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Medical center plans teaching program

By Allison Robertson

Mount Nittany Medical Center

Mount Nittany Medical Center (MNMC) has been involved in the training of medical students for a few years, training third and fourth year students. Now the hospital is expanding the teaching program even further, becoming a true teaching hospital.

In 2015, MNMC will be adding a residency program to its campus for students that have graduated medical school, becoming the teaching hospital for the Penn State regional campus.

“This program will formally elevate Mount Nittany Health to an academic teaching hospital, one of our strategic priorities,” wrote Steve Brown, FACHE, president and CEO of Mount Nittany Health, in an email.

Currently, doctors at Mount Nittany teach a few different fields of medicine to third and fourth year medical students from Hershey. In a few years, however, the hospital will take residency students who are ready for the next step after graduating medical school, and train them in family medicine.

The residency program at Mount Nittany was envisioned as part of the regional medical campus established in State College and created through the collaboration of the administration of Penn State University, Penn State College of Medicine Dean Harold Paz and the Board of Trustees. According to Dr. E. Eugene Marsh, Senior Associate Dean of the University Park Regional Campus of Penn State College of Medicine and Associate Director of Penn State Hershey Medical Group State College, discussions about this residency program have been going on for a number of years.

Marsh said the program is designed to focus on education, as well as to provide access specifically for the central Pa. community to clinical services in the area where they are needed.

“We want to train doctors in this area for this area,” said Marsh. “Our hope is that many of the residents that graduate from the program here will stay in the State College area and in areas around central Pa., where there is a real problem with access to healthcare.”

In addition, the leaders of the program recognize the national shortage of primary care doctors and want to address it the area, Marsh said.

Statistics bear out Marsh’s statement: there is a national shortage of primary care doctors that is projected to grow. According to the Association of American Medical Colleges, by 2020 there will be a shortage of more than 90,000 physicians—which includes primary care physicians—in the United States. In 2025, this deficit of physicians will grow to 130,000.

The residency program is expected to “benefit the community for many years to come,” he continued.

But there are still kinks in Penn State / MNMC’s plan. Marsh said that the leaders of the program are working to get the program accredited. The program needs a coordinator and director, so Marsh is recruiting a family physician with experience running a residency program, as well as searching for teaching staff as the program moves forward. This will all take place in the next year or so, before student recruitment is to begin. The program will begin to recruit medical students who are interested in family medicine and will start in 2015.

However, Marsh said, “There is a lot that has to be done to get us ready for that.”

When completing their residency in the area, students will learn about the environment and community, preparing students remaining in the area to better serve their patients’ needs.

“Since most residents remain in the communities where they receive their training, we would be essentially ‘growing our own’ primary care physicians – the area of greatest national need – right here in our community on the grounds of the Medical Center and the Penn State Hershey University Park Regional Campus,” said Steve Brown.

Six students per year will graduate from the residency program.

Residency programs are financed through CMS, or Centers for Medicare and Medicaid Services, which is a nationwide service through the government. In the past, there has been a freeze on the funding for residency programs. The freeze on funding will not, however, affect the program at MNMC as it will be mostly funded through CMS.

“Recent changes extend the caps for new programs, such as the residency program being planned involving Mount Nittany Medical Center,” wrote Richard Wisniewski, CFO, senior vice president for finance at Mount Nittany Health, in an email.

A Day in the Life of a Resident

In current medical education, medical school lasts four years. During the last two years, a medical student focuses more on clinical medicine than strict academics, meeting with patients and learning to be a good doctor and practitioner.

To accomplish this, in the last two years of medical school students study different types of medicine in a clinical setting under an attending physician. This on-the-job training is called rotations or clerkships. Each of the eight rotations—in medicines such as family medicine, pediatrics, psychiatry and neurology—lasts about four to eight weeks.

After picking a specialty from those eight categories, the student can then choose a residency program that focuses on what he or she would like to specialize in. A medical student then applies for a residency program after he or she has completed medical school. He or she visits programs all over the country, and makes a list of which programs he or she wants to participate in. The programs also make a list of which students they wish to accept, and then the National Resident Matching Program “matches” each student to a program.

The residency lasts three years, during which the resident will live in the area and learn from the doctors at the hospital.

Papia Nasiri is a first-year residency student at Penn State College of Medicine in Hershey, Pa., and thinks she wants to specialize in family medicine and gear her career toward hospital medicine.

“It’s hard to decide,” she said. “That’s what residency is for, to expose you to different fields so you know exactly what you want to do.”
Originally from North Carolina, Nasiri interviewed for 26 programs before she chose Penn State Hershey’s residency program.

“This program was exactly the one I was looking for,” she said, because the residents rotate through the local community hospital as well as work in the academic center, which has a strong reputation for education and research.”

Being in a community hospital allows for autonomy, she said.

“The community hospital has more of a patient population who’s not as well off,” she said, giving examples that the patients may be uninsured and have multiple medical problems.

Normally a residency program consists of just a community hospital or academic center. At Hershey, Nasiri sees both worlds.

“I wanted to have as broad an experience as I possibly could,” she said.

Nasiri’s typical day varies depending on the rotation she’s in. Generally as an intern, she arrives at the hospital and receives a list of patients. She checks up on each one to see if there’s been any change in his or her condition during the night.

After this, Nasiri meets up with her team, made up of three other interns and an attending physician. The team goes from bed to bed with a list of patients, visiting the patient, taking notes and then discussing each visit. They formulate a plan for each patient as a team and decide if they should consult other services or run more tests.

On average, Nasiri said she sees about eight patients a day.

Of the residency program at Hershey, Nasiri said, though she can’t pinpoint a particular problem, “No program is perfect. There’s always room for improvement.”

Though Nasiri loves the Hershey area, she hasn’t made a final decision on where she will work. She is waiting until she begins to apply for jobs, which won’t be until the third year of her residency.
Teaching at Mount Nittany Medical Center
Teaching hospitals, though they are geared toward teaching medical students, actually keep physicians learning, too, said Dr. E. Eugene Marsh.

“In my mind every hospital should be a teaching hospital,” said Marsh, adding that every healthcare professional should constantly be learning.

Once the residency program begins at MNMC, conferences will occur as a part of the teaching program and will be made available to members of the hospital’s faculty.
Angela Hardyk, MD, FACOG, OB/GYN, Mount Nittany Physician Group, began teaching third and fourth year medical students about five years ago.

Mount Nittany invited medical students to spend a rotation at the hospital to create a closer relationship with Penn State Hershey. Then, Mount Nittany expanded and opened up to other rotations, meaning that medical students from Hershey could spend their first two years in Hershey and then come to Mount Nittany for their clinical rotations, said Hardyk.

At Mount Nittany, there are now 13 medical students in the rotations.

Hardyk said that doctors get started teaching when they are just residents— teaching medical students during their residencies.

“Medicine in general is a lot of teaching,” she said. “Not only to students, but to other faculty that you work with, to nurses, to support staff, just kind of sharing knowledge and teaching all the time. I think it translates very well that we want to teach those physicians that are coming up through the ranks to practice good medicine and teach them what we know about our specialty.”

Hardyk works one-on-one with the medical student in the OB/GYN rotation, asking the student questions and seeing patients with him or her. If Hardyk has to attend to an emergency, Hardyk said, she gives the student a problem to work on so the student is always learning.

When Hardyk and the student are with a patient, Hardyk said she shares her thought process so that the medical student can hear it. She also explains why she wants to run a test or have an ultrasound done.

Even if the patient asks that the student not come in, Hardyk asks the student to read the patient’s chart.

“That doesn’t mean you can’t learn something from her [the patient],” Hardyk said.

After the visit, Hardyk discusses it with the student, and they reach a conclusion together.

Hardyk also tells her students to learn not just from her, but from every part of the patient care team, including the nurses.

The student also can come with her into the operating room, Hardyk said, where she can explain the reasoning behind her actions and teach anatomy while operating on a real person instead students just learning from a picture in a book or a cadaver, as the students did in their first two years of medical school.

 

“I think our patient population here, being well-educated, can appreciate what these students are here for, why they’re here, that it’s important that they’re doing this part of their education, and are oftentimes happy to let them in and be part of their education process,” Hardyk said.

Though obstetrics may be added later, the current plan for the residency program currently is based around family medicine.

“We’re an underserved, rural area,” Hardyk said. “So what we really need to do is to train primary doctors to come here.”

Hardyk trained and did her residency at Penn State Medical College in Hershey and chose to stay at Penn State to practice. She said she’s hopeful that MNMC will keep the quality people that they’re training.
Though Hardyk can only speak for medical students, she sees a huge benefit to having residency students at MNMC.

“The great thing about students is they keep you young, they keep you on your toes because they’re good students,” said Hardyk. “They’re always asking questions, they’re keeping you thinking, you have to stay up on what’s new and current in your specialty.”
Benefits for Researchers…and the Community
According to AAMC.org, Association of American Medical Colleges’ website, not only do teaching hospitals teach students to become healthcare professionals, but also “teaching hospitals are key centers of research where medical knowledge continuously evolves and new cures are found.”
Donna Fick, RN, PhD, Associate Professor of nursing at Penn State University, is leading a five-year intervention study to improve the care of older adults with delirium and dementia. The study, funded by the National Institute of Nursing Research, is taking place at three different hospitals: Altoona Regional Health System; Vanderbilt University Medical Center in Nashville, Tenn.; and Mount Nittany Medical Center, or MNMC.
Fick said that the she attempted to choose hospitals of varying sizes and units but also chose hospitals where her team had prior relationships.
“We chose MNMC because we had done prior research there and had a great experience working with MNMC hospital and staff. We also wanted to offer our community the opportunity to participate in research that has the potential to improve the lives of older adults,” Fick wrote in an email.
MNMC was also chosen because of the large population of older adults at the medical center. Fick ran a smaller study at MNMC before embarking on the larger one, and said that it was invaluable to have the staff that was familiar with the study to put it on a larger scale.

Though Fick doesn’t anticipate the research environment at MNMC to change significantly, she does see a benefit to MNMC becoming a teaching hospital.
“Teaching hospitals often have greater access to clinical trials, advanced technologies and highly skilled well-trained staff. There may be increased opportunities to collaborate with other disciplines and have medical student or residents involved in our research,” Fick wrote in an email.

Along with Marsh, Fick sees the importance of residency students and nursing students working together.

“The addition of residents and medical students to this will enrich the nursing student’s experience and our research team,” wrote Fick in an email. “It is crucial to teach students to practice and communicate in an interdisciplinary environment–as this is the world they will enter when they complete their education. Training disciplines together should lead to better communication and improved quality of care.”

Teaching hospitals also have a greater impact on the field of medicine through published research. Currently, Penn State Hershey publishes much more research than MNMC does, a difference in impact that the development of a teaching program may partly correct.

“A closer affiliation with“A closer affiliation with Penn State Hershey through this program will open the doors for our physicians to have many more research-related opportunities,” wrote Steve Brown, CEO of Mount Nittany Medical Group, in an email. “It also provides the researchers at Hershey more opportunities and different clinical sites for their research projects.

Penn State Hershey and MNMC have the same goals in mind: to train doctors in the area for the area. iation with Penn State Hershey through this program will open the doors for our physicians to have many more research-related opportunities,” wrote Steve Brown, CEO of Mount Nittany Medical Group, in an email. “It also provides the researchers at Hershey more opportunities and different clinical sites for their research projects.”

“The shortage [of family doctors] now is going to get worse over the next five to ten years,” said Senior Associate Dean of the University Park Regional Campus of Penn State College of Medicine and Associate Director of Penn State Hershey Medical Group State College Dr. E. Eugene Marsh. To him, that’s a much bigger issue than any concerns about competition between the residency programs at MNMC and those in other parts of Pa.

“We need as many family physicians as we can train,” Marsh said.

Marsh wants to learn from the program in Hershey. He said it’s an important thing for Pa. to have another program to train people to help in its greatest need.

“To achieve the kind of success that we all want to see, we will need to work together. This includes Penn State Hershey, Mount Nittany Health, community providers and the community at large,” said Marsh.