Casting a Vision

New DO School Names Its Founding Dean

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Medical Education Feature — August 2014

Tex Med. 2014;110(8):51-55. 

By Amy Lynn Sorrel
Associate Editor

Texas' medical education landscape continues to shift as plans for a third new Texas medical school — the University of the Incarnate Word (UIW) School of Osteopathic Medicine — move ahead with the hiring of Robyn Phillips-Madson, DO, as its founding dean.

Historically, osteopathic medical schools have focused on primary care, and the family physician who hails from Washington State tells Texas Medicine about her vision to carry on that tradition and bring much-needed physicians to underserved areas in South Texas. The private Catholic university in San Antonio also has schools of nursing, pharmacy, optometry, and physical therapy. 

The private UIW osteopathic medical school, along with two new University of Texas System allopathic medical schools — the Dell Medical School in Austin and the UT Rio Grande Valley School of Medicine — brings the total number of Texas medical schools to 12. (See "Inauguration: Meet the New Texas Medical School Deans," May 2014 Texas Medicine, pages 41-47.) 

Dr. Madson discusses some differences in launching the osteopathic school, as well as the impact of a new, unified path to accreditation for both MD and DO residency programs. And with all three new Texas medical schools planning to launch their inaugural classes in 2016 at a time when postgraduation training slots are in short supply, the former dean at the Pacific Northwest University College of Osteopathic Medicine in Yakima, Wash., says "it's medical education malpractice" if new schools are not also considering graduate medical education (GME) development. 

Texas Medicine: What did you think when approached for the job?

Dr. Madson: They didn't approach me. I found out about the job and applied because I was looking for a medical school where I could cast the vision as a founding dean. Before (at the Pacific Northwest University college), I was involved in the start-up of a new school, and I was brought on as assistant dean of clinical sciences. Then the founding dean left, and I became interim dean and was ultimately named permanent dean. 

So I understood start-up issues. But it's a once-in-a-lifetime opportunity to really be able to start a school from scratch. In this time of transformation in medical education, to have that opportunity to start with a blank slate is such a blessing. 

Texas Medicine: What is that vision you hope to cast?  

Dr. Madson: I would like UIW School of Medicine to be a place where all the members of the medical education community are empowered to achieve high levels of academic, professional, and personal success. That means a commitment to a learner-centered environment in which we are educating students to be patient-focused and developing meaningful partnerships across the whole spectrum of medical education, which includes not only the undergraduate piece but also graduate medical education and continuing medical education. And UIW is an organization that really emphasizes community service and social justice, so this is a great place to do justice-based research in medical education and in medicine in general — the social accountability that medical schools are being called to demonstrate. 

So I want our students to be physicians who understand how to address and meet the health needs of the society we live in and to be trained to serve people, especially those who are marginalized. We can help them by developing a curriculum that supports that and also research and service opportunities involving a wide range of partners. To set that transformational curriculum at a time when society demands accountability from institutions, that's a responsibility I don't take lightly. 

Texas Medicine: What are some of those service and research areas the school will focus on?

Dr. Madson: There will definitely be a focus on the underserved populations not only in San Antonio but also the region. And when we look at the region and our service area, the majority of it is underserved. UIW is designated as a Hispanic-serving university, so it has a history of doing that very well and improving access to education in all different kinds of programs, also increasing that access in the health professions.  

And just having a medical school in an area potentially can improve health outcomes, and that's a piece we are going to be looking at. It's not easy to demonstrate, I have to say, in a city like San Antonio where there are a lot of different confounding factors and lots of different health systems. Doing one small piece, you may not see evidence of improvement. But in smaller communities where we have students rotating for their third and fourth years — and I haven't identified all of those yet — you would be able to demonstrate that having medical education in a community does improve access and does improve quality of care because the physicians doing a lot of the teaching want to practice to higher standards or they are attracted because of the opportunity to teach. 

In my prior experience, our service area was the five states of the Pacific Northwest, and there were many smaller communities that had better recruitment of physicians because there was the opportunity to train medical students at those locations. 

Texas Medicine: Historically, osteopathic schools have focused on primary care. Will you continue that tradition? 

Dr. Madson: There will be a focus on primary care. To role-model that behavior, our faculty, administration, and staff will be primary care-dominant — general and internal medicine, pediatrics, and family medicine. That's not to say there won't be other specialists involved. But we want to role-model primary care and the importance of it, also to counteract the hidden curriculum in many medical schools of "you're too smart to be a family physician." I have heard more faculty say that. Students in the past heard it. And there's good literature to support [such occurrences]. So, if our mission is to increase the number of primary care physicians serving underserved populations, we need exemplary role models. That's not to say our students can't go into whatever [specialty] they want to go into. But they are going to come out of UIW with a solid primary care foundation from which they can differentiate into any specialty. And I'm hoping with the role models that we'll have for them, they'll want to go into primary care. 

Again, I want to intentionally recruit exemplary primary care role models so students do realize that primary care physicians are highly qualified diagnosticians, and they can provide what the country needs — patient-centered care that's economical, efficient, and effective — and also increase access to that kind of care. 

Texas Medicine: How are you preparing for the launch? What's different about starting an osteopathic versus allopathic medical school? 

Dr. Madson: Both MD and DO schools have to meet specific accreditation requirements. Osteopathic medical schools are accredited by COCA, the Commission on Osteopathic College Accreditation, which sets the standards for governance and finance, facilities, faculty, students, curriculum, research, and GME. Then setting the infrastructure to meet each one of those area requirements is basically what we started doing. The initial goal is to attain preaccreditation, followed by provisional accreditation; [the latter] is when you are permitted to begin recruitment of students. So to open in 2016, you want to be provisionally accredited in 2015 to start recruitment of students and the application cycle. Then any school remains provisionally accredited until it graduates its first class. 

It is a lot to do, and the preparation piece that's different for us compared to MDs is that we additionally have to focus on standards for osteopathic principles and practice and for demonstrating we are providing osteopathic care in a community. And they are pretty comprehensive standards. DOs are trained in the full scope of medicine, in addition to osteopathic principles of medicine and practice. So for the curriculum, we have classes for osteopathic principles and osteopathic manipulative treatment that have to be integrated across all four years. 

You need to develop a strategy so when your students are out and about on their rotations, they are getting that kind of instruction and opportunity to practice. You also want to make sure you have adequate lab space to do manipulation lab. And you have to have faculty who can train the students because that's a pretty intensive class. There are also osteopathic research pieces. So it covers a lot of those different areas of accreditation standards.

Texas Medicine: What's your response to concerns over developing new medical schools when GME slots are scarce? Are you also developing GME?

Dr. Madson: I have to tell you right off the bat, I am not a fan of opening new schools. So I thought long and hard about this opportunity. And the reason I came here was No. 1, because of the mission of UIW: the social accountability, the Hispanic-serving university designation. And I also researched possibilities for residency development, and there are some strong candidates that may not have been looked at by those who traditionally think of residency programs only being in very large institutions. 

Part of my experience from my past deanship was working with a team that developed teaching health center residency programs (community-based, primary care settings such as federally qualified health centers, community mental health centers, and rural health clinics). So there are other models out there. And again we are focused on primary care, so it's a little different emphasis. But I do agree: If you are going to start a school just to start a school, the bottleneck is GME. So you have to focus on that. That's why COCA, our accreditors, really focused on GME development and made it an accreditation standard. I support that standard because we must create new slots in order to develop programs responsibly. 

There are lots of GME opportunities across the country and in Texas. We continue as a profession through the American Osteopathic Association (AOA) and the American Association of Colleges of Osteopathic Medicine to work with Congress to lift the [Medicare GME] caps. While we do that, we can also look for other community-based models rather than the tertiary care, big health center models. Osteopathic medicine looks at smaller community models where graduates get an excellent graduate medical education just because they are doing the work they are going to continue to do in those communities. 

I always think about one of my girlfriends who's a DO. She did her residency in family medicine at a huge tertiary care center in the Los Angeles area and was recruited to a smaller community. The first patient she saw had an ingrown toenail, and she had no clue what do with it because she had been trained in inpatient medicine predominantly. She told me she felt she got educated once she left the tertiary care center and went into the community and really rolled her sleeves up. Those are the kinds of residency programs we are looking at potentially developing. We are in the very early stages. But you have to make that commitment; otherwise, it's medical education malpractice if you are not considering GME. Plus, now, it's an accreditation standard for us [new osteopathic schools].

Texas Medicine: What impact will the MD-DO GME accreditation merger have? (See "Uniqueness in Unity," January 2013 Texas Medicine, pages 43-48.)

Dr. Madson: It's challenging because this merger will take place over a couple of years. Those hospitals and entities that have been contacting us about starting GME programs assume it's going to be under a merged system. So now that there is a decision made that this is moving forward, I'm comforted to know we have our marching orders. I don't know exactly what all the rules are going to be, but I have an idea as this moves forward and we meet those standards. So that's what my plan is.

The benefits of the merger are, one, it's beneficial to the patient: It's easier to justify a single accreditation system for patient safety and standards of care. And that's not to say either system was substandard. It's just easier for people to understand across the board. 

Another benefit is for the students: Sixty percent of DO students are going into [allopathic] accredited residency programs now. That's not to say they all should. But there's this misperception that somehow one might be better than the other. This merger takes that piece out. 

With the assurances we will be able to maintain our osteopathic distinctiveness, it's very comforting to a lot of people and to a lot of students. Although, a majority of students look at it as a way to have a single "Match Day," rather than the two they have now. 

And third, this streamlines a lot of things. It also will potentially save money for schools with dually accredited programs. Instead of having a separate set of visits and reports that go to AOA and the Accreditation Council for Graduate Medical Education, they can consolidate those into one unified system of management and reporting.  

Texas Medicine: You are aiming for your first class size of 150 students. How did you come up with that number?

Dr. Madson: Again, osteopathic schools historically tend to produce more primary care graduates, so there's a great need. And that's the No. 1 reason: the great need for primary care physicians not only in Texas but also in the nation. The second thing is that osteopathic physicians tend to practice in more rural and underserved settings than their MD counterparts. So to get to those higher numbers, you are going to have to have a bigger class size. And third, we are a private osteopathic medical school, and budgets are highly tuition-dependent because we don't receive state funding. So a class size of 150 also provides that fiscal stability and funding availability for quality education, without driving tuition even higher than it is at a private institution.   

Texas Medicine: How did you get into medicine and education? 

Dr. Madson: I've always been good in science and drawn to people. My older sister was going to pharmacy school at the University of Washington. So I thought I could put myself through pharmacy school and use her books. Plus, my mom said it was a great career for women because you could work part-time, still make a living, and raise a family. And you could use all your science knowledge. 

Then I met my husband in pharmacy school, and he said, "With your abilities and the way you interact with people, I think you would be a really good family doctor." And I loved my family doctor so I thought, "What the heck?" So I worked as a clinical pharmacist in a hospital and ended up going to medical school at Michigan State, which has an MD and a DO school. I went to DO school because as a kid, one of my doctors was a DO and I had fallen out of a tree and he helped put me back to together again in a way that I think has really helped me long-term. 

So I went into family medicine and practiced for 27 years in solo practice. Then I sold my practice to the hospital where I had been a pharmacist and became medical director of a clinic. At that time, I was involved in state osteopathic and medicine politics and got recruited to go to the new medical school in Yakima, Wash., by my former dean from Michigan State. 

Texas Medicine: Do you think you will get back to practicing medicine? 

Dr. Madson: I was hoping to practice in my former job, and I never had the time. However, I do medical missions in Guatemala. That's something I'm hoping to continue and something you also have to do responsibly. I'm not a believer in drive-by medical outreach. It needs to be working with an in-country partner that's there long-term and that's sustainable. And you come alongside them. You don't tell anybody what to do. I like that model of showing students that's really the proper way to help people internationally. It's not an international medical rotation for tourism purposes. You're there to help them in any way that they identify, not that you identify.

Texas Medicine: How have you adjusted to Texas? 

Dr. Madson: It's been great so far. I've had the barbeque before. My son married a woman who graduated from The University of Texas at Austin. She was a cheerleader there, and they got married in Austin at the Salt Lick. It's a great state. The people have been so friendly and so welcoming. And the traffic is a big improvement over Seattle. Everybody tells me how hot it's going to be. I was here in September and October last year, and it was pretty toasty. So I've been prepared.  

Amy Lynn Sorrel can be reached by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email.


What's In a Name? 

Roughly 7 percent to 8 percent of the nation's practicing physicians are doctors of osteopathic medicine, or DOs. 

Unlike nonphysician "osteopaths" trained in "osteopathy" in other countries, U.S osteopathic physicians are trained in osteopathic medicine, which includes the full scope of medicine — like their MD (doctor of medicine) counterparts — in addition to hands-on osteopathic manipulative medicine principles and practice.

There are 30 accredited colleges of osteopathic medicine in the United States. Texas has one, the University of North Texas Health Science Center Texas College of Osteopathic Medicine in Fort Worth, and a second one under way, the University of the Incarnate Word School of Osteopathic Medicine in San Antonio. Together, the 30 schools represented 23,000 future osteopathic physicians — more than 20 percent of all U.S. medical students — in the 2013-14 academic year. 

Sources: Federation of State Medical Boards and American Association of Colleges of Osteopathic Medicine

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