This summer 108 second-year UNM medical students headed out to communities all across New Mexico to gain experience working with physicians serving patients in rural communities.
The program started at UNM in 1980 as the Primary Care Curriculum Program, and has since evolved into what is now called the Practical Immersion Experience Program (PIE).
PIE is required of all UNM medical students, PIE Director Daniel Stulberg said.
Students complete the PIE program when they’ve already been trained on how to consult and examine patients, he said. Medical students spend half of their time in the program in clinical practice and the other half of their time working on educational assignments.
As part of PIE, students are required to develop their own community service learning project, or choose from a variety of examples of community service learning projects already thought out, Stulberg said.
One community service learning project developed this year involved helping physicians facilitate adherence to the 2013 New Mexico Board of Medicine regulations on narcotic medication and controlled substance prescriptions, he said.
State prescription monitoring requires that physicians treating patients for pain with a controlled substance re-evaluate the patient’s pain every six months, Stulberg said. Physicians evaluate prescription history to make sure the patient is not abusing narcotics, or receiving narcotics from multiple sources. physicians prescribing controlled substances are also required to keep detailed records.
With the physician’s permission, PIE program students working on this particular community service learning project assessed a physician’s prescribing process, he said.
Stuhlberg said if a physician needed assistance in adhering to guidelines, students then offered a template for a systematic process for tracking prescriptions to meet the Board of Medicine requirements.
“The template makes it easier for physicians to document the fact that they’re adhering to NM guidelines,” Stulberg said.
Some physicians take the template and customize it to fit the needs of their own practice, he said.
“The project has been very well received by physicians. It’s very timely in their practice,” Stulberg said.
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The PIE program would not be possible without physicians who volunteer their time to let students into their practice to work with their patients, Stulberg said.
“Many of the volunteering physicians are devoted to serving the needs of patients who may not have access to healthcare,” he said. “We appreciate these physicians who also volunteer their time to train UNM medical students."
Joshua Romera worked on the controlled substance prescribing project with family physician, William Bowen, at La Familia in Santa Fe.
Romero said the overuse of opioids for chronic pain management is a major healthcare problem, both at the state and national level. He chose this project to gain more insight on correctly evaluating chronic in pain patients and to be informed on up-to-date prescribing guidelines.
“I firmly believe my time spent [on the controlled substance prescribing project] this summer will be beneficial for me as I move forward in my training because chronic pain will be present in all fields of medicine, no matter what specialty I go into,” Romero said.
Katie Myers is a UNM medical student working in a clinic in Roswell on a Hepatitis C program for their PIE project.
Myers said they learned through the program that many patients diagnosed with Hepatitis C years ago are not aware of new treatments available.
Most patients are only aware of an old treatment that only has a 19% cure rate for Hepatitis C type 1a and causes severe side effects, she said. Myers said she conducted an informative session August 26th on a new treatment that has a 93% cure rate for Hepatitis C type 1a, and less severe side effects. Attendees were also informed of clinics that offer the new treatment.
Prescription Trails is another community service learning project students can choose that involves prescribing physical activity rather than medicine to patients.
Prescription Trails is a walking program developed in 2006 promoting the use of trails, parks, and loops by patients, families, and pets.
Through Prescription Trails, healthcare professionals prescribe patients a walking plan and give them assessed locations that specifically fit their medical conditions, Director of Prescription Trails, Charm Lindblad said.
A pill or a laboratory test is not going to solve all medically related problems, and many don’t realize the outdoors is a free medical resource, she said.
Students completing the Prescription Trails program are sent all over NM to assess community trails for walkability, Lindblad said, and trails are graded on the quality of their surface and whether they are American Disability Act accessible.
Parks are also graded on their safety, whether they have trees for shade, and whether they have benches for resting, she said. Physicians write prescriptions for physical activity based on a patient’s medical status, and tailor which park or trail to send them to based on the park or trail’s grade level.
“The reason we assess parks and trails is because if we send a patient to a park or trail and they don’t have a good experience, they won’t go back,” she said.
Lindblad said that when a park or trail doesn’t meet accessibility criteria, the Parks Department is notified and asked that over time the park or trail be improved as funding for maintenance and repair become available.
Lindblad said she appreciates students who participate in assessing trails and parks for Prescription Trails because students spread out across communities all over NM covering a large area, covering grounds that Prescription Trails employees cannot quickly cover due to limited resources.
