Immersive MD program fosters systemic change
First cohort of Population-based Urban and Rural Community Health students become doctors
The first year of medical school brings lots of excitement for new students: getting to know professors and peers, taking foundational courses on core pharmacology concepts, and exploring the campus. For one group of School of Medicine Class of 2021 graduates, the first year also involved figuring out how to afford a month’s worth of meals and bus tickets for a family of three or four on an impossibly tight budget.
“The poverty simulator threw us into real-world situations in our introductory weeks at UMass Medical School,” said Poornima Manikantan, MD’21. The Longmeadow native graduated with the inaugural class of students in the Population-based Urban and Rural Community Health (PURCH) track. “It was an opportunity to simulate the difficult decisions that many community members face daily.”
In line with the PURCH mission, the simulation is an interactive, interprofessional educational experience in which students truly learn what it means to be a member of a family living at or below the poverty line that illuminates some of the many social determinants of health that impact their patients.
“You’re assessing how to get to work, pick up your kids from school, receive health care and buy groceries all without having access to transportation,” said Dr. Manikantan, now in her internal medicine residency at Stony Brook University Hospital in New York. “If you can’t make ends meet, you have to navigate the possibility of your house being foreclosed or checking your family into a homeless shelter. You make tough decisions, such as not getting groceries one week, then find ways to get services that could be of assistance.”
“It is a simulated month that takes place within a few hours where students navigate different social services and challenges,” said Justin Ayala, undergraduate education program coordinator for PURCH. “It recreates some of that anxiety that folks feel on an everyday basis in low resource communities. This can help our learners see and feel the lived experience of the patients that they may be interacting with.”
In the PURCH track, offered at the UMMS-Baystate campus in Springfield, students learn primary and sub-specialty care of patients within a population-health framework. Participants complete their preclinical and basic science courses in addition to program-specific courses such as Determinants of Health and Doctoring & Clinical Skills. In their third-year, students complete clinical rotations at Baystate Medical Center. The PURCH curriculum prepares students to practice medicine in diverse urban and rural communities, with a focus on underserved populations and analysis of social determinants of health. The 2021 PURCH cohort comprised six men and nine women, including 11 Massachusetts residents.
The program augments the MD track with additional emphasis on patient-centered, community-based care and innovative, immersive learning experiences. PURCH prepares students to manage the health of both individuals and populations.
“PURCH highlights ways to establish cultural and structural change. It enhances the student experience in learning about their community and how that knowledge influences everything from how they talk to their patients to understanding their community partners,” said Sarah McAdoo, MD, director of the PURCH population health capstone course.
Kevin White, MD’21, was the first student accepted to PURCH when it was launched in 2017. He was born at Baystate Medical Center in Springfield in 1995, and now, Dr. White is beginning his internal medicine residency at Walter Reed National Military Medical Center in Maryland. Inspired by the tradition of military service in his family, White is also a lieutenant in the U.S. Navy. Although he is far from home, he credits PURCH for the opportunity to train in the community that raised him.
“In first grade, I remember the school counselor asking what we wanted to be as adults. I would say I wanted to be a doctor,” White said. “My mother is a medical assistant, always helping others and putting people before herself. I wanted to be just like her.”
White was able to pursue that vision when he enrolled in PURCH after graduating from UMass Amherst. He was introduced to the UMMS environment when he participated in the BaccMD Pathway, an undergrad program that provides students from backgrounds underrepresented in medicine the opportunity of provisional acceptance to the School of Medicine.
“As I went through the program, I gradually became more interested in medicine. It brought together some of the qualities that I really aspire to emulate as a physician. PURCH definitely helped me solidify my interests in working with urban-rural community health populations. Springfield is extremely diverse, with vast Hispanic, African-American and Asian populations,” he said.
The PURCH curriculum focuses on cultivating physicians who are team-oriented, excellent diagnosticians, self-reflective, empathetic and leaders who can be led. Students in the program strive to exemplify those characteristics.
“PURCH is not just a track, it’s also a state of being,” said Kevin Hinchey, MD, senior associate dean for education at UMMS-Baystate. “It encompasses the essence and traits of what it means to be a doctor. Our goal is to teach our students to find and maintain humility and understanding while working with their patients.”
“On the surface of the water, we have all of our classes and academic work that outlines our responsibilities as providers,” said Rebecca Blanchard, PhD, assistant dean for education at UMMS- Baystate. “But underneath that water, deep down is the outreach and connection to the community. That’s what will really mold the physician.”
Colton Conrad, MD’21, moved to Springfield from North Carolina when he matriculated at UMass Medical School. From the minute he toured Baystate Medical Center, he knew it would be a great place to learn. Dr. Conrad is now serving his residency in emergency medicine at Baystate, which was his top choice. Like White, he was intrigued by the novelty of the program.
“I was really excited to be a part of a new program and be one of the first to step into the field with this specific training,” said Conrad. “I’ve been able to develop a better understanding of patients on a deeper level than their illnesses or ailments. They’re not just patients, they’re people living in a community,” said Conrad, noting that is his responsibility as a physician to meet his patients where they are.
Courses taken in the PURCH track provide the same information, build the same skills and develop the same competencies as the traditional MD curriculum, but PURCH focuses on a commitment to underserved populations. Courses bring real patient experiences to life both inside and outside the classroom, putting students in the shoes of people for whom they will care. The courses also show students the complexity of the human anatomy through the lens of other trades and professions.
“A car mechanic came in on our first day of classes,” said Conrad. “They taught us how they do a diagnosis and history of a car’s maintenance . . . asking questions like, ‘When did the problem start? What does it sound or feel like to you?’ The analogy was super insightful, especially walking into med school on day one.”
“PURCH unites people who are oriented around social determinants of health and finds avenues to provide care in a way that is cognizant of all of the other drivers that impact health outcomes, such as housing instability, internet access and food insecurity,” said Amanda Whitehouse, MD’21. Alongside her former classmate Conrad, Dr. Whitehouse is also beginning her career as a physician at Baystate Medical Center, in pediatrics. She taught for Teach for America before enrolling in medical school and believes firmly that education is critical in shaping the doctors of tomorrow.
“There is so much to be aware of as a clinician. You truly take on the role of an educator,” she said. “Medicine and teaching are synonymous, and I feel that PURCH puts us in the shoes of both the learner and the teacher. We learn from our patients as they do from us.”
An asset of the PURCH education is the collaboration with lay faculty, a diverse group of community members who are passionate about shaping the education of future providers. The community faculty live in Western Massachusetts and represent organizations that collaborate with PURCH and Baystate on the goal of developing culturally humble physicians as community advocates. They help augment curricula and teach by hosting student learning experiences and serving as standardized patients, a role for which they are trained to act as patients with specific medical conditions in simulated office visits where students interview and examine them.
Both the PURCH students and community faculty said this experience is invaluable and instrumental to structural change.
“Students participated in many moments where they were able to engage directly with families,” said Jenise Katalina, healthy families resource specialist at The Children’s Trust and former vice president of family services at Square One in Springfield. Square One provides a range of education and support services to help families grow cognitively, emotionally and socially. “I believe that we cannot create systemic change and address the needs in our community without an interdisciplinary approach. Not only did this program provide an opportunity to connect students with the community that they will be working in, but it also provided me and my organization with the opportunity to learn more about the medical schooling process and move our work forward with another lens on our work.”
“I remember showing the students my community when we went on a food desert tour,” said Charlie Holmes, leader of Springfield’s Service Employees International Union, and a standardized patient and community faculty member. “We developed a strong bond with this hands-on experience. It so much touched my heart when I saw the students volunteering in my community.”
Kathryn Norman, MD’21, chose PURCH after graduating from Harvard and working for the Centers for Disease Control and Prevention through the Public Health Associate Program in California for two years, where she developed a love for local health policy. Now an internal medicine resident at Beth Israel Deaconess Medical Center, Dr. Norman credits PURCH for immersing her and her peers in Springfield-based volunteer projects over the years, exposing them to the lifestyles and environments of their patients.
“I took part in a neighborhood workday through Revitalize CDC, a community development coalition. We went out and did some painting and gardening. I was painting a fence and a woman in her 50s, who was also painting, started chatting with me and shared how she had a personal connection to Baystate Medical Center in her family. I remember her saying how amazing it was to see a medical center grow and bring in students who were not part of Baystate, but who were coming out and learning about the community because they truly wanted to be there. It stuck with me,” Norman said. ■