OU-TU School of Community Medicine Expands Efforts to Grow Primary Care Services

At Bedlam Clinic, third-year medical students in the School of Community Medicine work in interprofessional teams with nursing and social work students, and with physician, pharmacy, social work, nursing and physician assistant faculty.

The OU-TU School of Community Medicine continues building partnerships and implementing initiatives aimed at filling Oklahoma’s growing void in primary care services, particularly in tribal, rural and medically underserved communities. The effort is funded by a multimillion dollar grant from the federal agency Health Resources and Services Administration (HRSA).

Since the original $4.7 million award in 2019, the college received a $2.8 million supplement. Both campuses are participating in the program made possible by the grant, with significant collaboration because many goals are interdependent. The program is led by co-principal investigators James Herman, M.D., Dean of the OU-TU School of Community Medicine, and Steven A. Crawford, M.D., Senior Associate Dean of the College of Medicine.

The program focuses on enhancing the primary care experience for current medical students, as well as creating a statewide outreach program to cultivate interest in healthcare professions among younger students. The efforts aim to repair a “leaky pipeline” that contributes to the formation of “primary care deserts” in non-urban communities across the state, said Tulsa project lead Frances Wen, Ph.D., a health services psychologist and professor in the Department of Family and Community Medicine. Students in medical education programs form the pipeline that ensures a flow of well-prepared medical professionals, able to meet healthcare demands in a region or community. However, while students’ interests may initially be aligned with primary care/ family medicine models, many ultimately go into specialty practice for a variety of reasons, creating the “leak” that drains the primary care workforce.

“There is an urgency about our work, which seeks to lay the foundation for outcomes that may not be realized for a decade or more,” Wen said. “To provide an exceptional medical education is only one step toward meeting the growing demand for primary care providers. We must also cultivate a certain mindset. We’re looking for people keying on this aspect of their future professional lives.” Strategic community partnerships are playing a major role in the effort. School of Community Medicine students are taking part in two-week or four-week rotations in primary care at the Muscogee (Creek) Nation. “The Muscogee (Creek) Nation has built beautiful clinics for one-stop healthcare services — dental care, eye care, consultations on diet and nutrition that interrupt the cycle of diabetes, lab work and more. Working within this sophisticated multiprofessional, team-based environment is excellent training that shows what high-quality primary care really looks like,” Wen said. Wen is hopeful for another HRSA grant that would grow a partnership between the SCM family medicine residency and the Muscogee (Creek) Nation. Other partners include the Chickasaw Nation, Comanche Nation, Variety Care,

Frances Wen, Ph.D.

Hillcrest Health System, George Kaiser Family Foundation and Physician Manpower Training Commission. Similar student opportunities are underway for Oklahoma City-based students.

SCM students are also taking part in an expanded curriculum that includes the courses Lifestyle Medicine and Health Promotion I and II, in which they learn how food and exercise can promote better health for their patients. They spend time in a culinary medicine setting to learn how to make healthy foods appropriate for specific medical conditions, like diabetes.

Students also learn that many of the health problems they encounter in patients are related to lifestyle and behavior. In turn, patients’ behaviors may be related to a history of trauma and the early use of tobacco and alcohol. Mental health services, which are increasingly being integrated into primary care settings, can help patients develop prevention and behavior change skills and make better-informed lifestyle decisions.

“As family health history influences individual health, historic trauma also has direct impact on lifestyle choices,” Wen said. “We’re working to build a trauma-informed workforce, which includes building greater awareness and teaching specific communication techniques to open conversations.” Addressing the shortage of primary care services also means building relationships with much younger students, particularly those from tribal, rural and medically underserved areas. Toward that end, the HRSA grant supported the creation of a statewide outreach program. Its initiatives expose students to community health needs with the intent to foster interest in primary care as early as kindergarten and continuing through 12th grade, while another follows students into college years. Community clinicians are also being recruited to serve as mentors, sponsors and referral sources to OU’s outreach and recruitment events. In addition, tribal partners have established youth camps that spur interest in primary care careers. The final step in this strategic progression is to close the pipeline, Wen said, citing residency programs, at OU and within other systems, that train in primary care. “The idea is that new M.D.s in residency tend to remain in these communities, becoming part of a statewide network we call the Primary Care Pathways Network — graduates giving back by investing in the health of entire communities.” She added: “If we are to effectively address chronic health disparities, we must do much more than simply encourage medical students to choose residencies and careers in primary care. The HRSA grants are invaluable in supporting our efforts to innovate and implement strategies for future success.”

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $7,530,860 with 10% financed with nongovernmental sources. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. government.