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Medical Education at the Crossroads: Bridging the Gap

Saint Thomas Residents
Family Medicine Program Director Christopher Dunlap, MD, examines a patient while (left to right) interns Mary Yawl, Jorden Clark and Carolyn Speegle observe.

Medical Nashville SignContinued from … A New Perspective

As how the College of Medicine teaches is being transformed, where it teaches is also changing. The University of Tennessee Health Science Center is expanding geographically, extending its reach across the state to offer new opportunities to students from middle Tennessee. UTHSC and Saint Thomas Health (STH) have expanded their existing partnership in Nashville to train medical residents – a collaboration that will create a new satellite campus for the university.

The College of Medicine was already a statewide educator of the Tennessee health care workforce, with a significant presence in Knoxville and Chattanooga, and an even more significant presence in Memphis. The creation of the new Nashville satellite campus and expansion of the residency program now gives the College of Medicine the ability to provide access to all regions within the state.

A World Class Partner with a Home Town Advantage

STH is the leading faith-based health system in Tennessee and part of Ascension Health, the largest not-for-profit health care system in the United States. STH comprises five hospitals: Saint Thomas West Hospital, Saint Thomas Midtown Hospital and Saint Thomas Hospital for Spinal Surgery, all in Nashville, plus Saint Thomas Rutherford Hospital in Murfreesboro and Saint Thomas Hickman Hospital in Centerville.

StThomasLogoThe decision to work together was a logical choice for both UTHSC and STH. Saint Thomas had the right mix of high clinical volumes, dedicated medical staff and organizational support to increase its graduate medical education impact. Eugene Mangiante, MD, professor of Surgery and Anesthesiology, and executive associate dean of Graduate Medical Education, says, “One of the things that adds credibility and reputation to a hospital is the fact that they teach, and that they have young minds there asking questions. And also, practicing physicians like to have the ability to teach residents.”

The College of Medicine wanted to strengthen its ability to meet Tennessee’s health care needs. “One of our missions is to deliver health care across the state and we’ve had kind of a void in Middle Tennessee,” says Dr. Mangiante. “Usually our residents choose to practice wherever their residencies are. I believe a lot more people will end up practicing in Middle Tennessee. I’m not just talking about Nashville, but middle Tennessee in general. A lot of our residents who do their residencies in Knoxville or Chattanooga choose to stay in those areas, not necessarily in those cities but in other counties, some of which may be underserved.”

The Nashville expansion will enable UTHSC to enroll more aspiring physicians, boosting its number of medical residents and fellows statewide from about 1,200 to 1,500 within two or three years. The new campus will also give UTHSC a significant presence in the state capital.

The new residency program builds on an already existing relationship. College of Medicine physicians have been training at STH through a limited residency plan for over 30 years, but recently that relationship has expanded, with the number of residents at Saint Thomas Health hospitals expected to increase from about 32 to about 200 over the next three years. Physician residents will train in five fields: family medicine, internal medicine, emergency medicine, general surgery and OB/GYN.

The Family Medicine Residency Program received its initial accreditation in January 2014. The program is based out of Saint Thomas Rutherford Hospital, a new, 286-bed hospital facility in Murfreesboro. Residents will also work in a newly renovated 16,000 square-foot clinic. In an effort to provide a broad spectrum of experiences, residents will have the opportunity to work with a variety of specialists within the local community. This opportunity provides a diverse patient population that will be seen throughout the three-year program.

Established in 1981, the Internal Medicine Residency Program is committed to enabling all residents to fulfill their personal and professional goals. Program graduates are qualified to pursue careers in general internal medicine, hospital medicine or enter subspecialty fellowship programs. Of recent graduates, 30 percent entered subspecialty fellowship programs, 37 percent entered traditional internal medicine and 33 percent entered hospital medicine.

The Emergency Medicine Residency Program’s first class began in July 2015. This community-based program offers the unique combination of a high-volume, efficient community hospital and a major university medical school. Residents play a hands-on role in managing patients and have the opportunity to perform numerous resuscitations and procedures, while faculty teach the “real world” of emergency medicine.

Saint Thomas Exterior New
Saint Thomas West Hospital, Nashville Tennessee

The General Surgery Residency Program will begin recruiting R1s and R2s in July 2016. Saint Thomas West and Saint Thomas Midtown Hospitals both have high volumes of operative cases that cover the range of general, vascular and endocrine surgery procedures. Saint Thomas West also provides extensive opportunities for breast, plastic, and transplant surgical experiences. In addition, the general surgery residency has a newly constructed simulation facility to provide an environment where residents and practicing physicians can learn and advance their technical skills prior to performing procedures on a patient.

The OBGYN Residency Program will begin recruiting its first year of residents in July 2016. Based primarily at Saint Thomas Midtown Hospital, residents will be trained in the largest obstetrics and gynecology hospital in the Southeast, which delivers almost 8,000 babies a year. Faculty have a variety of experiences that will provide a well-rounded environment for each resident. Residents will be involved in a vast array of surgical procedures and high-volume deliveries, and be strengthened by a robust didactic and simulation curriculum.

Dr. Mangiante expects the residency program to expand. “In the future, we plan on growing it. There are other areas where Saint Thomas has a real plethora of clinical material and subspecialties.”

The Right Time and the Right Place

Jessica Wells, MS, vice president for medical education and research for Saint Thomas Health and assistant dean for graduate medical education at UTHSC, says, “It just became the right time and the right place to really take a good look at our partners and how we can grow together.”

The aging population and the Affordable Care Act have increased the demand for physicians nationwide, and according to experts with the Association of American Medical Colleges, the United States will face a shortage of more than 130,600 physicians by 2025. Expanding enrollment at medical schools is one way to mitigate the problem.

The new campus should be a boon to the Nashville health care community. “Most who train in the area stay in the area,” Jessica Wells says. “The training now provides an opportunity to utilize excellent clinical care to train the next generation of health professionals for our community.”

But while UTHSC branches into Nashville, it still remains firmly rooted in Memphis, which has been home to the University of Tennessee’s medical school since 1911. “In fact, it increases our reach and makes us stronger both in Memphis and statewide,” says Ken Brown, JD, MPA, PhD, FACHE, UTHSC executive vice chancellor and chief operations officer.

Medical residents who will be trained in Nashville will still begin their studies in Memphis, which will remain the primary UTHSC campus, and the expansion will not diminish the resources invested in the flagship Memphis campus, which is currently undergoing a $300 million expansion and renovation project.

The estimated construction cost of the new Nashville campus is $40 million. There would be space for full-time and adjunct faculty and administrative and classroom space.

While the training program will initially serve aspiring physicians, it will eventually serve dentists, nurses, pharmacists and other health providers as well. Steve J. Schwab, MD, chancellor of the University of Tennessee Health Science Center, says, “We anticipate constructing a six- to eight-story, 120,000- to 150,000-square-foot building for academic space to support programs from all six UTHSC colleges.”

“We will also be expanding clinical opportunities for our other colleges at UTHSC …” says Chancellor Schwab. “This will position us to have major clinical health care training positions throughout the state – in Memphis, Knoxville, Chattanooga and Nashville. This positions UTHSC to meet the state’s health care training needs for the foreseeable future.”

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