In 2009, Deans Edward Buckley, MD and Colleen Grochowski, PhD of the Duke School of Medicine (SoM) asked for a group to come together to figure out how to promote primary care at the school. Duke had received a gift from the estate of Edith Martin that stipulated that the money be used to promote primary care. A group of dedicated educators started brainstorming together. Among that group, Dr. Viki Kaprielian found something called a longitudinal integrated clerkship which looked promising as a way to support student interest in primary care during the clinical year. Soon the Primary Care Leadership Track (PCLT) was born. I volunteered to direct the program, and since no one else seemed to want the job, I got it. I am Barbara Sheline, MD, MPH, Professor of Community and Family Medicine at Duke. Thanks to a team of creative and tireless faculty and staff, PCLT is thriving.
I came to Duke in 1990 from a residency in family medicine and a fellowship in social medicine both from the University of New Mexico in Albuquerque. Faculty jobs for myself and my husband, Jonathan Sheline, also a family doctor, brought us to Duke. I got all my degrees from UNC-Chapel Hill (BS, MD, MPH) so had to learn a new shade of blue.
Over many years at Duke SoM, I directed courses in problem-based learning, preventive medicine, social determinants of health, and the doctor-patient relationship. I worked with MD and nonMD faculty from all over the medical center as well as outside Duke. This came in handy when we started PCLT. We wanted input from physicians and non-physicians, primary care and specialty care, even patients. Within 2 months we had amassed an advisory council of 75 people! It seems that people at Duke were just waiting in the wings to be invited to promote primary care. Dr. David Hirsch, at Harvard, offered lots of great advice on how to create an LIC like they had at Cambridge Health Alliance. With that we were off and running.
The 8-month longitudinal integrated clerkship (LIC) opened up a lot of new possibilities for medical students. With the flexibility of being in outpatient clinics for 8 months, our students were available to follow pregnant patients for their entire pregnancy. Kim Dao, a midwife, was the first person in the Advisory Group to offer to take PCLT students longitudinally. She would put them in the Centering model of prenatal care. Centering is group prenatal care where women at the same stage in pregnancy meet as a group once a month for their medical check-up as well as discussion of topics of health and well-being pertinent to their stage of pregnancy. PCLT students were trained in group facilitation skills and allowed to co-lead the Centering groups with a midwife. Delivering the babies of “their” moms remains a highlight of the PCLT clinical year.
The goal of PCLT is to create primary care change agents to improve population health. I was most interested in getting PCLT students out of the medical center and into the community to see how groups address health improvement in nonmedical settings. Again, the 8-month LIC offered students the ability to work for one half day a week with community groups such as a clinic serving the homeless population or an agency that helps disadvantaged elderly get their medications. In the past, community agencies found it disruptive to have medical students come visit for a day or two. But with the commitment of a student for a half day for 8 months, agencies saw how the students could really contribute. The Community Team experience remains another highlight of the clinical year for PCLT students.
I was not particularly happy with my medical education at UNC back in 1980. We spent too much time in the hospital that first clinical year. I looked around and found nothing that called me. So I left and went across the street to the School of Public Health for a one-year MPH in Health Policy and Administration. It was a wonderful year meeting people from all over the world interested in improving health, not just treating illness. It was there I learned about family medicine and its focus on prevention.
As a family physician, I was trained in the importance of the doctor-patient relationship. After all these years of practice, it is still what I love best about being a doctor. Knowing that patient relationships are what most students interested in primary care are looking for, we created PCLT to maximize students’ ability to form relationships. In the 8-month LIC, PCLT students develop wonderful relationships with patients and their clinical preceptors. They also form strong relationships with each other.
Four years ago, one of the PCLT students remarked that she did not realize that I thought of the PCLT students as a team. That prompted me to create a leadership curriculum specifically designed to create team, foster risk-taking for a vision, and prioritize self care. The PCLT leadership curriculum starts before matriculation with a 2 ½ day leadership training. The first year PCLT students then meet weekly to learn from each other and support each other as they develop leadership skills. By the time they get to the clinical year, in second year, they know how to work as a team. As a team, they make sure everyone gets the most out of the LIC. They are in a unique clinical curriculum allowing them flexibility in how they meet some of their learning interests. They are the best people to know how to maximize their learning opportunities.
It is incredibly satisfying to watch a group of medical students follow their passions in community health and primary care. We in the PCLT leadership team have made a commitment to give PCLT students both roots to ground them and space to fly. I remain committed to seeing that students get to follow their vision for themselves as they continue on their journey to bring about a healthier population.