For Ali Sawani, attending the University of the Incarnate Word (UIW) School of Osteopathic Medicine was a leap of faith.
“At first this school wasn’t high on my list,” the second-year student from Dallas said. “I’d always heard that with new schools, you need to be careful. They’re still straightening things out, and you’re kind of the guinea pigs.”
Some of Mr. Sawani’s misgivings were confirmed at his initial interview in 2016: The Catholic medical school in San Antonio would not open its doors until July 2017, and at the time of the interview, the campus’ four buildings were not operational.
Yet other things about the school appealed to him.
“The thing I loved the most was the atmosphere that I felt here,” Mr. Sawani said. “I got to interact with the dean one-on-one during the interview while we were waiting in line for lunch. … I went on a few other interviews before I came here, and at very few other places did the dean even speak.”
He also discovered that differing spiritual beliefs are discussed openly in classes in relation to patient needs and the philosophical dilemmas of medical care.
That openness reflects the school’s medical education philosophy in general.
UIW School of Osteopathic Medicine is Texas’ second osteopathic medical school, after the well-established University of North Texas Health Science Center at Fort Worth Texas College of Osteopathic Medicine. And like many other new medical schools in Texas, UIW does not subscribe to the traditional approach of constant lectures and memorization. (See “Dell’s Different Direction,” May 2017 Texas Medicine, www.texmed.org/DellDifferentDirection, and “Fulfilling a Dream,” September 2017 Texas Medicine, www.texmed.org/UTRGVDream.) Instead, UIW classes from 8 am to noon each week day are designed to be either discussions between medical students and their professors or small-group problem-solving sessions.
UIW deliberately placed its School of Osteopathic Medicine in one of the poorest neighborhoods in San Antonio. After settling in at the defunct U.S. Air Force School for Aerospace Medicine at Brooks Air Force Base, the first class of 162 students and second class of 158 have already begun to identify and address community health needs, says founding dean Robyn Phillips-Madson, DO.
“This is designated as a medically underserved population area, and other areas of San Antonio aren’t,” she said. “When you look at the mission of the school and the university, and look at where we’re situated, it makes sense that a school that’s founded on principles of social accountability would be in an environment like this, where we can partner with the community to help.”
Part of that process involves getting students directly involved in the south San Antonio community the school calls home. This area has the highest poverty level, the least access to health care, and the lowest education scores in the city, according to Anil Mangla, PhD, the school’s director of public health and associate professor for biomedical research. For example, that part of South San Antonio has the highest rate of diabetic foot amputations in the state, according to data compiled by Dr. Mangla.
Several UIW programs focus on improving care in the area. Later this academic year, the school plans to open a student-run medical clinic for low-income patients. The school has created a “community engagement program” that pairs students with families who qualify for federal health insurance exchanges, Medicare, and Medicaid. Students check on their assigned families twice a month to assess their mental health, food insecurity, and access to care.
“What we’re really doing is implementing the case management that goes to [the family’s] house twice a month, makes sure their needs are met, and reports back to the physician,” Dr. Mangla said. “That’s very important because the physician doesn’t get a chance to understand what is happening beyond the office. … They can actually use that information to assist the patient,” because it gives the future physicians better context for patients’ medical issues.
At the same time, the program helps students understand which social services are available to their patients, says Jessica Gale, a second-year student who leads the Texas Medical Association’s student chapter at UIW. More importantly, it deepens the ties between students and the community in ways that transcend medical care.
“I know there are classmates who had really meaningful connections,” she said. “They visited [the families] outside of school-designated time, they had birthday parties with them. And what they reported is that the kids in that family look at the medical students and really see what’s possible for them. There’s a medical school that’s 15 minutes from my house and I could go there some day? That’s insane. It’s kind of blowing their mind on what’s possible.”
A different approach
Creating a medical school at UIW was in many ways a natural progression for the university, Dr. Phillips-Madson says. The Sisters of Charity of the Incarnate Word first came to San Antonio in 1869 to help with a cholera epidemic, and from that grew the double ministries of education and health care. The nuns founded a school for women in 1881 that later became the coeducational University of the Incarnate Word. UIW has had a heavy emphasis on health care, with schools for nursing, pharmacy, optometry, and physical therapy.
“This [medical school] kind of rounds out the order,” Dr. Phillips-Madson said.
The osteopathic school, which is privately funded through tuition and donors, cost about $50 million to build. That included gutting and revamping the old Air Force buildings to serve the needs of modern medical education.
The four-building campus has been tailored to UIW’s interactive teaching philosophy: There is only one lecture hall. The other classrooms are set up to facilitate small-group discussions.
Osteopathic principles are woven into the curriculum.
“For instance, in [training to conduct] the physical exam, we’d do the normal heart, lungs, that sort of thing,” said Ramona Ann Parker, PhD. She is associate dean for medical and inter-professional education and a registered nurse. “But then we also do what’s called an osteopathic structural examination where they really focus on soft tissue, focus on the lymphatic system. … And we teach [students] that should be one of their primary focuses, which is not seen in the allopathic world.”
UIW’s medical school has made structural innovations to fit its mission, Dr. Phillips-Madson says. For instance, UIW is not broken up into departments like physiology, biochemistry, or surgery. Instead, it is a single department designed to promote the integration of the curriculum.
“It’s removed the opportunities for ‘us versus them,’” she said. “We’re all working together.”
Naturally, there have been challenges. One of the biggest has been helping faculty members learn a new way of teaching medicine, says Dr. Phillips-Madson. Given their experience at other medical schools, it’s easy to slip back into lecturing rather than leading a Socratic dialogue.
“You can be the most exciting lecturer ever, but research shows that [students] aren’t going to remember more than 10 to 20 percent of what you imparted on them,” she said. “Why do that? It’s a waste of their time. So you engage them, and engaging isn’t as easy as it looks. But once [the professors do engage the students], they love it.”
This approach to teaching medicine also made many students uneasy for a while, Ms. Gale says.
“There was a lot of insecurity among my peers among the first couple months of this curriculum,” she said. “Are we being prepared? How do we know what we need to know? Are we going to be behind our cohort at other Texas schools? The expression we hear is, ‘Trust the process.’ And it really is real. We’re seeing now that we do actually retain a lot, and it’s seeming like we’ll do less cramming because we’re learning in a different way.”
The San Antonio community is getting an education as well: Despite the fact that osteopathic physicians comprise 8 to 9 percent of doctors in the United States, students and faculty often find themselves explaining to local residents osteopathic medicine and how it’s different from allopathic medicine, Dr. Phillips-Madson says.
New school challenges
A bigger ongoing challenge, however, is tuition. Like many osteopathic medical schools, UIW is private and costs up to $58,636 per year for tuition, fees, and health coverage, compared with an average of $20,730 for the other 11 Texas medical schools. Baylor College of Medicine in Houston, the only other private medical school in Texas, costs $24,363 per year.
Because most medical students rely on student loans, UIW students could graduate with much larger student loan debt.
This financial reality could compromise one of the school’s top goals: boosting the number of primary care physicians in Texas and the United States. (See “Physician Shortage Prompts New Medical Schools” page 37.) Because primary care physicians usually earn less than specialists, students graduating with higher debt loads could have a financial incentive to pick better-paying specialties.
UIW’s comparatively high tuition and corresponding student debt load also hurts recruitment, Dr. Phillips-Madson acknowledges. The school is tackling that by building a scholarship endowment and creating a research program to supplement donations and tuition money. Likewise, UIW plans to steer graduating students toward residencies in U.S. government programs that help them pay off loans through military service or work in federally qualified health centers.
“We’re also working on programs with individual communities where different businesses or chambers of commerce will pay back some of the loans to get people to come serve in their communities,” Dr. Phillips-Madson said.
And as with most new medical schools, UIW is grappling with the problem of establishing enough residency training slots for students to complete their physician training. (See “The Problem of Residencies,” left.)
Despite some challenges, UIW’s school of medicine is not hurting for applications, Dr. Phillips-Madson says. It received 3,407 for its inaugural class and 3,600 for its second class. Many are drawn to osteopathic medicine’s emphasis on primary care.
Mr. Sawani, who leans strongly toward pediatrics, says he’d consider residencies in nearby states like Oklahoma or Louisiana, if necessary. But his goal is to set up a practice or get into academic medicine in Texas to stay near family and friends.
“I am aware of the statistics that most people stay close to where they do their residency,” he said. “I’m hoping that I will love the residency program where I end up and I will want to stay.”
Tex Med. 2018;114(11):34-39
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