Chapter 15: Educational Projects with Physicians and Medical Students
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Description
Dr. Foxhall talks about the importance of educational outreach to the mission of the institution.
He lists the impact that educational initiatives have in the community.
Next he describes the Preceptorship Program initiated in the eighties at the UT Medical School in Houston. The challenge, he explains, was (and is) that “we need more primary care physicians” and medical students need to know that family medicine can be a viable career path. Dr. Foxhall explains that the Preceptorship enables medical students to spend a month with a family physician. He talks about the importance of targeting students early. He notes that in a national ranking of states and the availability of primary care physicians, Texas ranks #42. The grant supporting the Preceptorship was renewed several times and the program has been successful at convincing medical students to enter family medicine. Recently funding was cut and then transferred to the Texas Council of Family Physicians.
Identifier
FoxhallLE_03_20140311_C15
Publication Date
3-11-2014
City
Houston, Texas
Interview Session
Topics Covered
The University of Texas MD Anderson Cancer Center - An Institutional Unit; The Administrator MD Anderson Impact Information for Patients and the Public Education Institutional Mission and Values Beyond the Institution Overview
Transcript
Tacey Ann Rosolowski, PhD:
Now, education is certainly one of the cornerstone mission areas for MD Anderson. What would say the real impact of education is and can be for working against cancer?
Lewis Foxhall, MD:
Well, you know, from my point of view, it’s this idea of trying to help support the community physicians we work with in being able to provide the prevention, screening, early detection sort of interventions that we’ve been promoting. So it’s fine for us to just say, you know, “Go out and do that,” but giving them the knowledge and building their self-efficacy, their confidence, and being able to deliver those has been an important thing, I think, for us to do. I mean, it’s really [unclear]. We have experts here, you know, people that are knowledgeable in the area, and get them in front of the community physicians, whether they’re primary care or oncologists or others that can benefit from the knowledge that we have. So we create knowledge through research, but we also need to disseminate that knowledge and help improve practice across the board so everybody can benefit from these sorts of new findings and new information that we have, or just helping a new crop of physicians understand what we know and what they can do that works. So a lot of that’s just part and parcel of what we do.
Tacey Ann Rosolowski, PhD:
Well, it also sounds, too, like you are, you know, making a change in the culture of education in the physicians, getting physicians that may have never thought about survivorship or putting that on the list of what they need to think about with a patient. I mean, that’s changing their mindset, how to deal with this person sitting in front of me in the examination room. And that’s huge.
Lewis Foxhall, MD:
It takes that, and to change physician behavior as far as how they work with patients is a challenge at times and often goes beyond just the knowledge base. So that’s part of this grant is about how do they change their practice and what sort of system changes do they need to implement for making sure this works, and how do we foster communication across the specialties between primary care and oncologists, to be sure everybody understands who’s responsible for what and the patient doesn’t fall through the cracks anymore. So all that’s been written about, and the Institute of Medicine has recommended that all these things happen. It’s just they’re not happening, so this is an opportunity for us to really try to say how and what do we need to do to really make those connections and make those changes in practice so, (a), physicians are aware of the needs of survivors that are different from the usual population, and, (b), what do we need to do within the local practices to make that happen. By doing it through an education training program, then hopefully we’ll be able to share that information with people that are going through training, so when they go out and set up their practices or join another practice, they can carry that with them and disseminate it further. So that’s sort of the vague idea of what [unclear]. But anyway, you know, it’s a dissemination attempt to both improve knowledge, change behavior, and change practice that really takes all those things to do something different at the end of the day so that the patients can benefit.
Tacey Ann Rosolowski, PhD:
Absolutely, absolutely. I notice that there was some—oh, I was just looking at my notes about some other themes that were coming up in these projects, and there was preceptorships. And I wasn’t sure if what you were just describing is part of that or the preceptorships were part of it.
Lewis Foxhall, MD:
Well, that was an initiative I started working on when I was first at the University of Texas Medical School here in town and began working with the then director of that program, which was also initiated back in the eighties. There was this idea that then, like now, we need more primary care physicians and that students of medicine are much more likely to pursue a career in family medicine if they have some idea of what family medicine is like in the community. So unlike other subspecialty fields, there’s often not a good representation of family medicine within the medical school environment, and especially in an urban center like Houston.
Tacey Ann Rosolowski, PhD:
Meaning that there’s more focus placed on or pressure placed on choosing a more focused specialty?
Lewis Foxhall, MD:
Well, it’s just the role models are not there.
Tacey Ann Rosolowski, PhD:
Oh, okay, gotcha.
Lewis Foxhall, MD:
So it’s an outpatient specialty, they’re not in the hospital, so the chances of actually encountering a family physician during medical school tenure, especially early when you’re trying to figure out what to do, is limited. So this provided an opportunity for students who have some interest to go and spend a month with a family physician, and we have physicians all around the state who work with us as volunteers to host students during their summer breaks so that they could go out after their first year and have an opportunity to see what clinical practice is like. They’re mostly in the classroom their first year.
Tacey Ann Rosolowski, PhD:
Am I remembering correctly that you did that? (laughs)
Lewis Foxhall, MD:
I did. I did. So I spent some time with a physician in my hometown.
Tacey Ann Rosolowski, PhD:
Yeah, [unclear].
Lewis Foxhall, MD:
Yeah. So it was a little different, but it was the same basic idea. But, yeah, so this idea that, you know, well, it really would help if you’re just not sure what you want to do or you think that’s what you want to do but you’re not totally sure, then that gives you a chance to really get out and see what it’s like, and especially if we target it early, then for those students who have at least some interest in primary care, that they can see how it really works in the community, that it is a valuable and much appreciated service, and it’s a rewarding career that they may not realize just from what happens in a tertiary care hospital setting.
Tacey Ann Rosolowski, PhD:
What are the shortages of primary—I mean, what do the statistics look like for shortages of primary care physicians?
Lewis Foxhall, MD:
Well, it’s still bad. I mean, I think we’re forty-second or something in the nation as far as primary care physician supply.
Tacey Ann Rosolowski, PhD:
Really? And what does that mean in terms of doctors to—
Lewis Foxhall, MD:
I don’t remember the exact numbers, but it’s not enough to go around. So the challenge is one that is national. I mean, our ranking’s bad, but it’s not good anywhere, so [unclear].
Tacey Ann Rosolowski, PhD:
And you said Texas is forty-second in the nation in terms of shortages. Yikes.
Lewis Foxhall, MD:
Mm-hmm, mm-hmm, yeah. So we have, I think, compared internationally, comparisons also are not good with countries that have a lot higher rates of primary care service, have good quality care but lower costs and things like that. So there are lots of reasons to do it, but it’s an opportunity to try to help students at least level the playing field a little bit for students who are trying to figure out what to do with their careers and can understand better what they want to do in life.
Tacey Ann Rosolowski, PhD:
So this preceptorship program—because I notice it appears several times in the course of the years—
Lewis Foxhall, MD:
Yeah, this is a grant that got renewed and renewed and renewed.
Tacey Ann Rosolowski, PhD:
Yeah. So what kind of impact have you seen it having?
Lewis Foxhall, MD:
Well, we actually did an analysis that it showed that students who participated had significantly higher rates of adoption of family medicine careers. So tracking students through training and then eventually into their careers, we were able to demonstrate that beyond the idea that it has some face validity but we were able to demonstrate the positive impact of it.
Tacey Ann Rosolowski, PhD:
I don’t know why I want to ask this question, but I kind of have to ask it. Do you find that more women than men go into the field of family medicine?
Lewis Foxhall, MD:
It’s about half and half now.
Tacey Ann Rosolowski, PhD:
Oh, it is? Interesting.
Lewis Foxhall, MD:
Yeah. That’s just, you know, a reflection of the general trend in medical education, that there is a growing proportion of women over time. So, yeah.
Tacey Ann Rosolowski, PhD:
How interesting.
Lewis Foxhall, MD:
So that program continued for a number of years and was administered through our Education Coordinating Board and continued to do well until the funding was cut a couple sessions ago. So, anyway, so we transferred it over to the Texas Academy of Family Physicians. So the state funding was to help provide some stipends for the students to help cover their expenses and things of that sort, but that’s not available anymore. But still students do it just because they want to go do it, but we administer it through the Academy at this point.
Tacey Ann Rosolowski, PhD:
So what’s your take on why the funding was cut?
Lewis Foxhall, MD:
The funding was cut [unclear].
Tacey Ann Rosolowski, PhD:
The funding, who knows? Yeah. (laughs) The gods, the planets misaligned.
Lewis Foxhall, MD:
It’s a tiny little bit of money in the overall budget, but whatever. This was back a couple sessions ago when there was a major budget crisis, so they were just cutting everything.
Recommended Citation
Foxhall, Lewis E. MD and Rosolowski, Tacey A. PhD, "Chapter 15: Educational Projects with Physicians and Medical Students" (2014). Interview Chapters. 864.
https://openworks.mdanderson.org/mchv_interviewchapters/864
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