Located in the scenic foothills of the Blue Ridge Mountains in southwest Virginia, a new osteopathic medical school will welcome up to 150 students in August. The second DO school in the state, the Liberty University College of Osteopathic Medicine (LUCOM) in Lynchburg aims to address physician shortages in Appalachia and other medically underserved regions of the country.
Founded by the late Rev. Jerry Falwell Sr., the famed televangelist and conservative political commentator, Liberty University has a strong Christian outlook that the college will reflect, says Ronnie B. Martin, DO, LUCOM’s dean.
“All who come here are welcome and will be treated with respect. We have no faith requirement for students,” Dr. Martin says, noting that the first class includes Hindus, Muslims and other non-Christians. “But we have a Christian worldview at this institution. Prospective students need to make sure that they will be comfortable in this environment.”
A 40-year-old institution, Liberty decided to open a medical school as part of a long-term plan to become a comprehensive university upholding excellent academic standards, Dr. Martin says. The university has already launched a law school and a school of engineering.
Opening a college of osteopathic medicine rather than an MD school was a clear choice for the university’s governing board members, according to Dr. Martin. “They felt that osteopathic medicine’s philosophy of holistic patient-centered care and emphasis on the body, mind and spirit were compatible and consistent with their Christian worldview and educational convictions,” he says.
LUCOM’s mission is to produce community-based physicians who will practice needed specialties in underserved locales. These specialties include family medicine, general internal medicine, pediatrics, general surgery, emergency medicine, and obstetrics and gynecology.
“We will prepare our students to enter any discipline,” Dr. Martin says. “But through the design of our curriculum and the faculty role models I put in front of them, we are going to try to influence students to go into these primary and preventive care specialties.”
A private nonprofit institution, Liberty University received a $20.5 million grant from the Virginia Tobacco Commission to help pay for constructing and equipping the 140,000-square-foot building that houses the osteopathic medical school. Plans are also underway to build an 80,000-square-foot research building.
To attract students from economically disadvantaged locales, LUCOM is offering a 5% tuition discount to individuals from the state’s traditional coal and tobacco counties. Other scholarships are also available for students who make a commitment to practice in underserved areas.
“I place a big emphasis on recruiting students from Virginia,” Dr. Martin says. “But we will have students from all states and probably from other countries.”
Like many medical schools today, LUCOM has developed a curriculum that de-emphasizes the traditional lecture-based format in favor of small-group, case-based experiential learning. “Only a minority component of students’ education will be delivered by the classic lecture,” Dr. Martin says.
The school has adopted a spiral curricular design, notes Timothy O. Leonard, MD, PhD, LUCOM’s associate dean for biomedical affairs and research. This means that biomedical and clinical content is strategically reiterated throughout the curriculum, so that students’ understanding deepens with each successive encounter.
“In the traditional model of education, students are presented with material they are expected to learn and they are expected to produce some understanding of it on an exam. Then it’s on to the next subject area,” Dr. Leonard explains. “Students don’t necessarily have the opportunity to revisit and reapply what they learned previously.
“In the spiral curricular design, students revisit what they previously learned so they can recall it, expand upon it and apply it. That way there is more consolidation of understanding.”
Illustrating this concept, students will study anatomy in both their first and second year. First-year students will engage in cadaveric dissection during their body system-organized courses. In the second year, students will revisit their study of human anatomy in a more focused clinical context through targeted dissections and selected prosections that clarify common clinical procedures, such as joint injections and tracheostomies.
“When the second-year students are doing their dissection, they will have a better idea of what it is they are looking for and how to find it,” Dr. Leonard says. “And when they encounter abnormalities in the human body, they’ll have a better clinical basis for understanding and exploring those abnormalities.”
Longitudinal clinical experiences
From their first year, students will have many opportunities to develop their clinical skills, notes Eric Gish, DO, LUCOM’s associate dean for clinical affairs. They will practice interviewing patients and hone their physical exam techniques in 16 standardized patient rooms and six simulator rooms. Among the college’s high-tech tools are ultrasound machines that help students identify palpation landmarks and develop their manipulation skills, Dr. Gish says.
But students will also have longitudinal contact with real patients from the outset. In their first trimester, they will be paired up with individuals residing at a long-term-care facility in Lynchburg.
“The goal isn’t for the students to manage the patients’ care but for them to develop and maintain the humanity and humility that otherwise has the potential to be lost as they proceed in their education,” Dr. Gish says.
For its third- and fourth-year core rotations, LUCOM is partnering with Centra, a regional health system based in Lynchburg that includes four hospitals. Centra can take up to 80 students. To accommodate the rest of the student body, the college is forging affiliation agreements with other health systems and community hospitals in Virginia.
LUCOM wants to keep students in one community throughout at least their third year. “Our goal is not just to train students but to integrate them into the community they are serving,” Dr. Gish says. “By remaining in one place, students will learn what social services are available to underserved patients, what physician referrals are available, what services the nearest hospitals provide, what federally qualified health centers are out there—the entire support structure for that patient population.
“We also hope that if students start laying down roots, they’ll be more likely to return.”
LUCOM is also developing residencies at its clinical sites to entice future graduates to remain in those communities. In addition, the college has joined the osteopathic postdoctoral training institution (or OPTI) that includes the Edward Via College of Osteopathic Medicine—Virginia Campus in Blacksburg and the Campbell University School of Osteopathic Medicine in Buies Creek, N.C.
“We’re trying to collaborate with everybody in the region,” Dr. Gish says. “We feel that collaboration strengthens education, as opposed to competing, which breaks it down.”
In keeping with the school’s mission to care for the underserved, each student will serve an out-rotation in an impoverished community, which can be in the United States or overseas. Dr. Martin expects that many LUCOM students will pursue international rotations. One possible site is a hospital in Guatemala that Liberty University is building in partnership with Thomas Road Baptist Church in Lynchburg. Liberty has also approached hospitals in Cameroon and Tanzania about taking on LUCOM students.
LUCOM aspires to produce physicians who will have the knowledge and skills to practice top-quality 21st century medicine, Dr. Martin says.
“I challenge my faculty all the time to remember that we will not be training students to practice the way we did,” notes Dr. Martin, who practiced rural family medicine in Oklahoma in the 1980s and 1990s. “Medicine has advanced tremendously, and the old fee-for-service model is going by the wayside.”
In their second year, LUCOM students will get a taste of what it means to be practice-ready physicians when they take a business of medicine course. The class will cover the fundamentals of the patient-centered medical home model of care and practice-management basics, such as billing, coding and documentation in the age of electronic health records.
Overall, says Dr. Martin, memorizing facts is less important to medical students today, given the electronic information resources at everyone’s fingertips. “Medical knowledge is available to lots of people,” he notes. “What we have to teach our students is the interpretation, application and utilization of that knowledge.”
To ensure that students succeed in school and have the wherewithal to excel on the Comprehensive Osteopathic Medical Licensing Examination of the United States, LUCOM will assess students early in the first trimester and frequently thereafter, says Joseph F. Smoley, PhD, the associate dean for academic affairs.
“We need to make sure that the structure and pace of our curriculum are not only conducive to learning but also to taking the tests that are required for graduation,” Dr. Smoley says. “And we’ll need to identify early on any students who are having difficulties and give them the support they need.”
Estimated at roughly $45 million a year, the economic impact of the new osteopathic medical school on Lynchburg will be significant, Dr. Martin says. In turn, students and faculty will benefit from being part of a city of 78,000 people in a population hub of almost a quarter-million.
With four other institutions of higher learning nearby, the area has some 30,000 college students, which keeps Lynchburg “very young, very active and very vivacious,” according to Dr. Martin.
“Lynchburg is a very nice southern city,” he says. “It is a safe and economically stable area that is rich in colonial and Civil War history. Everything that you need is here.”