Primary Care-Population Medicine Program

Summary

In 2015 Brown University launched the Primary Care-Population Medicine (PCPM) Program, an innovative dual degree program designed to prepare students for a career in medicine and population health leadership. The program is the first of its kind in the United States, offering medical students the opportunity to earn both a Medical Degree (MD) and Master of Science in Population Medicine (ScM) in four years. According to Dean Paul George, MD, Director of the PCPM Program, the program was developed to address the critical deficiency of primary care providers in the U.S. (an estimated shortage of 20,400 providers in 2020^[1]) and to “create new-age physicians, who are well-versed in social determinants of health, health disparities, health economics, and population health.”

In addition to the traditional basic science medical school curriculum, the PCPM program integrates two additional major components: the Master of Science in Population Medicine coursework and the Longitudinal Integrated Clerkship (LIC). For the Master of Science in Population Medicine, students develop the knowledge and technical skills necessary for navigating the rapidly evolving 21^st century healthcare system through coursework in health systems and policy (US and abroad), biostatistics and epidemiology, quality improvement, and population and clinical medicine. Additionally, students perform scholarly work for their Masters by completing a thesis research project related to population health. The other major component of the PCPM program is the Longitudinal Integrated Clerkship (LIC), which begins in the third year of medical school. Instead of rotating through clerkships every six weeks, students in the PCPM program spend one half-day per week with a mentor in family medicine, internal medicine, obstetrics and gynecology, pediatrics, psychiatry/neurology, and surgery over the course of one year. Students are also assigned to a patient panel of 75-100 patients, whom they accompany to health care settings such as primary care offices, specialty appointments, the operating room, rehabilitation, and home care. Through this experience, students gain insight into the realities of navigating the health care system.^[2]

The program ultimately aims to graduate more primary care physicians, and also encourages specialization in areas of critical need like endocrinology and nephrology. PCPM students, however, are not required to enter a specific specialty in medicine, as the program recognizes students’ interests may change over time and acknowledges “the need for physicians trained in population medicine in all specialty areas.”^[3]

Keys to Success

Engagement with local community

One major strength of the PCPM program is its facilitation of local community engagement. In the third year, students complete a “Social and Community Context of Healthcare Project,” in which they learn about the health and social needs of the Providence community from members of the community. After speaking with community members and learning in depth about the specific local context, students propose and implement a project to address a community healthcare or social service need. Past projects have included educating people in local homeless shelters on how to deliver Narcan, an emergency treatment for opioid overdose (Rhode Island has one of the highest rates of opioid overdose-related deaths^[4]) and teaching local high school students about the health effects of vaping. According to Dean George, the Social and Community of Healthcare projects are unique and rewarding as students engage in projects that are “related to medicine, but not typical of medical education.”

Leveraging existing resources and talents

Dean George emphasized the importance of leveraging existing resources in creating a program that successfully alters – and enhances – the traditional medical school curriculum. While the Alpert Medical School briefly entertained creating a separate track for its PCPM students, the decision was made to keep PCPM and traditional medical students together for basic science education. The sharing of resources can go both ways. One unexpected benefit that came with the development of the PCPM program was the creation of the first course in the Masters Sequence on “Social Determinants of Health and Health Disparities.” Recognizing the salience of these topics, the Alpert Medical School leadership decided to offer the course that was initially designed for the PCPM program to all of its medical students, making “Social Determinants of Health and Health Disparities” an official requirement of the first-year curriculum.

Beyond the collaboration within the medical school, the PCPM program has also leveraged the expertise of leaders from the broader university. Integrating faculty from Brown’s School of Public Health and the University’s Department of Economics for the Masters coursework has been critical in developing and sustaining the program.

Ability to Inspire

Brown’s PCPM program, as the first of its kind, will hopefully serve as a model for other medical schools on how to integrate population health into the traditional medical school curriculum. Commenting on the changes he hopes to see in medical education and healthcare, Dean George said,  “I would love to see a course at every medical school on social determinants and health disparities [as well as] the intersection between clinical medicine and population health.”

Drawbacks & Limitations

The PCPM expands upon what is considered an already dense and demanding medical school curriculum. While Dean George said that the vast majority of students can handle the additional coursework in population health, he acknowledged that the program and the additional work it requires are not for everyone.

The impact of the PCPM program on the landscape of healthcare professionals remains to be seen as the first class has yet to graduate. How students of the PCPM program fare in comparison to traditional medical students is also a question that warrants further examination as the program evolves. Lastly, given that participants are not required to go into primary care, it will be interesting to see if the program is successful in increasing interest and practice in primary care.