12/6/2009
By MICHAEL STRAND Salina Journal
One of Apple's recent ad campaigns for its iPods and iPhones focused on the plethora of applications available for the hand-held computers, with the catchphrase "There's an app for that."

There's no app that takes the place of medical school -- yet -- but at the University of Kansas School of Medicine, lectures are recorded as podcasts, so many students skip the classroom.

And since the lectures can be downloaded and listened to anywhere, the students could be at a Starbucks, down in Westport -- or even in Salina.

And given that doctors tend to practice near where they went to medical school, a program that would allow them to attend medical school in Salina will likely increase the number of doctors in north-central Kansas.

If all the ifs can be resolved, as many as eight medical students could, by the fall of 2011 or 2012, be starting their four years of schooling while living in Salina, said Dr. Heidi Chumley, senior associate dean for medical education at KU. Within a few years, Salina could be home for more than 30 medical students.

It's not uncommon for medical students to spend part of their third or fourth year out in the field, but the program KU and Chumley envision could have students interacting with patients even in their first year of medical school.

"The state is facing a critical shortage of rural doctors," Chumley said. "If students get their training in rural areas, they're more likely to stay in rural areas."

While there's still "lots to work out," including accreditation, Chumley said, the goal is for Salina students to get "the same program as they would get if coming to our program in Kansas City."

"The first two years of medical school is classrooms and labs," Chumley said. "Here in Kansas City, all of our lectures are podcast, and many students don't come to class. We would replicate the labs -- even in K.C., we now use virtual microscopes."

Won't build a building

She acknowledges there are some parts of medical education that can't be done online.

"Gross anatomy cannot be done over the Internet yet -- we're working on how we'd do that," she said.

One thing KU probably won't do, Chumley said, is build a new building to house the school.

"At this point, we're not planning on building a new building. We're working on partnerships on space with several groups, but we don't have that nailed down yet."

Among the potential partners are Kansas Wesleyan University, Kansas State University at Salina, Salina Regional Health Center and Salina Family Health Care Center.

"I think it's a great idea ... I'm a big believer in decentralizing medical education," said Dr. Robert Freelove, director of the Smoky Hill Family Medicine residency program and CEO of Salina Family Health Care Center. "It's good to move out of the ivory towers of an academic medical center and have access to patients and specialists."

Learn here, stay here

Freelove said his experience shows that students who do their residency in Salina are likely to stay in the area to practice.

"The majority of our residents are practicing in Kansas, and in rural Kansas -- and that's because they trained here," Freelove said. "Studies show most will practice within 50 to 100 miles of where they train."

Chumley said eight was settled on as the size for each class because medical students generally gather in study groups of eight, making that a minimum critical mass.

Thanks to technology's ability to deliver the lectures and some lab work being done anywhere, "moving it away from Kansas City just makes sense," Freelove said. Both the clinic and Salina Regional would likely host students learning to work with patients. "We have a great medical community -- lots of great physicians who are great teachers."

Need to be self-reliant

The proposal, Chumley said, is somewhat modeled after one started two years ago by the Indiana University School of Medicine; that program is based in Terre Haute, on the Indiana State University campus. The first class to enter the program had eight students, the second had 13.

Peter Duong, director of the Terre Haute program, said the program was started to address the impending shortage of doctors in rural areas -- and to prepare medical students to practice in rural areas.

That preparation involves both different professional training and making sure the students are a good fit for rural life, Duong said.

When practicing in a rural area, "you have to be more self-reliant," Duong said, stressing that with modern communications, "today rural doesn't mean rustic."

For example, he said, rural doctors need to be familiar with telemedicine and other technologies for consulting with distant specialists -- and know how to implement that technology in their offices.

More than routine visits

And while it might seem counter-intuitive, Duong said, "Rural are often called upon to do much more than the routine clinical visit," so the program encourages students to learn more about specialties such as obstetrics, dermatology, or minor surgery.

Freelove agreed.

"As a rural physician, you end up seeing and doing a lot of things, because you're it," he said. "I've had students call me and say they've seen things they were told they might see once or twice in their career, and they're seeing it in their first couple years of practice."

"In our program, we don't concentrate on family medicine, but on primary care, general internal medicine, OB-GYN, and general pedes (pediatrics)," Duong said. "Those are the areas they'll use most."

But actually becoming a specialist isn't useful for a rural doctor.

"If you want to be a brain surgeon, this isn't the right place to train," Freelove said.

"If you specialize, you won't have the volume of patients, or the specialized facilities you need," Duong said.

Question of funding

The program does require additional resources, though Duong said support from the medical community has helped significantly.

"The question of funding has always been paramount," he said. Among the costs are room and board for the students, and equipping local physicians to serve effectively as teachers.

"What's really been super is the cooperation of the rural physicians," Duong said. "There were concerns at first that it would slow them down, having a student with them, but now they're calling and asking when they get their next students.

"The hard sell has always been to the state legislators," Duong said. "It takes seven years to train a physician -- four years of medical school and three years of residency. It's hard to talk to legislators about that when they're worried about balancing the budget this year."

KWU, K-State Salina

KU has talked with K-State at Salina and Kansas Wesleyan, and both schools are excited about the possibility of partnerships.

"We're pursuing what services we could provide," said Mike Mitchell, vice president for academic affairs at Kansas Wesleyan.

Access to various campus facilities "a place to eat, a place to study" are examples, Mitchell said. "We've had different arrangements at different times for using our facilities. This would be more intense and more ongoing."

Kansas Wesleyan could also provide space for cadaver work on its campus, and Mitchell said it's possible Wesleyan students could have access to the cadavers as well.

"I think we would work something out for mutual use of the cadavers," Mitchell said. "We had them some years ago, but discontinued it." Students taking physiology and anatomy classes, as well as those in the nursing program, could benefit from having medical students on campus, he said.

And Dennis Kuhlman, dean of K-State at Salina, sees benefits to his campus as well -- including partnerships with the college's flight programs.

Kuhlman said the number of doctors approved by the FAA to certify pilots as medically fit to fly is dwindling.

Getting aviation 'medicals'

"Examiners are becoming fewer and fewer," Kuhlman said. "Most of my students have to go to Manhattan or Wichita or Ellsworth to get their aviation medicals."

With exposure to the flight programs, Kuhlman said, some of the medical students might become interested in being certified through the FAA as flight surgeons.

The medical students could provide more general benefits as well, Kuhlman and Mitchell said.

"I think any time you get another academic program that's different, that's an advantage," Kuhlman said. "There's exposure to people who think in different ways, and have different interests."

"We've just had some general discussions, but we think there are lots of opportunities," Kuhlman said. ""We're going to support them every way we can to assist them and make it happen."

Freelove, too, sees broad benefits to Salina's current doctors.

"For the medical community, having those learners here can energize a place," Freelove said. "I see benefits to the hospital, our program, and the community in general."

n Reporter Mike Strand can be reached at 822-1418 or by e-mail at mstrand@salina.com.