Few medical schools embrace accelerated primary care track curriculum

Hoping to ease the physician shortage in underserved areas and boost the appeal of family medicine, the New York College of Osteopathic Medicine (NYCOM) of New York Institute of Technology in Old Westbury has launched an accelerated family medicine curriculum, aided by a five-year $950,000 federal grant.

Beginning next June, NYCOM will enroll up to 15 second-year students in the pilot program, which compresses the final three years of medical school into two and matches graduates into NYCOM-affiliated family medicine residencies. Enrollees will serve their third-year rotations at their residency sites, which fan across underserved urban, rural and suburban New York.

“We are shortening the pipeline to medical practice, reducing student indebtedness by eliminating a year of medical school, and putting trainees in areas where physicians are needed,” says Thomas A. Scandalis, DO, NYCOM’s dean.

NYCOM’s director of clerkship education, Leonard B. Goldstein, DDS, PhD, expects that careful screening will help ensure student retention in the accelerated family medicine curriculum.

Because of the demands of the accelerated program, only NYCOM students who are in the top half of their class during their first year and who scored at least a 27 on the Medical College Admission Test will be considered potential candidates. Students enrolled in either of NYCOM’s curricular options—lecture-based or problem-based learning—can apply to the accelerated program.

Candidates will need to provide a personal statement expressing their interest in family medicine and complete a questionnaire that will help determine whether their interests and attitudes mesh with family medicine. The prospects will be interviewed by NYCOM faculty and administrators and by clinical faculty at the training sites.

Curriculum closeup

Selected students will begin their second year in June with a 10-week introduction to family medicine. During the regular academic year, they will follow the same curriculum as other NYCOM students in the lecture-based or problem-based learning tracks. But accelerated students will also serve a longitudinal family medicine preceptorship and take part in a problem-based seminar in which they discuss patient cases in small groups.

In the spring of their second year, students in the accelerated program will participate in a “mini match” and be assigned to one of several training sites throughout New York state. The students will begin their rotations at their assigned site in June, immediately after their second year.

Finishing all of their clinical rotations in the third year, the students will serve the following four-week clerkships consecutively:

  • Internal medicine (two four-week rotations)
  • Obstetrics and gynecology
  • Pediatrics
  • Psychiatry
  • General surgery
  • Surgical selective
  • Subinternship in internal medicine or inpatient family medicine
  • Emergency medicine
  • Radiology
  • Internal medicine selective
  • Internal medicine elective.

The third-year students will serve clerkships in family medicine and osteopathic manipulative medicine concurrently with their other rotations.

Because of the early summer start and continuous nature of the curriculum, accelerated students will be able to complete the 130 weeks of instruction required by the AOA Commission on Osteopathic College Accreditation in three years rather than four.

Other NYCOM students serve five-week rather than four-week clerkships, typically at different hospitals and other training sites. Because the students in the accelerated continuum will serve all of their rotations at one hospital, “they will not need as much time at the beginning of each clerkship to get oriented,” says Abraham M. Jeger, PhD, NCYOM’s associate dean for clinical education.

The accelerated family medicine program also eliminates some of the fourth-year electives. “Fourth-year students normally use electives to decide on a specialty,” Dr. Jeger notes. Since students in the accelerated continuum will have already chosen family medicine as their specialty, they will not need those electives to explore possible career choices, he says.

One year after they begin their rotations at their assigned site, NYCOM’s accelerated program enrollees will stay to serve their three-year family medicine residencies. “Studies have shown that physicians tend to practice close to where they train,” Dr. Scandalis says. NYCOM hopes that the accelerated program’s graduates will practice in communities near or similar to those served by the training sites.

Students in the program who change their minds about family medicine or have difficulty with the accelerated pace can transfer back to NYCOM’s four-year curriculum. The extensive screening of candidates should keep such instances to a minimum, says Leonard B. Goldstein, DDS, PhD, NYCOM’s director of clerkship education.

“To be selected, students will need to demonstrate their passion for family medicine and serving the underserved, they will be interviewed by hospital faculty, and they will need to sign a contract to show their commitment,” Dr. Goldstein says. “But the contract does have an escape clause.”

On the frontier

NYCOM is one of only two osteopathic medical schools to have an accelerated curriculum option. The Lake Erie College of Osteopathic Medicine in Erie, Pa., has a three-year primary care pathway that is not specific to family medicine. Among other medical schools in the U.S., only the Texas Tech University School of Medicine in Lubbock has a three-year MD program, for students committed to family medicine.

“Several other colleges of osteopathic medicine have expressed interest in NYCOM’s accelerated family medicine continuum, but they want to see what our outcomes will be before starting their own programs,” Dr. Jeger says.

During the first six years of the pilot program, NYCOM will measure such outcomes as retention rates in the accelerated curriculum, performance on the Comprehensive Osteopathic Medical Licensing Examination—USA and on the American Board of Osteopathic Family Physicians certifying examination. “We need to make sure that the accelerated continuum will give graduates what they need to excel as family physicians,” Dr. Scandalis says.

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