A Medical School for the Future

The Indiana University School of Medicine welcomed its largest class ever this year as part of a steady expansion aimed at stemming a projected physician shortage throughout the state. The growth of the entering class—to 355 students—now makes IU the largest medical school in the country.

“We train more than half of all physicians in Indiana, so we have a huge stake in making sure there are adequate numbers of professionals in the right specialties, with the right skills,” said Jay L. Hess, MD, PhD, MHSA, dean of the IU School of Medicine and vice president for university clinical affairs. “As our population ages, more people develop chronic diseases, and treatments become increasingly complex, our state will need more physicians. Increasing our class size is an important part of the solution.”

The expansion is possible because of the school’s unique statewide system of nine campuses. Rather than squeeze students into classrooms and clerkships in Indianapolis, the majority of the growth is occurring at the school’s other locations in Bloomington, Evansville, Fort Wayne, Gary, Muncie, South Bend, Terre Haute and West Lafayette.

For decades, those campuses have played a critical role in training students during the first two years of their medical school careers, when the curriculum focuses on basic sciences. More recently, the sites have expanded to offer clinical rotations that introduce third- and fourth-year students to patient care and expose them to different medical specialties.

To accomplish that, the school is partnering with more than 50 health systems and nearly 3,000 community physicians across the state who welcome students into their practices and dedicate significant time to training the next generation of doctors.

To Peter Nalin, MD, the executive associate dean for educational affairs, the set-up is a win for both the students and the communities.

“Today there’s a wide spectrum of health care that is delivered in rural, suburban, and metropolitan areas,” Nalin said. “Students who get exposed to those environments in their training will be well-suited for their experiences in residency and understand where they’re needed in the physician workforce of tomorrow.”

Research also shows that students who spend part of their time at a regional campus and develop relationships are more likely to return to practice there or in a similar community—helping to meet the health care needs of Hoosiers in every corner of the state. 

A Range of Experiences

Annually in August, about two-thirds of the entering medical student class arrives at one of the eight regional campuses throughout Indiana. This year, roughly another 125 third- and fourth-year students are also completing clinical rotations there.

Students who have completed clerkships at regional campuses say they receive a stellar education that prepares them well for residency.

J.J. Cox, MD, graduated from the IU School of Medicine in May after spending the majority of his time at the program in Gary, located on the campus of IU Northwest. He grew up in Portage, the son of an electrician and an office manager, and studied chemistry at IU Northwest.

When it came time to apply to medical school, the idea of staying in that part of the state made sense.

“I’m from the area, and I can definitely see myself going back to the area to practice, so why not do my rotations there and meet some of the physicians I am going to be working with—my future colleagues,” said Cox, who is now a first-year resident in obstetrics and gynecology at Mercy Hospital in St. Louis.

He got a lot out of the smaller setting. During clinical rotations, it was usually just him and the attending physician—no other medical students, residents or fellows. As a result, he received a great deal of one-on-one attention and lots of opportunity to interact with and care for patients.

During his surgery rotation, he shadowed four surgeons and scrubbed in on nearly every procedure.

Jennifer Addo, another student from the Northwest campus who is currently pursuing a master’s in public health from Harvard University, said she thrived in that environment.

“It’s you and the physician and you don’t have to compete with other students to get time in the OR,” said Addo, who was recently selected as an American Medical Association Foundation Physicians of Tomorrow Award recipient. “That also pushes you to step up your game. You can’t hide behind someone who’s a gunner. You have to know the answers. It challenges you to be a better student.”

Patrick W. Bankston, PhD, an associate dean of the School of Medicine and director of the Northwest campus, said partnerships with numerous health care systems ensure students at regional campuses are introduced to a diverse patient base. His program is affiliated with several hospitals in communities that range from inner-city Gary, with a high Medicaid population, to Munster, a bedroom community of Chicago.

That range of experiences gives students a very good sense of what it might be like to practice a particular specialty on a day-to-day basis.

“This is community medicine,” Bankston said. “Certainly at a tertiary care setting, you’ll see things you won’t see in a community setting. But in a community setting, you’ll see things that happen commonly, and that is the kind of medicine most students will practice.”

Students assigned to regional campuses also have the option to complete electives in Indianapolis or elsewhere in the country. To broaden his experiences, Cox took electives in gynecologic oncology and maternal fetal medicine in Indianapolis, giving him exposure to an academic medical center.

“Everyone always wants you to tell them which is better,” Cox said of the difference between studying in Indianapolis and at a regional campus. “There is no answer to that. Both are very good options.”

Teaching Forward

The expansion of clinical rotations throughout Indiana doesn’t just provide students more options. The school’s statewide system is unique in that it permits as many hospital systems as possible to participate in medical training. And it gives IU alumni and other community physicians the opportunity to be involved in medical education in meaningful ways.

“We have a tremendous spirit in Indiana of giving back and teaching forward to the next generation of physicians,” said Nalin, the Dolores and John Read Scholar in Medical Education.

“We’re grateful for the alumni and practicing physicians across Indiana who partner with us year after year to teach our medical students.”

Among those volunteers is Rebecca Wolinsky Galante, MD, a 1984 graduate of the IU School of Medicine and an internist in Munster. She has been a volunteer faculty member at the Northwest campus in Gary since 1992.

Through an introduction to clinical medicine course, she teaches first-year medical students such basics as how to introduce themselves to patients, where to stand in an exam room, and how to take a proper history.

“I love being part of the IU School of Medicine,” said Galante, who recently joined the board of directors of the IU School of Medicine Alumni Association. “It’s really nice to interact with the students, to help them understand the process of becoming a doctor and how important it is to have respect for your patients.”

David Van Ryn, MD, an emergency physician at Elkhart General Hospital, is the clerkship director of emergency medicine for the South Bend campus. The hospital offers both electives and core clerkships in various disciplines, including pediatrics, internal medicine, orthopedics, emergency medicine and others.

“The long-game is that it’s a recruiting tool,” he said. “The more students are exposed to a community, the more they are exposed to mentors and colleagues, the more likely they are to say, ‘That was a healthy environment, it’s a healthy place, and I’m going to look at coming back there.’”

Like Galante, Van Ryn described having students around as energizing, and said it also makes him and his colleagues better at their jobs.

“You see people on your medical staff just blossom,” said Van Ryn, a 1981 graduate of the IU School of Medicine. “They feed off the inquisitive nature of the students. I think an awful lot of us have always looked for an opportunity to give back to the school and do some educating. There are a lot of people who would not be comfortable or happy in a full-time faculty role, but some part-time teaching is just beautiful.”

When the statewide system for medical education was being created in the late 1960s and early 1970s, it was planned to be “a medical school without walls, both in space and in time.” The hope was to use all available resources throughout the state for medical education.

Today, the School of Medicine is closer than ever to living out that vision, and it’s a beautiful thing for all involved—most especially for the patients IU medical students will one day serve.