Ellen Cosgrove

Expanding access to hepatitis C virus treatment—Extension for Community Healthcare Outcomes (ECHO) project: Disruptive innovation in specialty care†

The Extension for Community Healthcare Outcomes (ECHO) Model was developed by the University of New Mexico Health Sciences Center as a platform to deliver complex specialty medical care to underserved populations through an innovative educational model of team‐based interdisciplinary development. Using state‐of‐the‐art telehealth technology, best practice protocols, and case‐based learning, ECHO trains and supports primary care providers to develop knowledge and self‐efficacy on a variety of diseases. As a result, they can deliver best practice care for complex health conditions in communities where specialty care is unavailable. ECHO was first developed for the management of hepatitis C virus (HCV), optimal management of which requires consultation with multidisciplinary experts in medical specialties, mental health, and substance abuse. Few practitioners, particularly in rural and underserved areas, have the knowledge to manage its emerging treatment options, side effects, drug toxicities, and treatment‐induced depression. In addition, data were obtained from observation of ECHO weekly clinics and database of ECHO clinic participation and patient presentations by clinical provider. Evaluation of the ECHO program incorporates an annual survey integrated into the ECHO annual meeting and routine surveys of community providers about workplace learning, personal and professional experiences, systems and environmental factors associated with professional practice, self‐efficacy, facilitators, and barriers to ECHO. The initial survey data show a significant improvement in provider knowledge, self‐efficacy, and professional satisfaction through participation in ECHO HCV clinics. Clinicians reported a moderate to major benefit from participation. We conclude that ECHO expands access to best practice care for underserved populations, builds communities of practice to enhance professional development and satisfaction of primary care clinicians, and expands sustainable capacity for care by building local centers of excellence. (HEPATOLOGY 2010)

Early Predictors of Physicians' Practice in Medically Underserved Communities: A 12-year Follow-up Study of University of New Mexico School of Medicine Graduates

Background Substantial numbers of people are medically underserved because of rural residence and/or economic circumstances. The mission of many medical schools is service to this group, so the ability to identify applicants likely to serve this population is valuable. Method In 2009, the authors asked graduates from their medical school, class of 1997 and forward, if they practiced in a medically underserved community in the past year. Variables obtained from medical school applications and scores from a survey of attitudes toward the underserved measured at matriculation were analyzed using logistic regression. Results Of 244 practitioners, 35% reported working in an underserved community. Rural background, older age (25+) at matriculation, and being a member of an underrepresented minority were independent, statistically significant predictors of practice in an underserved community. Conclusions Schools wanting to increase the number of practitioners caring for the underserved could consider older as well as rural and minority applicants.

Revitalizing problem based learning: student and tutor attitudes towards a structured tutorial

Background: The pre-clinical curriculum at the University of New Mexico School of Medicine is a hybrid model that includes small group, problem-based learning (PBL) tutorials and didactic lectures. A structured tutorial format was piloted for the human sexuality/reproduction organ system block for the PBL component. The objective of this study was to compare the acceptability of the structured format and its effectiveness with that of a traditional PBL tutorial. Methods: Students were surveyed after the renal/endocrinology block of 2004 (traditional tutorial format) and after the human sexuality/reproduction block of 2004 (structured tutorial format) (n = 70). Survey questions covered the quality of learning and of tutorial. Students (n = 132) and tutors (n = 24) who participated in human sexuality/reproduction in 2004 and 2005 were surveyed for attitudes about the structured tutorial overall and specific components. Means of responses were compared using t-tests. Results: Students indicated that the structured tutorial format supported a greater improvement in their basic science and clinical knowledge and their ability to evaluate information (p < 0.05). The majority of students and tutors recommended the structured format for tutorials in other blocks. Conclusions: We demonstrated the acceptability of a structured tutorial format to students and faculty. Faculty members perceived greater depth of learning and participation by the students.

Facilitating Physician Relicensure and Reentry into Clinical Practice:: Collaboration between a State Medical Board and a Medical School

This article summarizes results of a unique, 10-year collaboration between the New Mexico Medical Board and the University of New Mexico School of Medicines mini-sabbatical program for physicians considering relicensure and reentry into practice. The Board assesses all physicians wishing to reenter active practice to determine their background and needs, and the medical schools office of continuing medical education then evaluates candidates for their retraining goals, coursework, and faculty involvement. Progress is measured weekly, at course completion, and three months thereafter. Of the 27 physicians referred from the Board between 2004 and 2014, five were judged to require more extensive residency retraining and four received administrative medical licenses. Twelve of the 18 eligible candidates elected to enter the medical schools mini-sabbatical program. The median training was four weeks (160 AMA PRA Category 1 Credits™). Their education did not interfere with the learning of medical students an...