The nation’s poorest state, with a median household income of approximately $37,000 per year, Mississippi ranks 50th in both physicians per 100,000 and primary care physicians per 100,000. Seventy-nine of the state’s 82 counties are in federally designated health professional shortages areas.
Since its founding in 1955, the University of Mississippi Medical Center School of Medicine in Jackson had been the state’s only four-year medical school. Graduating no more than 100 physicians a year during most of its history, the school could not meet the medical needs of the state’s nearly 3 million people.
Recognizing the need for another medical school in Mississippi, particularly one that would produce primary care physicians, the leaders of the Mississippi Osteopathic Medical Association five years ago joined forces with a 100-year-old Baptist institution of higher learning to develop the state’s first osteopathic medical school—the William Carey University College of Osteopathic Medicine (WCUCOM) in Hattiesburg. Provisionally accredited by the AOA Commission on Osteopathic College Accreditation (COCA), the college opened in fall 2010 and is expected to become fully accredited when its inaugural class graduates in 2014.
Led by administrators with experience in setting up clinical training sites, WCUCOM has forged partnerships with more than 40 hospitals and clinics across Mississippi, three in Louisiana and one in Florida. Through a traditional discipline-based curriculum steeped in osteopathic principles and practice, the school strives to instill passion for osteopathic manipulative medicine in all of its students.
Although Mississippi ranks at or near the bottom on a number of key educational measures, data from the Association of American Medical Colleges indicated that many college-educated Mississippians were leaving the state to attend medical school. WCUCOM founding dean Michael K. Murphy, DO, who led the college from 2008 through 2010, notes that the University of Mississippi’s medical school had to turn away roughly 300 well-qualified students from Mississippi annually, and hundreds more from the other Gulf states of Louisiana, Arkansas and Alabama, for lack of seats. And at the time he joined WCUCOM, some 50 osteopathic medical students from Mississippi attended DO schools in other states, Dr. Murphy remembers.
“In our feasibility study, we documented the potential for attracting quality students and faculty to WCUCOM and developed a long-range vision for the college,” says Dr. Murphy, who today serves as the director of medical education at Bluefield (W.Va.) Regional Medical Center.
Each year, WCUCOM’s applicant pool grows as the college gains recognition, points out Darrell E. Lovins, DO, MPH, the school’s dean since April 2011. “For our first class, we had more than 1,000 applicants. For our second class, we had over 1,700 applicants. And for our third class, it looks like we may have more than 2,000 applicants,” he says. The current COCA-approved class size for WCUCOM is 100 students.
Roughly half of the students in the first two classes hail from Mississippi, with the rest mostly from Alabama, Arkansas, Louisiana and northwest Florida. But students from far-flung regions with an interest in practicing in Gulf Coast states are welcome to apply, Dr. Lovins says. The school targets students from the South because they are more likely to remain in the region to practice.
Among all states, Mississippi has the highest proportion of black Americans, who make up more than 36% of the population. To promote a diverse student body, WCUCOM recruits from historically black colleges and universities in the South, as well as from other colleges, Dr. Lovins says. “Ensuring diversity among students and faculty is a challenge for all DO schools,” he notes.
Joining WCUCOM in 2008 as the associate dean for clinical sciences, Dr. Lovins previously served as the executive director of A-OPTIC , a multistate alliance of osteopathic medical schools and hospitals spearheaded by the University of Pikeville-Kentucky College of Osteopathic Medicine. WCUCOM participates in this osteopathic postdoctoral training institution, which is striving to set up residencies in Mississippi and neighboring states for the school’s graduates.
Dr. Lovins has already secured clinical training sites for third- and fourth-year students at a growing list of facilities throughout Mississippi.
One of the 634 preceptors eager to take WCUCOM students on rotation is Sister Anne E. Brooks, DO, founder and chief administrator of the Tutwiler (Miss.) Clinic, located in the Mississippi Delta, the most impoverished portion of the state.
Featured last month on a CBS Evening News report, Dr. Brooks is the only physician in Tutwiler and one of just three practicing in economically depressed Tallahatchie County. She will help train WCUCOM students at her clinic and at Northwest Mississippi Regional Medical Center in Clarksdale, a 166-bed hospital 15 miles to the north.
Dr. Brooks was very excited when she learned about WCUCOM’s formation in the early stages and has been involved in the initiative ever since, serving on the Dean’s Advisory Council. “There aren’t many DOs in our part of the state. So it was of great interest to me that suddenly we began blossoming and soon we will have a whole tree of potential DOs,” she says.
Dr. Brooks made the five-hour drive to Hattiesburg, which is in the southern part of Mississippi, for the school’s first white coat ceremony in 2010. “I cried because it was so exciting,” she remembers. “And it was so impressive because as the students received their coats, we learned about their previous degrees. We have a humdinger class down there.”
While the first class won’t start rotations until the next academic year, Dr. Brooks already has mentored some WCUCOM students. During winter break in the 2010-11 school year, several students shadowed her as she made her rounds in the hospital and treated patients in the clinic.
Building on the basics
For students’ first two years of medical school, WCUCOM uses a “tried-and-true” discipline-based curriculum, as Dr. Lovins puts it, one that features a lecture-discussion format. In this model, students study subjects such as biochemistry and pharmacology longitudinally, with each course building on previous courses. Dr. Lovins believes that medical students benefit from deep preparation in the basic sciences before they tackle clinical sciences and begin treating patients.
However, for some classes, the school incorporates other pedagogic concepts, such as small-group learning and reciprocal peer teaching. “No one system is perfect,” Dr. Lovins says.
While COCA requires osteopathic medical schools to integrate OPP throughout their curricula, WCUCOM is especially committed to doing so, Dr. Lovins says. A 1983 graduate of the A.T. Still University of Health Sciences-Kirksville (Mo.) College of Osteopathic Medicine, he attributes his zeal for OMM in part to his education.
“As a young DO student at Kirksville, studying under Paul E. Kimberly, DO, one of the leading lights in OMM, I saw the value of manipulation as a tool,” Dr. Lovins says. “I think everybody who has the letters DO after his or her name needs to be proficient in OPP. This means philosophically thinking like DOs. But it also means being able to use your hands in osteopathic palpatory diagnosis and osteopathic manipulative treatment.”
After graduating, Dr. Lovins completed his family medicine internship and residency in the U.S. Navy, in which he served for more than 26 years. “I used the tool of OMT on a nearly daily basis during my training, and I continued to use my manipulation skills when I actively practiced in the Navy,” he says.
Dr. Lovins also taught a manual medicine class in the Navy to both osteopathic and allopathic physicians. “Some of my best students were MDs because they saw the value in what we do,” he says. “Sometimes those with the DO degree don’t recognize that value,” he laments, noting that he graduated from medical school during the era when DOs were still fighting for parity with MDs and emphasized the similarities of osteopathic and allopathic medicine rather than DOs’ distinctiveness.
With the mind-set that OMT is an integral part of the DO difference, Dr. Lovins guides WCUCOM’s curriculum and the hiring of faculty members. “We aim to convince students that OMT is a skill that has value in the care of people and should be used regardless of reimbursement issues,” he says. “In hiring faculty, we look for people who can communicate OMT’s importance and utility to students.”
Because only 320 or so DOs practice in Mississippi, WCUCOM students will serve most of their rotations under MD preceptors. In concert with A-OPTIC, the college gives MD preceptors some instruction in manual medicine so they feel more comfortable supervising students performing OMT. But the school can’t force preceptors to let DO students do manipulation, Dr. Lovins notes.
To promote continuity of instruction in OPP, WCUCOM has prepared a “reading curriculum” that students will complete in conjunction with their rotations. “I cannot guarantee that students are going to be using their hands during their rotations because that’s going to be each preceptor’s choice. And I can’t dictate to the preceptors what to allow our students to do. But I can at least make sure that students’ cognitive development in OPP is continuing by the fact that every rotation they go on will have an osteopathic component in their reading,” Dr. Lovins explains.
Dr. Brooks, for one, has high hopes that WCUCOM graduates will make a big difference in Mississippi, including the Mississippi Delta. While primary care physicians are needed in her area, so are all other medical specialists. “The closest endocrinologist is an hour and a half away from us,” she says. This poses a great hardship for her many patients with diabetes mellitus and thyroid conditions. In fact, one patient who has metastatic thyroid cancer could not afford the gas to drive the 115 miles to the endocrinologist and had to be driven by a volunteer.
But the class of 2014 will not be minted soon enough to meet the immediate needs of the Tutwiler Clinic, which sees some 8,500 patients a year. “I’m desperate to have a doctor assist me at my clinic,” Dr. Brooks says. “I am 74 and sure could use some help.”