Tailored educational tracks prepare tomorrow’s primary care physicians to meet the needs of California’s underserved

Growing up in the small farming town of Live Oak, Emanuel Jaramillo and his family learned firsthand what it’s like to live among the ranks of California's medically underserved.

Despite a strong sense of community and other positive qualities, the city of about 6,000 completely lacked health services. Live Oak residents – roughly half of them Latino and nearly a third living under the poverty line – were forced to leave town for their care.

“A local bus passed through about twice a day, usually when people were at work,” recalls Jaramillo, now a UC Davis medical student. “That meant if you didn’t have adequate transportation, you most likely couldn’t see a doctor – let alone a specialist.”

When Jaramillo’s father developed a serious brain infection, he was fortunately able to obtain specialty care at UC Davis. But each follow-up appointment involved several hours of travel, forcing Jaramillo’s mother – now the family’s sole breadwinner – to miss a day of work and crucial income.

Later in college, Jaramillo witnessed the consequences when there’s no access to care at all. During a study abroad program in Mexico, he met a patient in his 20s who had lacked prompt diagnostic services in rural Oaxaca. The man’s common, highly treatable cancer had metastasized and was now terminal.

Targeting social needs

Today Jaramillo is part of the Rural-PRIME program, a tailored educational track for UC Davis medical students who wish to work in underserved rural areas. The initiative, whose acronym stands for Programs in Medical Education, is one of several innovative programs at UC Davis for future doctors who intend to practice medicine in ways that aid underserved populations and help fulfill unmet societal needs.

The range of programs offers highly motivated, socially conscious students like Jaramillo additional curricula that are variously designed to equip them with the tools to practice primary care in rural, valley or urban underserved settings; to better serve California’s new and expanding Latino plurality; or to enter primary care practice more quickly – but with all of the requisite skills – at time of historic demand.

“My experiences locally and studying abroad motivated me to pursue rural medicine because they opened my eyes to the injustices these communities face,” Jaramillo said. “I have the opportunity to pursue medicine – a privilege not many are given – and because of this, I believe I have a social responsibility to be a voice for those who are unheard.”

Overall, approximately a quarter of the matriculating class annually enrolls in one of the Rural-PRIME, SJV PRIME, TEACH-MS (short for Transforming Education and Community Health for Medical Students) or ACE-PC (Accelerated Competency-based Education in Primary Care) tailored clinical tracks.

Rural-PRIME is the legacy track, launched in 2007 as part of a larger UC effort across five institutions. The newest program is Prep Médico, a partnership with The Permanente Medical Group and a pipeline initiative that will build the next generation of physicians who will advance Latino health.

Common threads

Applicants to all med school-level tracks must first be accepted to the UC Davis School of Medicine before being considered for a tailored pathway, which usually requires additional knowledge or experience with underserved populations and public health. While each track is customized for a specific population, common themes run through all.

Most involve early, intensive experiences with the populations that students will eventually serve. By using the community as a classroom, educators hope to help students experience the realities and fulfillment of primary care and service to the underserved, and to confirm – and strengthen – their commitments to practice in these areas.

Most tracks also involve some degree of training in public and population health, meant to help students both understand greater systems that affect individual patients, and empower them to act as physician-leaders toward community-wide solutions.

Coursework in health equity, cultural competency and inclusiveness also helps cement respect and responsiveness for the health care and cultural preferences of diverse patients. The training prepares future physicians to earn trust of patients of differing cultures and socioeconomic situations and to negotiate treatment or preventive measures suitable for each patient’s real-world context.

For example, TEACH-MS students participate in the Summer Institute on Race and Health, a four-week clerkship that explores race’s impact on health and identity and includes practice in cross-cultural dialogue. The workshop’s leader is Jann Murray-Garcia, who helped establish the concept of cultural humility in health care and is now an adjunct professor at the Betty Irene Moore School of Nursing at UC Davis.

Spirit of partnership

Nearly all tracks involve partnerships with other health systems and providers. Rural-PRIME sites host and mentor students in return for expanded telemedicine services, the prestige of participating in medical education and the prospect of drawing future physicians.

The Permanente Medical Group is a cornerstone of both Prep Médico and the ACE-PC program, a pioneering three-year pathway for primary care physicians. The TEACH-MS program for urban communities collaborates with Sacramento County. San Joaquin Valley PRIME is a partner-ship among three UC campuses.

For more information on select tracks, please visit the photo links in the sidebar.