion of JABSOM class size, there has been a 3% contraction of GME positions in Hawai‘i from 241 to 233.

Hawai‘i is in the bottom quintile of GME positions per population as noted in Figure 1.

Physician workforce shortages persist and worsen • 700+ physicians short and expected to worsen with population aging and physician retirement • Largest shortages are in primary care (Family Medicine and Internal Medicine) • Insufficient access to primary care leads to increased costs and long-term mortality • Shortages in general surgery, OB, and orthopedics – worse on neighbor islands • Many physicians no longer care for Medicaid/Medicare, yet all GME programs do • The present GME financing system is inadequate to maintain and grow additional positions to meet Hawai‘i’s physician workforce needs.

• Additional strategies are needed to reverse the decline of GME positions in Hawai‘i Despite the shortages, JABSOM graduates practice throughout the state. We aim to increase neighbor island rotations to encourage Graduates to practice in those communities.

Creating Future Physicians for Hawai‘i | 25

Federally-Designated or State-design Where JABSOM gradua LEGEND Mental Health HPSA —

Kaua‘i Island

Primary Care HPSA — Primary Care + Mental Health HPSA — Medically Underserved Area/Pop — MUA / MUP + Mental Health HPSA —

Child Psychiatry Family Medicine Geriatrics Internal Medicine Obstetrics & Gynecology Pediatrics Psychiatry Sports Medicine

Leeward Coast Cardiology Child Psychiatry Family Medicine Geriatrics Internal Medicine Obstetrics & Gynecology Pediatrics Psychiatry Surgery

Wahiawa & North Shore Family Medicine Obstetrics & Gynecology

KPHC / KKV / Waikiki Health Center FQHCs & Queen Emma Clinics Addiction Medicine Family Medicine Internal Medicine Obstetrics & Gynecology Pediatrics Psychiatry Surgery – General & Orthopedics

HPSA = Health Professional Shortage Areas, MUA = Medically

26 | Creating Future Physicians for Hawai‘i

ated HPSA / MUA / MUP Areas in Hawai‘i tes practice (partial listing) Ko‘olauloa Family Medicine

Ko‘olaupoko Family Medicine Internal Medicine Pediatrics Psychiatry

Maui Island Child Psychiatry Internal Medicine Family Medicine Obstetrics & Gynecology

Moloka‘i Island Family Medicine Internal Medicine

East Hawai‘i Child Psychiatry Family Medicine Internal Medicine & some visiting subspecialists Geriatrics Obstetrics & Gynecology Pediatrics & some visiting subspecialists Psychiatry Surgery

Lana‘i Island Child Psychiatry Psychiatry Family Medicine (2022)

North Hawai‘i Family Medicine Surgery

Underserved Areas, MUP = Medically Underserved Populations

Creating Future Physicians for Hawai‘i | 27



Adventist Health - Castle Medical Center



Kokua Kalihi Valley



‘Ahahui o na Kauka (Association of Native Hawai‘ian Physicians)



Kuakini Health System



Nancy Atmospera Walch School of Nursing (UH Manoa) Office of Student Equity, Excellence and Diversity (UH Manoa)



Area Health Education Centers: o o o o o o o o o

Hilo Huli Au Ola (Maui) Na Lei Wili (Kaua‘i) Waianae Waimanalo American Samoa Commonwealth of the Northern Mariana Islands (CNMI - Saipan) Republic of Palau



o

Yap, Federated States of Micronesia



Tripler Army Medical Center



Daniel K. Inouye College of Pharmacy (UH-Hilo)



VAPacific Islands Health Care System





Hawai‘i Health Systems Corporation

Wahiawa General Hospital and Wahiawa Nursing and Rehabilitation Center



Hawai‘i Medical Service Association (HMSA)



University Health Partners of Hawai‘i - Clinical Practice Sites:

 Hawai‘i Pacific Health o Kapi‘olani Medical Center for Women & Children o Pali Momi Medical Center o Straub Medical Center o Wilcox Medical Center 

Hawai‘i Residency Programs, Inc.



Hawai‘i State Department of Education



Hawai‘i State Department of Health



Kaiser Permanente Moanalua Medical Center and Clinics



Kalihi-Palama Health Center



Kipuka Native Hawai‘ian Student Center (UH-Hilo)

 Papa Ola Lōkahi (Native Hawaiian Community Organization) 

The Queen’s Health Systems o

The Queen’s Medical Center

o

Queen’s Medical Center - West O`ahu

o

North Hawai‘i Community Hospital

o Communication Sciences & Disorders o Psychology  Waianae Coast Comprehensive Health Center  Waikiki Health Center  Waimanalo Health Center  Thompson School of Social Work & Public Health (UH Manoa)  Numerous medical offices of volunteer faculty physicians throughout Hawai‘i and the US Pacific  Numerous hospitals throughout Asia who provide training and research opportunities for JABSOM student

Creating Future Physicians for Hawai‘i | 29

For more information on the John A. Burns School of Medicine, please visit our website at: http://jabsom.hawaii.edu/ 651 Ilalo Street Honolulu, Hawaii 96813

32 | Creating Future Physicians for Hawai‘i