Making the Rounds

Statewide hospital affiliations provide enriching COM student rotations and residencies

Story by Bob Kronemyer

The College of Medicine has a rich and distinguished history of providing students and residents with a variety of educational experiences by aligning with hospitals around the state. Whether COM partners provide the opportunity to experience a faith-based holistic approach, practice rural medicine, or participate in clinical simulation, the primary goal is to mint physicians who are clinically well trained.

Complementing the University of Illinois Hospital & Health Sciences System in Chicago are other affiliated hospitals in the metropolitan area, plus those connected with regional campuses at Peoria and Rockford. “Any one hospital is going to have a particular emphasis, based upon its geographic location and whether it is public or private,” says Raymond Curry, MD, senior associate dean for educational affairs. “It is important that students have opportunities to see a wide variety of clinical problems in myriad settings.”

For example, a student or resident working at the university hospital in Chicago will be more likely to encounter patients who require organ transplants or who are enrolled in cutting-edge cancer treatment trials than at the Jesse Brown VA Medical Center, which is across the street from the main Chicago campus. There, trainees will help care for patients with a broad range of common conditions, with a high prevalence of chronic illnesses such as chronic obstructive pulmonary disease (COPD), heart disease and prostate cancer.

“The VA system has a distinctive care model that has been closely linked to academic medicine for decades, and provides a high-quality, coherent training experience for students and residents,” Curry notes.

Curry says that residency programs bring clear mutual benefit to the college and affiliated hospitals. “The residents benefit by having that breadth of experience in the different kinds of clinical care settings, while the affiliate institution benefits by having the residents onsite to assist in patient care and to provide intellectual stimulation for the attending staff—they learn from the residents, just as the residents learn from them,” he explains. “These clinical experiences are the heart and soul of medical education; without clinical affiliates, we would not be able to teach clinical medicine at all.”

Teaching hospitals are also a magnet to attract top-notch physicians. “The education and research functions of a teaching hospital attract physicians who are conducting leading-edge research and are interested in being connected to the intellectual climate of an academic medical center,” Curry says. In addition, medical students benefit by working side by side with and learning from residents. “This helps show students what their next step is in professional development and training,” he notes.

During the past 15 years, there has been tremendous innovation and change in the models for residency education to help ensure physician competency and patient safety, according to Curry. “This makes partnerships between teaching hospitals and medical schools all the more important,” he says.

For instance, residency accreditation has changed from process oriented measures like a rotation in a particular area of the discipline, or frequency of lectures, to improved educational and health outcomes. “It is a very different paradigm,” Curry observes.

A number of the faculty at affiliated sites are also alumni. “Students have spoken most fondly about the mentoring they have received from alumni,” says Kathleen Kashima, PhD, senior associate dean of students. “Many of the faculty are volunteers who participate out of their love for teaching.”

CHICAGOLAND AFFILIATION: FORWARD-THINKING AND FAITH-BASED

For the approximately 190 medical students at the Chicago campus who participate in rotations, Advocate Health Care represents the COM’s primary affiliation outside the university in the greater Chicago area.

As the executive vice president and chief medical Officer at Advocate Health Care, COM Alumnus Lee Sacks understands the value of clinical experience throughout the MD curriculum

At any given time, there are a total of 48 students (16 in medicine, 12 in surgery, 12 in ob/gyn, 4 in pediatrics and 4 in family medicine) rotating at one of three large Advocate hospitals: Advocate Christ Medical Center, Advocate Illinois Masonic Medical Center and Advocate Lutheran General Hospital. And over the past decade, more than 150 students from the College of Medicine have matched into Advocate-based residency programs.

“Our commitment to medical education is longstanding,” says Lee Sacks, MD ’77, executive vice president and chief medical officer at Advocate Health Care, with headquarters in Downers Grove, Ill. “We not only have an obligation to help train the future generation of healthcare providers, but we are given the opportunity to be intellectually challenged and stimulated by the students. This makes Advocate more attractive for residents and fellows, as well as for physicians and other caregivers, as a place to work.”

Sacks completed some of his student rotations at the COM at what is now an Advocate hospital and fulfilled his residency in family medicine at Advocate Lutheran General Hospital. He points out that the Advocate network exposes students to a diverse population of patients and clinical opportunities. “Do they want to stay in an academic medical center, or be out in the communities, or go into research?” Sacks says.

Sacks also notes that Advocate is a leader in the shift in healthcare reimbursement to value. As a result, students are exposed to patient registry, innovative care-management programs and patient activation. “There is a relentless focus to achieve the triple aim of improving outcomes, enhancing the patient experience while reducing costs,” he says.

Being able to practice the art of medicine and interact with experienced clinicians, including nurses and pharmacists, at Advocate allows students to apply book knowledge to real-life situations, making judgments in real time. “Exposing the student to different styles of clinicians and how clinicians interact with patients helps the student figure out what he or she needs to do to be successful,” Sacks remarks.

Moreover, Advocate is a faith-based organization that embraces a holistic approach to healthcare. “This teaches students to serve the health needs of individuals, families and the community in a holistic manner,” Sacks says. “We also deliberately reach out to our patients to respect and incorporate their faith-based values. I have learned over time that this can make a big difference when patients have a difficult diagnosis. Regardless of one’s faith, it is important to be able to relate to and understand the patient’s perspective on faith. It is the recognition that faith plays a key role in healing.” Advocate is also developing a curriculum on disparities of care in its patient population.

Advocate has a number of residencies in partnership with the COM, including family medicine. In fact, “together we train more primary-care physicians than any other organization in the state of Illinois, and many have stayed within Advocate,” Sacks says. “This helps with the specialty imbalance and physician staffing needs across the state.”

ROCKFORD: A MECCA FOR RURAL MEDICINE

The three hospital affiliations for student rotations at the Rockford campus are SwedishAmerican Hospital, OSF Saint Anthony Medical Center and Rockford Memorial Hospital, all located in Rockford proper. Required rotations for third-year students include family medicine, internal medicine, OB/GYN, psychiatry, pediatrics and surgery. Fourth-year students choose most of their specialty rotations. “I am impressed by the level of commitment of these hospitals,” which provide clinical experiences for 55 third-year and 55 fourth-year students, says Inis Jane Bardella, MD, visiting professor and head of the department of family and community medicine in Rockford.

Farion Williams (left) and Mitch King encourages students with an interest in rural medicine to explore opportunities to serve communities that might not otherwise have easy access to medical care.

The COM in Rockford features the Rural Medical Education Program (RMED) in family medicine, which was established in 2003 and has a separate admissions process that targets applicants from rural communities within Illinois. “Right now, half of our medical students are on a rural medicine track,” says Mitchell King, MD, Rockford associate dean for academic affairs.

The fourth-year RMED curriculum includes a 16-week rural preceptorship, where the students work with different physicians in rural communities throughout Illinois, including the rural Katherine Shaw Bethea Hospital (KSB) in Dixon, Ill., about 40 miles southwest of Rockford.

Inspired in part by RMED and the Underserved Pathway Program, a supplemental curriculum to help students learn how to meet the needs of underserved populations; about 40 percent of Rockford graduates enter practice in such communities, both urban and rural.

The Rockford campus also provides integrative educational opportunities for fourth-year students. For example, because the UIC College of Pharmacy also has a regional site on the Rockford campus, “many of the students are paired with a fourth-year pharmacy student,” notes Alex Stagnaro-Green, MD, regional dean of the COM in Rockford. “One of the major focuses of medical education in the current era is interdisciplinary training.”

King points out that medicine is a team effort to provide care to patients. “Therefore, it is important that each of the team members be aware of the capabilities of each other,” he says. Training helps others become familiar with the background and training of each individual, “and what we can then expect from each discipline as we try to maximize patient care.”

Teaming with pharmacy, nursing or any other discipline encountered in the clinical environment is a natural fit for the Rockford campus, according to King. For instance, outside nursing schools have participated in learning events on campus to broaden clinical exposure.

The residency program in Rockford began in 1971 and is one of the original 50 family medicine training programs in the United States. To complement the RMED program for medical students, Rockford has a rural medicine residency track that is part of the campus’ family medicine residency program. Residents complete their first year at SwedishAmerican Hospital, followed by the second and third year at KSB in Dixon.

“There are studies that show that experience of medical training in a rural community will lead people to choose a rural site for practice,” says Farion Williams, MD, assistant dean for graduate medical education at Rockford, who helped establish and accredit the rural track program. “These are communities that might not otherwise be able to draw someone to practice.”

PEORIA: LEADERSHIP IN CLINICAL SIMULATION

Close by the downtown Peoria COM campus are located both OSF Saint Francis Medical Center and UnityPoint Health Methodist hospital. These two affiliated institutions engage in medical student education, as well as in 11 residencies (ranging from neurosurgery to family medicine) and seven fellowships (such as cardiology, gastroenterology and interventional radiology) comprising a total of more than 270 residents and fellows.

The COM also works with the two hospitals in areas of research, says Sara Rusch, MD, Res ’81, regional dean of the Peoria campus. One notable collaborative venture between OSF HealthCare and the Peoria site is the Jump Trading Simulation & Education Center, a roughly 67,000-square-foot clinical simulation center replete with an operating room, six patient rooms and an ambulance. Opened in 2013, Jump enlists actors to simulate trauma and home health visits, among other health issues, for training of medical students, residents and fellows, as well as nursing and other care providers.

Medical students begin in Jump during their second year, for which their first simulations may occur while studying drugs of abuse. Upon entering a room at Jump, the students will encounter a simulated overdose. “Even this early in their education, students are expected to be able to identify the type of drug which would present with these symptoms,” Rusch explains.

Peoria Regional Dean Sara Rusch understands the importance of collaboration with community partners like OSF Healthcare and UnityPoint.

And by the time the students complete medical school and are preparing for residency, their simulation training allows them to assume care of six sick simulated patients, including resuscitating a cardiac arrest, conveying bad news like a terminal prognosis in a sympathetic manner, and transitioning care to another doctor as seamlessly as possible. “This gradually increasing complexity of the simulation carries over to the residency training, where there also is increased focus on skills unique to each specialty,” Rusch says.

The Peoria campus was created in 1970, and the majority of the current primary care providers in the tri-county Peoria area trained at one of the local hospital residency programs. “Our two partner hospitals and the collaboration between them has helped to build Peoria’s healthcare economy and delivers exceptional patient care to the region,” Rusch says. “Healthcare is about 18 percent of the Greater Peoria area economy and provides life-saving medical care for a wide range of conditions. The partnership between the COM at Peoria and our academic affiliate hospitals is strong because we share similar goals. Together, we are able to train and retain exceptional physicians, provide excellent patient care and perform research that enhances the outcomes for our patients.”

In fact, the Peoria campus’ mission statement is “Lead Collaboration to Improve Health.” “We improve health by educating physicians,” Rusch observes. About 60 percent of primary care physicians in the Peoria area trained in a COM Peoria residency and about 25 percent of all area physicians are University of Illinois graduates.

“The opportunity to teach also attracts physicians to Peoria for practice,” she says. Furthermore, there is improved health through direct patient care. “Our research also builds on collaboration with our partner hospitals,” she adds, with research focused on the neurosciences, cancer, health outcomes and education, particularly education using simulation.

Across all of the COM’s campuses, senior associate dean of students Kashima believes that strong student rotations and residency programs statewide are a draw for students to apply to the medical school. Each year, the Association of American Medical Colleges surveys graduating students at most medical schools. “Consistently, our clinical training has been rated one of the best things about the medical school,” Kashima says.

A NETWORK OF EXPERTISE

The College of Medicine partners with affiliate hospitals from across the state to provide medical students and residents with exposure to diverse clinical specialties, patient populations and service environments. Listed below are the Academic Year 2015-16 hospital affiliates.

CHICAGO

• Advocate Christ Medical Center (Oak Lawn)
• Advocate Illinois Masonic Medical Center
• Advocate Lutheran General Hospital (Park Ridge)
• Jesse Brown Veterans Administration
• John H. Stroger Jr. Hospital of Cook County
• MacNeal Hospital (Berwyn)
• Mercy Hospital and Medical Center
• Mt. Sinai Hospital
• Northwest Community Hospital (Arlington Heights)
• St. Francis Hospital (Evanston)
• St. Joseph Hospital
• University of Illinois Hospital & Health Sciences System
• Weiss Memorial Hospital

PEORIA

• OSF St. Francis Medical Center
• Children’s Hospital of Illinois
• UnityPoint Health

ROCKFORD

• Crusader Clinic
• Katherine Shaw Bethea
• Mercy Rockford
• OSF St. Anthony
• Rosecrance
• SwedishAmerican Health System

URBANA

• Carle Clinic/Carle Foundation Hospital
• Christie Clinic (Champaign)
• Presence Covenant Medical Center
• VA Illiana Health Care System (Danville)