Medical education in the U.S. is going through a growth spurt. After decades without a single new school, five new medical schools have opened since 2009, and 10 more are being accredited — a response to the growing doctor shortage.
Besides producing more doctors, many of the new medical schools are also trying to reshape medical education. Florida International University's College of Medicine in Miami is one of these new schools. Its approach to rethinking medical school is a community-based medical curriculum.
At FIU, each medical student is assigned a neighborhood in the Miami area and a family who lives there. Dr. John Rock, the medical school's founding dean, says the mission is to improve the health of the family and the quality of life in the neighborhood.
"We've adopted those neighborhoods, and we never leave. Clearly, we have a commitment to those neighborhoods to be there and to work with households and with the community to address the socio-determinants of health care," Rock says.
Rock has long worked in medical education at Johns Hopkins and as chancellor of Louisiana State University's Health Sciences Center. Starting a new medical school, Rock says, gave him and other educators a chance to try something new.
Rock says he wants his medical school to produce more primary care physicians. But he believes the school's commitment to community care will also make better doctors of the students who pursue specialties.
FIU's community-based care curriculum was shaped by Dr. Joe Greer, a gastroenterologist who founded and directs the Camillus Health Concern, a free clinic in Miami that cares for the poor and the homeless. He's served as an adviser to two presidents and received a MacArthur Fellows award. He believes medicine — and medical education — has to be better.
"What we've become is a nation of interventionalists. If you're dying, I'll save you. But, it's sort of like in America, we won't let you die, but we'll let you suffer. So how do we get beyond that?" Greer asks.
By putting students in the neighborhoods, Greer says, they can begin to learn that treating a disease oftentimes means more than just treating a single patient.
For example, he explains, it might start with asking why a patient is diabetic.
"Well, maybe it's because they're obese. Why are they obese? Well, maybe it's the type of food they have access to, and they're in a poor neighborhood, and they have no access to fresh fruits or vegetables," Greer says. "Why aren't they exercising? Well, the gangs sort of prevent you from doing that. Plus, it's South Florida. It's 100 degrees in the summer, 70 percent humidity, and there's no shade or pools in these poor neighborhoods."
Through the community care program — which they call Neighborhood Help — the doctors at FIU say they are determined to make actual, measurable improvements in the health and quality of life in the neighborhoods they've adopted.
'Pointed In The Right Direction'
For some students who have come from other parts of the country or from affluent families, plunging into some of Miami's poorer communities is an eye-opening experience. But there are others, like Patricio Lau, who moved to Miami from Nicaragua when he was 14, for whom it's a homecoming.
"One of the neighborhoods we're working with is trailer parks. So, I'm used to that. I have lived there. It's one of the good things about Neighborhood Help, because I feel that I can actually give back to the neighborhoods that I am from," Lau says.
Other new and established medical schools are also making commitments to community-based medicine. Greer says a brand new medical school like FIU has an advantage.
"Changing a curriculum in a medical school is like turning a battleship in a pool. Luckily, all we had was a raft. Now our job is to make sure that raft is pointed in the right direction, so that when it becomes a battleship, it has the ability to turn when the turns are needed to adjust to society," Greer says.
Greer says that as a medical educator, he has another charge as well: to help give students the inner strength and inspiration they need to carry them through their careers. "You have these great young minds and incredible hearts," he says. "It's our job to make sure they stay that way."