Learning from Cuba

Barone and Skinner in Viñales
Adam Barone, OMS-I , (left) and Daniel Skinner, assistant professor of health policy

Daniel Skinner and Adam Barone

For a week in March 2019, we were privileged to visit Cuba to learn about the nation’s health care system. Our contingent ran the health professions gambit, including people in nursing and medicine, health care administration, global health, health communication and health policy. But our mission was unified: to learn about health care in Cuba and use the experience to reflect on our situation in the United States.

While in Cuba we met with physicians (both urban and rural), diabetes and vaccine researchers, farmers, educators, medical students, HIV-AIDS patients and more. We visited medical schools, clinics, physicians’ offices, rural villages and more. We walked the streets of bustling Havana and rural Viñales. At night, we processed what we had seen and explored our thoughts – often with the sound of salsa music in the background.

Though Cubans acknowledge that their system is not perfect (and what system is?), they are proud of what they have accomplished in health care. Despite widespread poverty – compounded by a lack of resources that has been intensified by the American-led embargo – Cuba’s infant and maternal mortality and life expectancy rates are comparable to those in the United States, and lack the racial and class-based disparities that plague American health outcomes.

Cuba is deeply invested in medical education, for aspiring physicians both in Cuba and around the world. A drive through the western parts of Havana reveals a vibrant, sprawling complex of buildings immersed in vaccine and other biotechnological research. In a nation that cannot afford the high costs associated with widespread acute and chronic illness, Cuba’s focus is on prevention, from frank talk about STI prevention, to mandatory vaccines that are not part of our regular vaccine schedule in the United States – such as vaccines against tuberculosis, leptospirosis and typhoid fever – to the much-discussed treatment they are exploring for lung cancer, to genomic research that aims to prevent diseases before they arise.

Cubans emphasize the hyper-rational organization of the system’s three-level approach to health care delivery, with family physicians located in communities serving as the first point of contact (including house calls), “policlínicos” serving as a community-based second tier and hospitals serving as a last resort for cases of acute need. While Cubans are allowed to access any of these tiers at any time, most opt to utilize the system as it was intended. Few Cubans go to the hospital when they do not need to. The system incentivizes this through unfettered access and by building trust in the overall design.

A particular highlight of the trip was when we American students were afforded an hour to converse with Cuban medical students at the Victoria de Girón Institute of Basic and Preclinical Sciences.The students compared notes on their experiences. Despite significant resource differences in education systems, the students found they utilized common textbooks and study strategies. Perhaps the most important takeaway was the revelation that their lives – their aspirations, as well as challenges – were not so different. Two days later, as further evidence that friendships were in the making, the students met again, this time in an unplanned run-in at a fashionable Havana art and music center, where yet more conversation and connection took place.

Cuba has a lot to offer osteopathic medicine in particular. After all, osteopathic approaches to health care emphasize the importance of the physical exam and prevention, turning to pharmaceuticals and technologies only when necessary. In Cuba, where many drugs and expensive equipment are hard to come by, there is an opportunity to reflect on core principles and see what osteopathic principles can accomplish in a resource-poor environment. It is well known that Americans overuse medical technology and testing; in Cuba, the problem is the inverse, where the American embargo is making it hard for Cubans to get some of the medical equipment they need.

In the weeks and months to come, we plan to explore ways to strengthen connections with Ohio University and Cuba. The clinicians and researchers with whom we met emphasized their hope that we could see past diplomatic tensions and focus on mutual goals of addressing pressing health needs, such as collaborative diabetes and cancer research. Sometimes, working on common projects can serve as a kind of diplomacy in its own right. Other osteopathic colleges have found value in such connections as well. Clearly, as our experience reminded us, the future of medicine – from the training of clinicians to research – is in global connectivity.

Daniel Skinner, Ph.D., is assistant professor of health policy. He is director of Ohio University’s Comparative Health Systems – Cuba program, administered through the Global Health Initiative.  

Adam Barone, M.S., is a first-year medical student.

 

Behind the White Coat: A Night of Storytelling

 

Sami Nandyal, OMS-II

“‘But how are you really?’ This is the question that often aches in my chest, fighting to get through my lips and to the ears of my fellow medical students. And sometimes it is the question I am wishing to be asked. We spend countless hours of our life pouring information into our cortices, pushing and pushing forward, suppressing breakdowns, postponing the moment we let ourselves relax and unload ‘just until the exam,’ knowing very well that there is a mile-long line of exams following that one, waiting to be our next excuse to avoid wellness and vulnerability.

Before I make our lives sound like something to be pitied, let me open the window and let in some other, coinciding rays of reality into the room. Many of us take steps each day to pursue our own wellness, for our own sakes and for the wellness of our future patients. We are working to keep human connection at the forefront of our minds, damming back science’s tendency to see patients and people as a clump of cells and molecules with or without dysfunction. We refuse to forget the experiences, hopes, fears, joys and pains permeating the tissues around hearts. When Aiesha came to me with the idea of Behind the White Coat: A Night of Storytelling, she was moved to bring out these hidden permeations in her peers and facilitate the connections and reminders of those elements within all of us.

The people we meet in class are all incredible people, and Aiesha and I want to know the students sitting next to us every day on a more personal level. After two months of medical school, Aiesha realized she only knew facts about her peers, not stories nor characteristics about them. We want to know their fears, their flaws, what events have made them the person they are.

On February 7, the normally treatment table-filled OMM room was dimly lit; an arch of seats speckled the ground facing a central riser where a microphone stand towered. People began filing in, hushed and subdued, maybe due to full bellies from the food that lined the hallway, the calming lights, anticipation or a combination of them all. Students watched eight of their classmates share tales of loss, growth, family, love and laughter. Two students shared original poetry about how their hometowns shaped them, one student talked about the regret of not speaking up and another taught us the lessons learned from losing a grandparent to disease and the importance of cherishing life.”

Aiesha Polakampalli, OMS-I

“The night ended with a first-year student volunteering to share a story about his relationship with his grandfather and how this relationship shaped his cultural identity. Before this event, I had never spoken to this student before, even though I know I walked past him almost every day in the library, his head buried in a textbook. Now, I can walk down the hallways of Grosvenor and see this student who before was a stranger, but now a friend who I can connect with over the pain of missing a grandparent. The students who performed and attended felt that this event was a necessary breath of fresh air, a humbling reminder of who we are and why we commit ourselves to a lifetime of service.”

On this February evening, more than 70 students, faculty and staff gathered in the OMM lab on our Athens campus to participate in “Behind the White Coat,” a storytelling event organized by Aiesha and Sami. Inspired by  “The Moth” Podcast, Aiesha and Sami created this space for students to share deeply personal stories with the intent of fostering community and enhancing connections with each other. We are thankful to the Barbara Geralds Institute for Storytelling and Social Impact at the Scripps College of Communication for their generous financial support for the event.


Watch the videos at YouTube.

Behind the White Coat Spotify Playlist


 

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Our new curriculum is all about that teamwork

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It’s Monday morning, and the entire first-year class at Ohio University Heritage College of Osteopathic Medicine is meeting a new patient.

Spread out over three campuses in Ohio and connected by videoconference, more than 260 medical students—the first to be trained in the College’s innovative new Pathways to Health and Wellness Curriculum—are starting their week as they do routinely on Mondays: diving into the simulated patient case on which their learning activities for the week will build.

They’ve just finished a quiz to assess how well they’ve mastered assigned material—readings, PowerPoints, recorded lectures—assigned in preparation for this week’s topic. After taking the exam individually, they take it again in a standing eight-student cohort who collaborate on lab and learning activities, mirroring the way modern health professionals increasingly work in teams.

This week’s patient is visiting the doctor for a wellness check-up. A Heritage College faculty member assigns each group a question for the fictitious patient to answer. HCOM_004Another faculty member takes the role of the patient, answering students’ questions about diet, exercise, and more. The class is alive with interaction, as students chime in from their microphone-equipped stations. As the patient answers questions, students suggest further follow-up questions.

In the coming week, all the specialized material the students learn, from biochemistry to gross anatomy to social factors affecting health, will be woven into their understanding of this patient’s case.

Welcome to “Osteopathic Approach to Patient Care 1 – Wellness,” the only fall semester class on the first-year academic schedule. A course on acute illness follows in the second semester; the second-year curriculum will feature courses on chronic illness, then return to wellness.

The new curriculum, launched in fall 2018, represents one seamless arc, following patients through stages of sickness and healing.

The Pathways to Health and Wellness Curriculum (PHWC) demonstrates what medical training of the future looks like: training organized around detailed patient cases, delivered to and absorbed in teams, and designed to present information in a way the physician will use it. It abandons auditorium lectures for a “flipped classroom,” in which students prepare outside class for interactive, team-based exercises in the learning space. Information coming from formerly discrete disciplines has been merged into a holistic, practice-centric way, offered by faculty from disciplines relevant to the case.

“We are given cases with patients’ names, their whole history, their whole medical background,” says first-year student William Naber. “Together, we take the material we learned that week and apply it to the case. And we help each other understand things that we didn’t understand about the case. That’s why the teamwork keeps coming back in over and over.”

Jody Gerome, DO ’05, associate dean for curriculum, says the PHWC continues the long-standing Heritage College practice of putting students into health care spaces like clinics and hospitals from their early days, yet now it replicates such practice venues in the classroom.

This ensures that “the way that students are introduced to major concepts is through the lens of a patient experience,” she says. “The faculty build the content that they’re teaching together, as a team, and then deliver it as a team. Students are then working in teams to synthesize the information.”

Dr. Ken Johnson, the College’s executive dean and OHIO’s chief medical affairs officer, says the PHWC is integral to the school’s mission.

“It teaches students in a way that research has shown they learn best, and that prepares them for the new realities of health care in the 21st century,” he says. “The doctors we train in it are going to come out of medical school already proficient at working on a modern health care team—with the patient at its center.”

This story was originally published in the winter 2019 issue of Ohio Today, the magazine for OHIO alumni and friends.

 

Summer research experience allows student to create hope for cancer patients

Nathan reynoldsHeritage College, Cleveland, student Nathan Reynolds, OMS II, gained firsthand experience in research-driven medical care this summer through the Pediatric Oncology Education Program at St. Jude Children’s Research Hospital in Memphis, Tenn.

Reynolds is one of 54 students in the country selected to take part in the program, where he worked under the guidance of Melissa Hines, M.D., a researcher and practitioner in the pediatric intensive care unit. Reynolds was part of a research team evaluating diagnostic criteria for hemophagocytic lymphohistiocyosis, a disorder of the immune system that causes the body to attack itself, causing organ failure and ultimately death, if untreated. By determining which diagnostic criteria are the best predictors of the disorder, the team hopes to increase the likelihood that future patients are diagnosed correctly in early stages.

Reynolds dreamed of a career treating cancer patients even before he started medical school. And now, thanks to his summer experiences at St. Jude, he appreciates even more fully how he can translate new research findings into hope for these patients. He also encourages other Heritage College students to take advantage of research opportunities to advance the scope and quality of health care.

Reynolds delved into his summer experiences through an interview with the college.

Why is it important for you to work with cancer patients?

I’m excited about the medical advances and research in the field of hematology and oncology, and that translates directly into my motivation for wanting to treat cancer patients. In the face of a catastrophic disease, I want to treat and help guide my future patients on their cancer journey to achieve the highest quality of life with the longest duration possible.

Who is your mentor?

My mentor was Dr. Melissa Hines, and she taught me the importance of integrating research into your clinical practice, as it helps you be a more focused and better clinician. She also taught me the importance of keeping a mentor throughout and beyond medical school. The idea of having a second set of eyes to look over a paper, or to discuss a manuscript or research proposal, is important on the continuum of a career.

Aside from your experiential learning in research and clinical treatment, what have you learned through this program?

We learned about the history and mission of the hospital; the ethics of clinical trials; the pathophysiology of hematologic and solid tumor malignancies in the pediatric population; the therapies the kids are given (chemotherapy, immunotherapy, radiation therapy, targeted therapy, surgery); the global mission of taking the research conducted at St. Jude and bringing it to developing countries; palliative care and hospice in the pediatric oncology population – as well as support services for the families; and St. Jude’s vaccine development and manufacturing operation.

What are the plans for publishing your team’s research findings?

We’re still about a month away from submitting the finalized manuscript, and it will be my first peer-reviewed article submission. I have one other publication, but it is a chapter in a textbook. Our project had two objectives: to evaluate the sensitivity and specificity of the HLH-2004 diagnostic criteria, and to create a novel scoring system based on readily available, non-invasive clinical and laboratory variables that can be used to predict an early diagnosis of HLH.

How has the Heritage College supported your efforts?

The Heritage College is doing a phenomenal job encouraging students to pursue research opportunities both within the institution and externally. The research process is integral to medicine, so having an environment that fosters that early on in our medical career will lead to more D.O.s being involved in research projects once we enter into our residencies and beyond.

Reynolds received a bachelor’s degree in biomedical sciences at Western Michigan University in 2012, before earning a master’s degree in public health from Hebrew University in Jerusalem in 2014. There, he developed skills in statistical analysis and research, which he applied through his work in the clinical trials office of the Taussig Cancer Center at Cleveland Clinic from 2015 to 2017. After working in data collection and regulation for lung, bladder and kidney cancer patients for two years, Reynolds began his medical education in 2017 at the Heritage College, Cleveland, where he recently began his second year.

Alumnus Dr. Moomaw addresses graduates, talks psychiatry, flight surgery

Forty years after starting medical school with our first entering class, alumnus Ronald C. Moomaw, D.O. (’80), brought it all back home May 7 as commencement speaker for the Heritage College class of 2016. Moomaw, a psychiatrist and flight surgeon who works with NASA astronauts, reminisced about the high adventure of launching a new medical college in converted dormitory buildings and lauded the school for giving him “the chance to have the most fascinating life I could possibly imagine.” He was one of 24 medical students who began their studies here in 1976. With 129 new physicians, the class of 2016 is the largest graduating class in the college’s history.

Watch a video of Dr. Moomaw’s commencement address.

View a gallery of photos from Commencement 2016. See more photos on Facebook. 

Read more.

40 Things to Know: We dance

The Heritage Ball at the Baker Ballroom

Many families have deep traditions that make for memories and lifelong connections. Our college is no exception.

On Saturday, Jan. 9, students from all three Heritage College campuses gathered in Athens for the high-gloss Heritage Ball, also known as the HCOM Prom. Sponsored by the Family Practice Club/Student Association of the American College of Osteopathic Family Physicians, this annual event means it’s time for students, faculty and staff to brush off the formal wear and join in the Nae Nae. View photos from this year’s Heritage Ball.

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Dancing is nothing new for us. Back in the early 1980s, our students celebrated with their classmates during the annual Champagne Dinner. By the 1990s, the Family Practice Banquet gave students a reason to pull out their dance shoes. And in the 2000s, the banquet, which began as a modest sit-down dinner with guest speaker, evolved into today’s gala.

The Heritage Ball at the Baker BallroomMemories aren’t just made in the classroom. Here they’re made on the dance floor, a football field and the stage in Irvine 194. The Heritage Ball is just one example of the many events our students have initiated over the last 40 years as ways to enjoy time outside the lecture hall with their classmates, families, faculty and staff. Our students develop friendships that remain long after graduation.

With the opening of our two new campuses, we’re watching traditions change as we grow. New traditions are emerging at our Dublin and Cleveland campuses. Will Dublin’s Ugly Sweater Holiday Potluck stand the test of time?

Our People: Mark Loudin, Technology Expert and Friend

Mark-Loudin

“I have never enjoyed anything more than becoming friends with our many students”

There are those who sit in the front of the class and those who prefer the back of the class. And then there are those who’d rather sit with Mark Loudin.

How many of our alumni, faculty and staff did a spell in the Irvine 194 lecture hall control booth with Mark? Mark joined the Heritage College in 1999 as multimedia producer and director, with a responsibility and an incomparable talent for ensuring that the classroom technology works effortlessly for faculty and students. A familiar face – and voice – to nearly half of our graduates, many of us have have appreciated his warm welcome and a moment of respite in that dark room, participating in the classroom intensity from behind the glass wall, and enjoying Mark’s company, counsel and hundreds of refrigerator magnets and collection of college memorabilia.

Favorite part of his job: “Seeing a first-year student attending orientation, timid and afraid, without confidence and a bit more than overwhelmed. In four short years, that same individual blossoms into a confident, competent leader and then graduates – and enters a practice as a trusted and life-altering physician.”

Thoughts on technology: “Computer-age students have demanded that we change the way we approach education. We record and post thousands of classes and events and make them available in minutes online. We have integrated several types of technology into a cohesive unit of learning, which is unique of any medical school on the planet. Our students are amazing, and giving them the proper tools to learn and truly integrate the medical knowledge they must possess helps them in the real world.”

Inspiration: “I have had a very fortunate career. I have interviewed two sitting presidents, worked NFL sidelines for thousands of games, won a bunch of TV awards. All of that pales in my mind to the pride and accomplishment I feel on a Heritage College graduation day. I have never enjoyed anything more than becoming friends with our many students, and I certainly enjoy keeping in touch with as many as I can.”

Parting thought: “Let’s go! On to the next ideas, advancements and accomplishments!”

Our People: Anthony Chila, D.O.

Chila_Banner

“The hands-on part is central to the whole idea”

Chila has had contact with every Heritage College graduating class, and his passion for teaching osteopathic manipulative medicine (OMM) has left many Heritage College alumni with a favorite Chila story. He joined the Heritage College faculty in 1978, and today is a professor emeritus of family medicine and faculty practitioner at University Medical Associates. A leading authority on OMM, he has served a variety of leadership roles in the American Academy of Osteopathy and in 2013 received the American Osteopathic Foundation’s Educator of the Year award.

Favorite class?: “I always had a great deal of favoritism for the Class of 1982. I enjoyed that group of people tremendously. I think they had as much fun with me, poking fun at me, as I had with them, harassing them. It was just a kind of a chemistry with that particular group. And that, by the way, was part of my learning process.”

Osteopathic medicine’s “secret sauce”: “The hands-on part is central to the whole idea of what an osteopathic physician is or is to be. Unfortunately, there is so much material thrown at students that it just boggles my mind that they can struggle with the hard-core academic material and still have some interest and some hope that they want to get something from the hands-on.”

His inspiration: “That ‘aha’ moment when you are working with your hands and you are trying to explain to a student or intern or a resident what it is you are looking for, how it is that you are preparing to make a diagnosis and what it is that you’re doing when you are implementing a treatment. There is something about that close work one-on-one with the student or resident over a patient and there seems to come a time when a huge light bulb goes on and a student literally says ‘aha, I understand what you’re talking about.’”

Parting thought: “Happy 40th anniversary, Heritage College of Osteopathic Medicine. It’s been a pleasure and a privilege to be with you.”

 


Founding Voices
Perspectives from those whose personal story is woven into the college’s beginning.