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Interviewer: How can you apply what you learn in the classroom to the broader community? That's a question that's being asked at a lot of academic medical centers. Welcome to conversations between colleagues with thescoperadio.com at AAMC Learn Serve Lead, exploring the innovative ideas shaping the landscape of academic medicine.

This episode, we get the opportunity to listen to a conversation between Kathryn Corona and Sanila Math. They're both second-year medical students at the Spencer Fox Eccles School of Medicine at ÈËÆÞÖгöÊÓƵ of Utah, and also Intermountain Population ÈËÆÞÖгöÊÓƵ Scholars.

So, the first question for both of you is how have you personally struggled to connect what you learn in the classroom to the practice of medicine? Sanila, why don't you go ahead and start?

Sanila: Yeah, I think that's a great question. Thanks for posing that. So, I got my undergraduate degrees in ethnic studies and anthropology at the ÈËÆÞÖгöÊÓƵ of Utah, and that was extremely helpful in, A, teaching me the transformative power of education and then, B, teaching me what sort of inequities different communities faced based on our history of just America in general and how different systems in our community were built, and how they operate, and often weren't built to serve the communities they're meant to serve.

And so, that offered me a nice framework to begin to think about what issues our communities face, but I didn't really feel like there was a lot of intersection with public health and population health as it related to health care for those communities.

And so, through the Population ÈËÆÞÖгöÊÓƵ Scholars Program, I think it's been great in helping me expand my education from within the classroom to these communities to see how we can begin to take this education that we are receiving out and begin to help others reach that level of understanding of these issues and what we can do to address them as well.

Interviewer: And do you have a specific example of something you learned in the classroom that then you were able to take out into the field through this program?

Sanila: I think there are a lot of examples. I think within medicine you always hear about different issues that communities face within our system. We always hear, "Oh, the system is so broken. Here are all these issues, yada, yada, yada." They get thrown at you and then you never really learn what to do to fix them.

And within population health, since it combines a lot of different elements like business and how systems operate in a community driven by profit, at least for me it helps me begin to understand what drives the way these systems kind of function.

And for me, who's never had any sort of business learning or knowledge, I can start to understand, "Okay, this is why insurance companies operate this way." And once I can understand that, I've still got a long way to go, but I can begin to understand how we can begin to dismantle those oppressive systems that harm our communities as well.

Interviewer: Right, because you have to understand something before you can do something about it.

Sanila: Right, exactly. And I think that's why population health is nice because it teaches you a lot about these communities that you'll be serving inevitably, and in order to do that effectively, you have to expand your education from within the classroom to outside. So, I think you can only serve people when you understand the issues that they're facing and what they need.

Interviewer: And hearing about it and seeing it can be two different things.

Sanila: Right. Totally.

Interviewer: Kathryn, tell us about your experience when maybe you struggled to connect what you learned in the classroom with the practice of medicine.

Kathryn: Absolutely. The first whole year of medical school really, I felt like I was under a fire hose of information, and I didn't have a lot of time and bandwidth to really get out and practice medicine. And even when I did get into the clinics, etc., I didn't have any skills to bring to them. I was brand new and baby.

And it felt a lot like my undergraduate degree in public health where we learned a lot about problems and not a lot about solutions, to be honest. It felt like many, many lectures and series and presentations were, "Oh, isn't it so hard to be poor? Isn't it so hard to be minoritized? Isn't it so hard to have a chronic disease?" And you just kind of walk away being frustrated by how hard life was.

Interviewer: And then through this program, have you been able to make some connections, and do you have a specific example of that?

Kathryn: Yeah, absolutely. We did our bugs and drugs section in the spring. We learned all about every kind of bacteria and virus you can be infected with, including chlamydia and gonorrhea, which are really fun. Chlamydia especially is an intracellular organism. It lives inside your own cells, and so it's really hard to stain for. And we learned all about the microbiology and what it looks like and what the internal mechanisms of this bacteria are.

And we also had a slide on that presentation that pointed out Utah is 53rd out of 50 states for screening for these STIs. It sounds impossible, but we do count Guam and Puerto Rico in there, so we get 53rd out of 50. That's really a number we can't be proud of.

And then later in that summer, I got paired through this Intermountain Population ÈËÆÞÖгöÊÓƵ program with a mentor who's the medical director of Select ÈËÆÞÖгöÊÓƵ, who's the insurer for Intermountain ÈËÆÞÖгöÊÓƵ. And they asked me to work on their quality improvement team to improve their rates of screening among their beneficiaries, especially among teenage girls and really young women.

So, I got to do what I feel like few medical students get to do, which is talk to vendors, call people up, be in stakeholder meetings, train different clinics, go do a program evaluation, roll out this new ability to test for STIs at home so that these patients who really aren't interacting with the health care system . . . Young, healthy women aren't showing up.

One of the things we learned in our microbiology class is that this is a normally asymptomatic organism. It's not causing people great distress, until you get pregnant. And I got to fix that. It's not all the way fixed, but I got to be a part of that fix.

Interviewer: Sanila, tell me about some other experiences you've had as an Intermountain Population ÈËÆÞÖгöÊÓƵ Scholar that have been beneficial to what you want to do as a physician, a future physician.

Sanila: I think something that's been particularly valuable for me within this program has been the mentorship aspect. I truly believe in the importance of mentors in teaching you and helping you learn as an individual, and just having someone that you can kind of talk to about what you're learning.

And knowing that they've done the same thing and they're applying what they've learned within their career now is really nice because that's just one of the best ways to learn, I think.

And so I had the opportunity to be paired with Dr. Matt Eastman. He's a physician in family medicine, and everything that he's imparted on me has just been really valuable in figuring out how I want to craft my own practice as a future health care provider, what sort of impact I want to have with my patients, and how I can begin to achieve that in regards to what opportunities I'm involving myself with now.

Interviewer: And in traditional medical school, you would never have that opportunity.

Sanila: Yeah, I think oftentimes we're left to our own accord to find mentors like this. It's so rare that we get the chance to be in a program that kind of forces us to be with someone, but in a good way. So, I think it's really valuable in that sense that it's kind of given to us and all we have to do is show up and be willing to learn.

Interviewer: Kathryn, how about you? Have there been other experiences you've had as an Intermountain Population ÈËÆÞÖгöÊÓƵ Scholar that have helped you?

Kathryn: Absolutely. I'm someone who came to medical school wanting to do primary care, loving family medicine, but then have been really discouraged by the financial and structural barriers that make primary care really unattractive, especially to medical students at a flagship school like ours who have an opportunity to do really high-caliber, subspecialty, high-prestige careers.

And one of the things that this program has done is connected me to people in internal medicine and family medicine who are doing really innovative, really exciting things, and connected me to recruiters who are able to say, "This is what compensation looks like. Here's how we can sweeten the pot."

Intermountain is paying for half of our tuition right now, which really reduces the financial need to pursue paycheck above all else. So, it's made primary care both feel lucrative enough and exciting enough to really keep my interest.

Interviewer: Do you know if there are other programs similar to this at other institutions, or was this program pretty unique to Utah? And was it one of the reasons you chose Utah?

Sanila: So I had the opportunity to attend a session yesterday. It was a lunch round table discussion facilitated by the second-year med student at Geisinger, and she was telling me about how they have a similar program where the constituents of that program are required to go into primary care and their tuition is covered in full.

And then they do similar things to what we do where they're paired with a mentor who can help educate them on population health, and then they have classes that they need to attend that also teach them about what population health encompasses and how you can incorporate that into your practice as well.

Kathryn: There are other medical schools who do something similar to fill that primary care gap who have maybe a three . . . At UNC, there's a three-year primary care pathway. I believe at several Southeastern schools, they have primary care links.

However, those schools require you to basically sign your name on the line at the very beginning of school and really commit from the beginning to a very narrow practice goal. And I love that our program, I can opt out. It's up to them the whole time I'm in this program to keep me convinced that I want to go into primary care. And so I don't feel like I've signed my name to a line that is going to tie my hands. I'm still free to explore.

In terms of a private-public partnership, this is completely new. This is a really different program model than all of those other incentives.

Interviewer: As we wrap up this conversation, if somebody was listening, what would your final thoughts be to encourage them to perhaps pursue this? Who could most benefit from this program in your mind?

Sanila: The program, I think just anyone who believes in health equity. I really think even if you're not a part of this program, specifically trying to learn about population health and educating yourself on what all impacts somebody's health care access and quality I think is really important.

I mean, I'll give a plug for this program. This is the way to do it, I think. Being a Population ÈËÆÞÖгöÊÓƵ Scholar gives you the opportunity to expand your knowledge from within the classroom to outside, to our communities.

Kathryn: It's a win-win. If you want to practice in the Mountain West, which most people who come to Utah do, this is the program for you.