Department of Family Medicine Medical Student Education Section University of Washington E304 Magnuson Health Sciences Building 206.616.7889

Kimberly Kardonsky, MD Sharon Dobie, MD, MCP Lynn Oliver, MD Genya Shimkin, MPH Audrey Lew

November 15, 2018 Dear Colleagues, The Underserved Pathway (UP) is pleased to share our 2018 annual report. The 2017-2018 academic year was a dynamic and exciting one, which culminated in our welcoming a new Faculty Director, Dr. Kimberly Kardonsky. Our founding Director, Dr. Sharon Dobie, has retired, though she remains involved as a mentor and advisor. The Pathway team worked hard this year to deliver content and experiences that build on students’ required curriculum, and inspire and nurture their interest in working in underserved communities. We continue to work closely with the Targeted Rural/Underserved Track (TRUST) and the new Community-focused Urban Scholars Program (CUSP). As interest in the UP continues to grow, we look forward to expanding our network of mentors, and pursuing new partnerships throughout the WWAMI region. Please feel free to contact us with any comments or suggestions. Kimberly Kardonsky, MD Underserved Pathway Director Sharon Dobie, MD, MCP Underserved Pathway Faculty Lynn Oliver, MD Underserved Pathway Faculty Genya Shimkin, MPH Underserved Pathway Program Manager Audrey Lew Medical Student Education Section Manager

UW Department of Family Medicine

UNDERSERVED PATHWAY ANNUAL REPORT 2017-2018

IN MAY 2018, 62 STUDENTS GRADUATED WITH A

CERTIFICATE FROM THE UNDERSERVED PATHWAY

74 MEMBERS OF THE CLASS OF

2018 PARTICIPATED IN THE

UNDERSERVED PATHWAY.

DEPARTMENT OF FAMILY MEDICINE

MEDICAL STUDENT EDUCATION SECTION

UW SCHOOL OF MEDICINE

UPATH@UW.EDU

https://depts.washington.edu/fammed/education/programs/upath/

PROGRAM HIGHLIGHTS

54% of 2018 Pathway graduates matched in

a primary care residency, compared to 30%

of non-Pathway graduates.

PRIMARY CARE RESIDENCIES

Between July 2017 and June 2018, students submitted 431

module evaluations, with 84% saying the module content

was likely to impact their future work.

All Pathway modules are now publicly available!

MODULES

All Pathway students are required to complete 24 hours of

service learning. The class of 2018 completed over 3,000

total hours of service during their medical school careers.

SERVICE LEARNING

After 12 years with the Underserved Pathway, Dr. Sharon

Dobie has retired and Family Medicine welcomed Dr. Kim

Kardonsky as new Pathway Director!

NEW PATHWAY DIRECTOR

ACROSS THE SCHOOL OF MEDICINE, 300

STUDENTS WERE ENROLLED IN THE PATHWAY

DURING THE 2017-2018 SCHOOL YEAR.

"I am thankful to the Underserved Pathway for keeping me

connected to my core value of service throughout medical school."

-Matt Novack, MD, UWSOM Class of 2018

R1, Tacoma Family Medicine

OverviewandParticipation

TheUnderservedpathway(UP)started11yearsagoattheUniversityofWashingtonSchoolofMedicine(UWSOM)toaddressthephysicianshortagesinunderservedareas;theUPtrainsmedicalstudentstoworkwithunderservedandvulnerablepopulations.TheUPhasseveralcurricularandextra-curricularcomponents,includingdevelopingafoundationofknowledge,longitudinalmentorship,andcommunityservicelearning.

ParticipationThreehundredstudentsparticipatedintheUPduringthe2017-2018academicyear.InMay2018,62studentsgraduatedwithcertificatesforcompletionoftheUP.Sinceitsinception,366studentshavegraduatedfromtheUP.Wecontinuetoseeinterestfromstudentsacrossoursixcampuses,asshowninFigure1.Infact,themajorityofstudentsenrolledinthePathway(59%)spenttheirFoundationsPhaseonregionalcampuses.Figure1

7%

13%

18%

41%

6%

15%

UNDERSERVEDPATHWAYENROLLMENT,BYFOUNDATIONSCAMPUS,2017-2018 (N=300)

Alaska Idaho Montana Seattle Wyoming Spokane

Figure2

*projectedgraduatesin2019

MentorshipWehavebeenfortunatetohave147activementorsthispastyear.Manymentorshavemorethanonementeeatatime,withsomementors(especiallyTRUSTpreceptors)havingasmanyasfivementees.Mentorsandmenteesmeetonceperacademicquarterandthiscanbeinperson,byemail,phone,orskype.Studentsmayseekoutamentorbasedontheirgender,culturalbackground,specialty,geographicarea,orpracticewithspecificunderservedpopulations.Whilemoststudentsselecttheirownmentor,pathwaystaffkeepalistofmentorsthroughouttheWWAMIregion,andworkwithstudentsseekingguidanceinfindingamentor.SharingthejoysandchallengesofworkinginanunderservedareaisakeycomponentofUPmentorship.WehopethatsomedaysoonwewillhavemorementorswhoareUPgraduateshelpingcontributetotheecosystemofcaringfortheunderserved;wealreadyhaveafew!

1

13

19

15

26

29

48 47

44

62 62

71

2 0 0 8 2 0 0 9 2 0 1 0 2 0 1 1 2 0 1 2 2 0 1 3 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2019*

UNDERSERVEDPATHWAYGRADUATES2008-2018

Figure3

CommunityServicePathwayscholarsarerequiredtocomplete24hoursofservicelearningthroughoutmedicalschool.Wefindthatingeneral,studentsgoaboveandbeyondthatrequirement,withmanystudentscompletinghundredsofhoursofservice.Studentsareinvolvedinavarietyofactivities,includingadvocacyatthelocal,state,andnationalpolicylevels.Indeed,oneofourIdahostudentswasinstrumentalinthepassageofMedicaidexpansioninIdahoduringthe2018mid-termelections.Manyofourstudentsvolunteeratfreeclinics,healthfairs,mentoringevents,orserveascommunityorganizersrallyingsupportforissuesthataffectpublichealth.

OutcomesInthe2018residencymatch,54%percentofUPgraduatesmatchedinprimarycare(definedasFamilyMedicine,Pediatrics,PrimaryCareInternalMedicine,Medicine-Pediatrics)versus36.6%ofthetotalUWSOMgraduatingmedicalstudents,or30%ofnon-UPgraduates.Figures4and5showthebreakdownofstudentsmatchinginprimarycarespecialtiesbyPathwaystatus.Figure4showsonlyPathwaygraduates;Figure5showsthefullgraduatingclassofUWSOM.

12

19

12

21

71

12

A K EWA ID MT WWA WY

NUMBEROFACTIVEMENTORSBYREGION,2017-2018

Figure4

Figure5

28%

0%

13%

11%

46%

PATHWAYGRADUATESMATCHINGINPRIMARYCAREVERSUSOTHERSPECIALTIES,2018

N=61

FamilyMedicine(17) Medicine-Pediatrics(1) Pediatrics(8)

PrimaryCareInternalMedicine(7) Non-PrimaryCareSpecialties(28)

54%ofPathwayGraduatesMatchedinPrimaryCare

17%

1%

14%

5%

63%

UWSOMGRADUATESMATCHINGINPRIMARYCAREVERSUSOTHERSPECIALTIES,2018

N=227

FamilyMedicine(38) Medicine-Pediatrics(2) Pediatrics(31)

PrimaryCareInternalMedicine(12) Non-PrimaryCareSpecialties(144)

37%of2018UWSOMgraduatesmatchedinPrimaryCare.The percentagedropsto30%ifyousubtractthePathwaygraduatesfromthetotalclass.AmongstudentsmatchinginPrimaryCare,40%graduatedinthePathway.

ModulesandEvaluationsAkeycomponentoftheUPcurriculumisouronlinemodules;allstudentsarerequiredtocomplete10modulestograduate,andweoffer28modulestochoosefrom.Topicsrangefromskills-basedcontent(healthliteracy,motivationalinterviewing)tooverviewsofspecificpopulations(LGBTQhealth,immigrantandrefugeehealth,ruralhealth),tomodulesthatfocusonspecificdiseases(substanceusedisorders,HIV).Thisyearwemadeourmodulecontentpubliclyavailable!Youcanviewourmoduleshere:https://canvas.uw.edu/courses/1176574Allparticipantsarerequiredtocomplete“WhoaretheUnderserved”andallTRUSTscholarsarerequiredtocomplete“UnderstandingPopulationHealthData.”Asidefromthosemodules,themostcompletedmodulesare“PatientswithHIV/AIDS,”“BehaviorChangeandMotivationalInterviewing,”and“TheDangerofaSingleStory.”Figure6

NewModulesThisyearweintroducedsixnewmodules,anddiscontinuedsomeolderones.Forexample,weretiredthe“Advocacy”module,andreplaceditwithtwonewmodules“AdvocacyI:PhysiciansasAdvocates”and“AdvocacyII:ToolsforPhysicianAdvocates.”Wealsoexpandedthe“PovertyandChronicLowIncome”moduleintotwoseparatemodules:“Poverty:Definitions,Characteristics,andPolicy”and“PovertyandHealth.”Finally,inresponsetostudentfeedback,

73

33

25 24 23 21 21 20 20 19

14 14 13 12 11 11 11 10 10 9 8 5 4 4 3 2 2 1 1

COMPLETEDMODULEEVALUATIONS,2017-2018

weintroducedtwonewmodules:“RacismandHealth”and“RacismandDiscrimination:TheLivedExperience.”Inlastyear’sstudentfeedback,multiplestudentsrequestedamoduleonveterans,andthisyearPathwayteamdevelopedandlaunchedanewVeterans’Healthmodulewithhelpfromstudentandfacultyveterans.Theteamplanstohaveanin-personmoduleonthetopicin2019.Duringthe2017-2018schoolyear,weofferedthreein-personmodules(liveeventsfeaturingaguestspeaker,paneldiscussion,orlecture)includingthefirstofaseriesonPovertyfeaturingProfessorScottAllardfromtheUWEvansSchoolofPublicPolicyandGovernance.OthermodulesinprogressorincontemplationstageincludehumantraffickingandNativeAmericanhealth.SinceUWSOMcoversafive-stateregion,onegoalintheupcomingyearistohaveoneoftheWWAMIsitesoutsideofSeattlehostorco-hostalivemodule.ModuleEvaluationsOfthemoduleevaluationssubmittedduringthe2017-2018schoolyear,299reportedthemodulecontentencouragedtheirinterestinworkingwithunderservedpopulations.SeeFigure7forasummaryofthemostencouragingmodules.Thesesevenmodulesareamongthemostpopular,andthusreceivedthemostreviews.Amongmoduleswith20ormoreevaluations,thesesevenmodulesscoredhighestonthequestion“howencouragingordiscouragingwasthecontentofthismoduletoyourinterestinworkinginunderservedcommunities?”Figure8highlightscommentsfromstudents’feedbacksurveys.Weusetheirfeedbacktoimprovemodulecontentandkeepthecontentcurrentandrelevant.Figure7

Figure8

83%

79%

79%

72%

70%

70%

68%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Reflections:ChimamandaAdichie:TheDanger…

BehaviorChangeandMotivationalInterviewing…

PopulationHealthData(formerlyPublicHealth…

PatientswithHIV/AIDS

IntimatePartnerViolence

IntroductiontoHomelessness

WhoaretheUnderserved?

%ofStudentswhofoundcontentencouraging

Howencouragingordiscouragingwasthismoduletoyour

interestinworkingwithunderservedpopulations?

W H O A R E T H E U N D E R S E R V E D ? “I liked the way that this module presented such complexissues, but I think it would have been helpful to readpersonal experiences from physicians. For example, itwould have been informative to learn about a time inwhich a physician was faced with a patient belonging to aspecific underserved population that they did not knowto help, and how they went about learning how toaddress the patient's concerns.”

P O V E R T Y : D E F I N I T I O N S , C H A R A C T E R I S T I C S , A N D P O L I C Y

“I really appreciated the "Spent" exercise and will use it to sharewith others when discussing the realities of living in poverty.”

E X P L O R I N G D I S A B I L I T Y “I thought this was the best module I have done so far. Very thought provoking!”“More info on mental illness disabilities would be wonderful (maybe even awhole module would be awesome!).”

I N C A R C E R A T E D H E A L T H C A R E “It might have been nice to have some info or supplemental resourcesabout how a physician practicing in the general community can besthelp any of their patients who have been incarcerated in the past... Itwould also be inspiring to get any info available on rehabilitationprograms or social justice campaigns focused on addressing theseissues on a larger scale and how physicians can be involved in this.”

We use student feedback and comments toimprove our module content and keep thematerial dynamic and up-to-date.

I N T R O D U C T I O N T O S U B S T A N C E U S E D I S O R D E R S “I have a personal interest in opioid-replacement therapy, so it would havebeen interesting to learn more about that those programs and, especially, thesupport they have in the various WWAMI states.”“I liked the NIH Drug Abuse resource page; this will be helpful for me to sharewith future patients.”

L G B T Q H E A L T H “I adored the interactive modules from the National LGBT HealthEducation center.  Thank you for introducing us to this resource!”

M E D I C A R E 1 0 1 “Though perhaps not related to underserved populations, I really want to knowmore about how Medicare funds residency positions which, in turn, affects thenumber of doctors available to treat underserved populations.”“Maybe I just missed it, but a good resource for estimating cost of services andmedications would be great - I was not super accurate in the quiz and wish I had abetter sense of these things!”

STUDENT COMMENTS

R U R A L H E A L T H I A N D I I “[I would like more content on] the ethics of establishing limits as arural doctor.”“Real life examples of what certain states or regions have done thathave been effective in improving rural health carestructure/access.”

I N T I M A T E P A R T N E R V I O L E N C E “I really appreciated the links to state-specific information. Inthe past when learning about intimate partner violenceconversations about what to do once a patient disclosesviolence often get answered with "well that would depend onthe state" so I am glad to now have that resource!”

O R A L H E A L T H “I really liked the Smiles for Health online curriculum. Great information!”

Modules publicly available at https://canvas.uw.edu/courses/1176574

Community-focusedUrbanScholarsProgramandTargetedRuralUnderservedTrackTheCommunity-focusedUrbanScholarsProgram(CUSP)isnowinitssecondyear.TheCUSPteamhasadmittedfournewfirst-yearstudents,whowilljointhefourstudentsselectedinCUSP’sinitialyear.AllCUSPScholarswillparticipateintheUPandcompleteprimarycarepracticumatanurbanunderservedsiteinSeattle.Thesestudentsalsocompletetwoelectivecoursesonurbanhealthequity;bothclassescounttowardsgraduationintheUP.TRUSTadmits32studentsperyearacrosssixWWAMIcampuses;theyarerequiredtocompletetheUP.

EnhancedEvaluationsAgoalinthisnextyearistoenhancetheevaluationprocess.StudentsareaskedtoevaluatetheonlinemodulesandcompleteanendoftheUP-experienceevaluation.Wearelookingatwaystoincreasethereturnrateandtoexpandfeedback.Possibilitiesincludefocusgroups,phonecallsorsomeincentivetocompletesurveys.WealsowilllookforwaystoexpandaccesstoevaluationsforotherkeyindividualslikepreceptorsorRegionalDeans.ItisimportanttoustounderstandtheUP’simpact,andidentifyareasforimprovementorgrowth.

StaffChangesandUpcomingProjectsTeamChangesTherehavebeenanumberofstaffchangesinthepastyear.Dr.SharonDobieisretiringandhasgraciouslystayedontomentortheincomingnewdirector,Dr.KimKardonsky,whoisexcitedtobringherpassionforruralhealth,NativeAmericanhealth,andwomen’shealthtotheteam.Dr.LynnOliver,afamilyphysicianwithover30yearsofexperience,isnowamemberoftheUPteamaswell.Dr.Oliverbringsawealthofexperienceindomesticandglobalunderservedhealth,andiscurrentlydevelopinganewmoduleonsextrafficking.TrackingOutcomesBeyondResidencyTheoverallgoalofthePathwayistotrainfuturephysiciansforworkinunderservedareasandwithvulnerablepopulations.Weworktotrackourgraduates’residencyspecialties,andarenowteamingupwithresearchersattheSchoolofMedicinetoexplorethequestionofwhereourgraduatespracticeaftercompletingresidency.Usingde-identifieddatafromtheAmericanMedicalAssociation,wewillcomparethepostresidencysitesofpracticeforUPgraduateswithotherUWSOMgraduateswhodidnotcompletetheUP.Thisresearchisinitsearlystagesandwelookforwardtopreparingandsubmittingamanuscriptforpublication.

OurImpactonStudentsInconclusion,wewouldliketoshareaquotefromMattNovack,MD,anR1TacomaFamilyMedicine,waswrittenduringhisfourthyearofmedicalschool:

“LikemanystudentswhomatriculateattheUniversityofWashingtonSchoolofMedicine,Iwasinterestedinprimarycareandunderservedcarepriortomedicalschool.Ihadspenttimevolunteeringathomelesssheltersandfreeclinicsandtheseexperienceswerethebasisofmydesiretobecomeaphysician.Duringmedicalschool,itwaseasytolosesightofthebigpictureofwhatIwantedoutofmyfuturecareer.Thefirst2yearsemphasizedbuildingdetailed,specialty-specificknowledgeforStep-1.Ispentmoretimestudyingdiseasemechanismsratherthanhowdiseasepresentsinaprimarycareclinic.TheUnderservedPathwaywasaprotectivefactorinmaintainingmyinterestinprimarycare.IestablishedamentoringrelationshipwithaprimarycarephysicianatHarborviewMedicalCenter.Wemetregularlytodiscussthestrugglesandjoysofprimarycare,whichgavemeamorerealisticunderstandingofthefield.Iparticipatedinclinicalvolunteeropportunities,suchasCasaLatinaandCHAPDermatologyClinic,whichreaffirmedthefulfillmentIgetfromservicetoothers.FortheUnderservedPathwayresearchrequirement,Iresearchedopioidprescribingpracticesinprimarycareandoutcomesforpatientsafteropioidprescribingisstopped.Thisresearchhighlightedthevulnerabilityofpatientsafterthediscontinuationofprescriptionopioids.Inmyfuturepractice,Iwanttoimproveoutcomesformarginalizedpatientsbymaintainingprimarycarerelationshipsthroughoutadverselifeevents,suchasopioiddiscontinuation.IamthankfultotheUnderservedPathwayforkeepingmeconnectedtomycorevalueofservicethroughoutmedicalschool.”

UnderservedPathwayTeamHealthSciences,E-304206-616-7889KimberlyKardonsky,MD LynnOliver,MDPathwayDirector PathwayFacultykardok2@uw.edu oliverl@uw.eduSharonDobie,MD,MCP GenyaShimkin,MPHPathwayDirector(2006-2018) ProgramManagerdob@uw.edu gshimkin@uw.edu