PROVIDENCE, R.I. [Brown University] — Amid rapid changes in health care policy that are increasing the need for leaders in community-based primary care, the Warren Alpert Medical School of Brown University has begun to develop a novel M.D./Sc.M. program in Primary Care and Population Health. The plans underway would create a four-year, dual degree program for 24 students a year beginning in fall 2015.

“Primary care is a vitally important area of medicine in Rhode Island and around the country,” said Dr. Edward Wing, dean of medicine and biological sciences. “The best care will come from doctors who are trained to understand and improve the community health of their patients. Future primary care doctors must therefore be trained in population health, policy, epidemiology, technology, and teamwork.”

Treating a patient with high cholesterol is not only a matter of prescribing a pill or telling a patient to change behavior, but also of understanding the barriers in the patient’s neighborhood to exercise, the local availability of healthy food options, and cultural influences on diet and activity.

New models of health care are designed not only to treat individual patients but also to encourage medical teams to produce high-quality outcomes across entire patient communities. Meanwhile, as more patients gain access to health care, the Association of American Medical Colleges estimates that the nation will face a shortage of 45,000 primary care physicians in 2020, a year after the first students would graduate from the Alpert Medical School’s new program.

“We desperately need to control health care costs in Rhode Island and across the United States,” said Brown University President Christina Paxson, a health economist. “By training more primary care physicians, we can contribute to controlling costs while maintaining high-quality care.”

A new student experience

The pedagogical emphasis across the program’s four years would be on teaching students not only the medical knowledge they need to become physicians, but also public health policy, leadership skills, and how to work with other health professionals who are part of the broad care teams that serve patients.

“The proposed integration of a rich population health curriculum into students’ training would be unique among medical school programs,” said Dr. Jeffrey Borkan, whom Wing has appointed assistant dean to spearhead the effort. Borkan has also served as chair of the Alpert Medical School’s Department of Family Medicine since 2001.

In the current working proposal, classes in the new program will emphasize active learning rather than passive lecture-style teaching, Borkan said. And rather than structuring student clerkships as a string of separate rotations through specialty clinical settings for six weeks at a time (for example, internal medicine followed by pediatrics followed by surgery) students would instead engage in nine-month, physician practice-based clerkships, where they follow a cohort of patients through their various interactions with the health care system, under the mentorship of local primary care physicians.

“In these longitudinal clerkships, students would experience a continuity of relationships with their patients and mentors,” Borkan said. “They could observe the natural history of disease and wellness over time and learn the continuum of care as it is encountered by patients and their care teams.”

After months of planning, medical school officials including Wing, Borkan, Dr. Paul George, assistant professor of family medicine, and Dr. Philip Gruppuso, associate dean for medical education, held their first meeting on Jan. 8, 2013, to gather feedback from a newly formed advisory board charged with providing the dean with advice and recommendations. The school is continuing to work on several other fronts, including deeper planning of the curriculum, identifying sites and practices for clerkships and residencies, and steps toward obtaining accreditation for the program.

A successful program will not only add to the ranks of primary care physicians in Rhode Island, Borkan said, but also improve the quality of care around the state and perhaps inspire similar programs at other medical schools.

“When the first class graduates in 2019, we hope they will not only become leaders in a new model of primary care, but that their education itself will have become a model,” Borkan said.

The Advisory Board for Primary Care and Population Health

Thomas A. Bledsoe, Associate Professor of Medicine, Alpert Medical School
George S. Bottomley, Director and Assistant Dean, Johnson & Wales University
Nancy Carriuolo, President, Rhode Island College
Stephanie Chafee, First Lady of Rhode Island
Steven M. Costantino, Rhode Island Secretary for Health and Human Services
Daniel DiPrete, Radiologist and Alpert Medical School Alumnus
David M. Dooley, President, The University of Rhode Island
Christine Ferguson, Director, Rhode Island Health Benefits Exchange
Michael Fine, Director, Rhode Island Department of Health
Marie Ganim, Director of Policy and Deputy Chief of Staff for the Rhode Island Senate
Marie Ghazal, Chief Executive Officer, Rhode Island Free Clinic
Deidre Gifford, Medical Director, Rhode Island Executive Office of Health and Health and Human Services
Jane Hayward, President, Rhode Island Health Center Association
Dennis Keefe, CEO and President, Care New England
Christopher F. Koller, Rhode Island Health Insurance Commissioner
G. Alan Kurose, President, Coastal Medical
Gus Manocchia, Chief Medical Officer, Blue Cross/Blue Shield of Rhode Island
John Murphy, Chief Medical Officer, Lifespan
Elizabeth H. Roberts, Lieutenant Governor of Rhode Island
Mary Sullivan, Interim Dean, College of Nursing, The University of Rhode Island
Jane Williams, Dean and Professor of Nursing, Rhode Island College
Jeffrey Borkan, Chair, Department of Family Medicine, Assistant Dean of Medicine for Primary Care, Alpert Medical School
Michelle Cyr, Associate Dean of Medicine for Academic Affairs, Alpert Medical School
Mark Fagan, Professor of Medicine, Alpert Medical School
Paul George, Assistant Professor of Family Medicine, Alpert Medical School
Philip Gruppuso, Associate Dean of Medicine for Medical Education, Alpert Medical School
Christina H. Paxson, President, Brown University
Terrie “Fox” Wetle, Associate Dean of Medicine for Public Health and Public Policy, Brown University
Ira Wilson, Chair, Department of Health Services, Policy, and Practice, Brown University
Edward Wing (Committee Chair), Dean of Medicine and Biological Sciences, Brown University