Cubas Latin American Medical School A New Primary

Cuba’s Latin American Medical School: A New Primary Care Pipeline Scott Loeliger, MD, MS September 2009

Shortage of family medicine residents trained in the US • Downward trend in number of family medicine residents • Only 42. 4% of family medicine residency slots filled by US medical school graduates in 2009 • Most of the remaining slots were filled by IMGs and graduates of osteopathic medical schools 1 1 Source: Results and Data 2009 Main Residency Match (NRMP)

Family Medicine Residency Positions Filled by U. S. Medical School Graduates Source: Bodenheimer T. N Engl J Med 2006; 355: 861 -864

US graduating medical students choice of specialty/subspecialty n= 11, 525 AAMC 2008 Medical School Graduation Questionnaire results Source: http: //www. aamc. org/data/gq/allschoolsreports/2008_ss. pdf

Shortage of minority physicians in the US • African Americans, Hispanic Americans and Native Americans comprise more than 25% of the U. S. population, yet they account for less than 10% of the physician workforce 1 • Census Bureau estimates these groups will comprise 28% of the US population by 2010 and 39% by 2050, yet recruitment efforts and federal incentive programs have plateaued recently 2 1 2 Medical Education Futures Study, Policy Brief “Underrepresented Minorities in Medicine: The Need for a Diverse Physician Workforce, ” July 2008 U. S. Census Bureau accessed September 1, 2009

Percent of US Medical School Enrollees, Practitioners, and Medical School Faculty Compared to Representation in US Population by Race/Ethnicity, 2004 Source: Medical Education Futures Study, Policy Brief “Underrepresented Minorities in Medicine: The Need for a Diverse Physician Workforce, ” July 2008

Minority students are an important key to primary care workforce • Diversity in the health workforce is important to guarantee high quality and culturally responsive care • Minority doctors are more likely to provide primary care in medically underserved areas and to poor, underinsured, uninsured, and/or predominantly minority populations 1 1 Council on Graduate Medical Education, Twelfth Report Minorities in Medicine, 1998

Federal HRSA Title VII Health Professions Program Funding Program FY 2005 ($million) FY 2006 ($million) % Change Health Careers Opportunity Program (HCOP) $35. 6 $4. 0 -88. 9% Centers of Excellence (COE) $33. 6 $11. 9 -64. 7% Primary Care $88. 8 $41. 3 -53. 5%

Latin American Medical School (ELAM)

History of ELAM • Created in 1998, after Hurricane Mitch • Offers full scholarships for over 10, 000 students • 101 ethnic groups • 29 countries • Over 100 are US students from low-income minority families

Different from Previous Scholarships: Aiming for Sustainability • Student selection: poor, indigenous, marginalized • Bridging program – Pre-med program ensures students have solid foundation in Spanish and basic sciences • Training geared to country of origin • Looking for commitment to underserved

Accreditation • Fully recognized by the Educational Consortium on Foreign Medical Graduates (ECFMG) • Included in the International Medical Education Directory (IMED) • Also accredited by the California Medical Board and WHO

Curriculum • 6 year program – Years 1 -2: basic clinical sciences – Years 3 -5: clinical rotations and public health – 6 th year: hospital based internship – 5 out of the 6 years include a 7 week rotation in Family Medicine

Curriculum • Scientifically similar to US medical schools • Added emphasis on: – Public health – Health equity – Community outreach – Community service – Complementary and alternative medicine – Disaster medicine

Characteristics of US ELAM students

Characteristics of US ELAM students • From low-income and minority communities in the US • Commitment and pledge to serve the underserved • Debt-free • Fully bilingual

Characteristics of US ELAM students • High caliber students • Many could easily have attended med school in the US, but chose not to: – Financial barriers – US medical programs did not excite or engage them “ELAM was my first choice, not my last resort. ” – Kareese Gayle, 5 th year medical student

Gender of US ELAM students

Race/Ethnicity of US ELAM students

Geographic regions represented by US ELAM students

Demonstrated commitment to community service • Student Health Brigades • Student-run health outreach and recruitment programs in underserved communities each summer • Salud Southwest Exchange, July 2009 “How to provide free or low-cost health care to those most in need was once a blurry vision in my mind. Now it has been manifested in stark clarity in so many centers we visited in the Southwest. ” – Keasha Guerrier, 5 th year ELAM student “Many of us are already organizing for returning to communities we visited. I’m thrilled to start and continue in the struggle for the healing of humanity. ” – Elicia Garcia Steele, 1 st year ELAM student

Demonstrated commitment to community service Salud New Orleans, LA: August 2009 • Goal: To foster the development of community leadership skills in future doctors and provide sustained service to a specific underserved community over multiple years • Design and implementation of community needs assessment of a 10 block radius in the Lower 9 th Ward of New Orleans • 3 year project in collaboration with a local community clinic

Specialty interest of US ELAM students and graduates: all years ELAM Source: MEDICC Survey data, 2009 US n= 73

Challenges for US ELAM students • Financial barriers • Preparing and taking USLME • Transition to US Health System • Stigma and/or lack of awareness by residency programs about ELAM and its curriculum

Medical Education Cooperation with Cuba (MEDICC) • Mission: To enhance cooperation among US, Cuban, and global health communities aimed at better outcomes

MEDICC’s efforts to support US ELAM Students • Thabo Mnisi Fellowships – funding to defray USMLE costs • Mentorship Program – connecting students and graduates with US physician mentors • MD Pipeline to Community Service – creating linkages with community based clinics and public hospitals

Thabo Mnisi Fellowships • Named for a South African physician trained in Cuba who dedicated his life to underserved care • Awards range from $700$4, 500 depending on need, academic standing and commitment to service • Fellowships help defray costs of USMLE exam and prep courses • 38 Fellowships awarded since 2007 2008 Mnisi Fellows

MEDICC Mentorship Program • Began in late 2008 • Provide guidance through six years at ELAM • Offer advice on USMLE preparations • Provide orientation to US healthcare system • Assist with residency applications • Follow graduates’ careers

MEDICC Mentorship Program • 57 students enrolled to date • 32 Mentors participating • Each Mentor has 1 -3 mentees • Matched according to specialty, and geographical region • Priority given to students closest to graduation • All primary care specialties represented; majority family physicians

Mentorship Matches by Graduation Year YEAR Graduate 6 th 5 th 4 th 3 th 2 nd 1 st TOTAL MENTEES 7 5 9 10 6 11 9 57 MENTOR MATCHES 7 5 8 3 3 32 % MATCHED 100% 89% 30% 50% 27% 33% 56%

MEDICC MD Pipeline to Community Service – Links students and graduates with community clinics, public hospitals and other community health facilities • Summer shadowing and externships for students • Transitional employment for graduates as they prepare for residency programs – Reinforces pipeline into frontline primary care settings

ELAM Graduates: Unique IMGs • No brain drain! • In contrast to US students from other offshore medical schools, US ELAM grads: – Have no significant debt burden – Have a commitment to underserved care – Have received medical training which emphasizes, prioritizes and highly values family medicine – Are fully bilingual – Are a diverse health workforce

US ELAM Graduates • Where are they now? – First cohort of 8 students graduated in 2007 – Most recent class graduated 17 doctors – Recently created their own Alumni Association to support each other after graduation and into the future

Looking Forward • 3 grads matched so far, many more in pipeline for 2010 and 2011 matches • More clerkships needed to demonstrate clinical skills – Albert Einstein is providing spaces for ELAM students in their Senior Electives • More outreach needed to residency programs in underserved areas • More Mentors needed

Thank you! MEDICC Contact Info: Rachel True, MPH Academic Program Director rtrue@mediccglobal. org