CU2RE Program Nearly Triples in Size, Aiming to Address Primary Care Shortages in Alabama
What began as a small, progressive program has quickly grown into a multi-campus initiative aiming to grow the number of primary care providers for the state of Alabama and address critical shortages. Since its launch in 2020, the Comprehensive Urban Underserved and Rural Experience (CU2RE) program has nearly tripled in size, expanded to all of the UAB Heersink School of Medicine’s campuses, and is on track to open a pipeline program for undergraduate students in 2022.
CU2RE, funded by a $7.5 million HRSA grant, is a complex program run by many dedicated physicians, program managers, and staff out of UAB’s Department of Family and Community Medicine.
“We are here to provide meaningful learning experiences where program content is relevant, engaging, and offers an enhanced understanding about the role primary care plays in building strong healthcare systems, positive outcomes, and health equity,” said CU2RE Program Director Adrienne Fowler Payne.
Payne and other leadership note the excitement they feel with the program’s growth in year two. The first cohort of eight students just finished their initial year of programming, and the second cohort, starting in January, brings 15 new students to the program.
“Our students have a strong desire to learn about and address the needs of medically urban underserved and rural patient populations in the state of Alabama,” Payne said. “CU2RE plays a role by offering extracurricular educational opportunities to prepare and guide students to a medical career in primary care. We aspire to continually increase program enrollment and have opportunities to connect with more students in the years to come.”
Extracurricular opportunities include a patient panel, in which students are paired with 10 patients that they will follow over the course of their medical training and serve as health coaches, early clinical training that begins when they start medical school, service learning, and hybrid learning modules that prepare students to become compassionate and innovative primary care leaders. Now that CU2RE is expanding to other campuses, program leaders expect the impact to multiply.
“The growth we have seen in just one year of CU2RE is encouraging,” said Jill Marsh, M.D., director of the rural and urban underserved pathways. “We have engaged deeply-committed family medicine partners at all UAB regional campuses, and the snowball effect of growing our student and faculty cohorts has led to even greater shared excitement about the future of primary care at UAB and for the state of Alabama.”
CU2RE now includes students from all of UAB’s medical campuses. All CU2RE students will spend time learning about primary care and telehealth, studying health disparities, conducting research, and understanding how to provide culturally competent care for different patient populations. The CU2RE team in Birmingham works closely with regional faculty and coordinators to ensure that the CU2RE students receive all the benefits of the program at their campus alongside their CU2RE peers. This model builds continuity and collaboration among UAB’s medical campuses, another goal of the CU2RE grant.
First-year CU2RE students like Laura Catherine Cresswell, from Arab, Alabama, are excited to begin the curriculum in January 2022.
“Primary care is the first line of defense in healthcare,” Cresswell noted when discussing what drew her to primary care in the first place. “It’s most patients’ first interaction with a health care provider, so I think it is very important to make them feel supported to build the foundation.”
Cresswell and other students are paired with a faculty mentor who will work with them one-on-one throughout medical school. Her upcoming mentorship and 10-patient panel are the two program components that most excite Cresswell.
“I liked the idea of having a patient panel that I follow throughout my time in medical school,” she said. “One of the key parts of treating people in rural areas is creating meaningful, long-lasting relationships. I am excited to see this firsthand!”
Similar to Cresswell, first-year medical student Amiria Blakely was drawn to CU2RE because of her passion for primary care and the chance for earlier clinical exposures.
“I am most excited about the hands-on learning experience,” said Blakely. “I’m thankful that I will have the opportunity to work with a set of patients who will allow me to play a role in their health care.”
Blakely will finish medical school at the Tuscaloosa campus, and the CU2RE program will follow her there. She and other Tuscaloosa-bound students will work with program site directors Cecil Robinson, Ph.D., and Grier Stewart, M.D.
Javier Jurado Velez, part of the urban underserved pathway, is ready to learn more about the holistic side of primary care through CU2RE’s integrated curriculum.
“From housing and food access to mental well-being, multiple aspects of a patient's livelihood can accentuate the health inequities they may experience,” he said. “I applied to the CU2RE program since it offered a unique opportunity to work closely with patients from underserved communities in a well-rounded, longitudinal program.”
Velez and the other students have a lot to look forward to, as well as hard work ahead of them as they begin. As the CU2RE program continues to grow, leadership is looking to the future for inspiration and innovation.
“CU2RE, and all its related programming, is a great step for us to take for Birmingham and our state,” said Irfan Asif, M.D. Asif serves as the department chair, professor and associate dean for primary care and rural health in the UAB Heersink School of Medicine. He is also the principal investigator for the CU2RE program grant.
“The program hinges on providing students with early clinical exposures and educational experiences that enforce the innovation that is and must continue to happen in primary care,” he noted. “Telehealth, practice transformation, working well on an interprofessional team—these are all necessary skills for our students to learn as they grow into the next generation of primary care leaders.”
Meet all of the new members of the second CU2RE cohort here.
Beverly VonDer Pool, M.D., Retires After 40-Year Career in Family Medicine, Women’s Health
Beverly VonDer Pool, M.D., has enjoyed a career has spanned both coasts and four decades, but her primary goal – improving health for women and families through the practice of compassionate, evidence-based family medicine – has never wavered. She retired at the end of 2021 and colleagues say her legacy stretches from the clinic to the classroom and beyond.
“Dr. VonDer Pool is a pioneer in family medicine. She has been a part of the long history of our department and her impact can be felt through the generations of family physicians that she has trained, as well as the patients who have been cared for by her and those she has educated along the way,” said Irfan Asif, M.D., professor and chair of the Department of Family and Community Medicine and associate dean from primary care and rural health. “In particular, she has had tremendous influence on how we provide women’s health at UAB. We appreciate all that Dr. VonDer Pool has done for us.”
VonDer Pool, an associate professor in the Department of Family and Community Medicine who has most recently practiced at the UAB Highlands Family Medicine clinic, joined UAB in 1992 as the Family-Centered Maternal Care director, a role she held in 2003. In that role, with the help of more than $1 million in training grants and federal Healthy Start grants, VonDer Pool supervised four midwives, many family medicine residents and UAB medical students in the delivery of hundreds of babies. She also joined UAB midwives in providing prenatal and gynecology care to women in Birmingham’s underserved West End, before the West End Health Center was created. In addition, VonDer Pool worked with UAB Maternal-Fetal Medicine, using grant funding from rural health initiatives, to train four family medicine doctors to provide advanced surgical maternity care to rural counties in Alabama.
From 1995 to 2003, VonDer Pool also served as the director of family medicine predoctoral programs at UAB. She helped lead UAB’s Minority Medical Education Program from 1993 to 1999 and was also a board advisor and mentor at UAB for the Robert Wood Johnson Foundation, the nation’s largest philanthropy dedicated solely to health. From 1995-2020, VonDer Pool served annual as director, national adviser and faculty for Advanced Life Support workshops, training Alabama family medicine residents, nurses and physicians for obstetrics emergencies.
VonDer Pool served as the Obstetrics, Women’s and Home Bound Patient Director at Ascension St. Vincent’s East Family Medicine from 2003 to 2020 before returning to the UAB Department of Family Medicine in 2020. Despite her busy teaching, practice and administrative abilities, she continued to make time for house calls on her way home – a rarity in health care today.
VonDer Pool earned her medical degree from the University of California at San Francisco and completed her residency in 1982 at the University of Washington.
VonDer Pool has been repeatedly honored for her work as a physician and as an educator. Among numerous awards, she won an Argus Award, given by UAB medical students to the faculty members and mentors who made particularly powerful contributions to their education. In addition, in 2020, she received a Lifetime Faculty Teaching Award.
She was a member of the American Academy of Family Physicians, the Society for Teachers of Family Medicine and the Alabama Academy of Family Medicine Physicians. She also served on numerous committees and task forces at UAB, including the School of Medicine Admissions Committee Clinical Council, the Student Health Services Task Force, the Women’s Primary Care Resident Focus Group, the Clinical Education Task Force, the Clinical Sciences Subcommittee, the Clinical Academic Committee, the Patient/Family Education Committee, the Professional Rural Leaders Pipeline Committee, OB Clinical Leadership team, and the VIVA UAB Medicaid Obstetrics Quality Assurance Committee.
From 2011 to 2020, VonDer Pool was also a Birmingham Community Board Member for Birth Well Partners, a nonprofit organization that trains community doulas to provide one-on-one support to under-resourced pregnant people in central Alabama.
Fittingly, a phone call from a patient helped VonDer Pool reflect on her career as she neared retirement. On Nov. 7, she received a call from a woman she had diagnosed with a rare obstetric disorder decades earlier. VonDer Pool had helped the woman safely deliver her son, and the woman was calling to thank her again. Her son had just turned 27 that day.
VonDer Pool said she is thankful for “a great family medicine career of service, receiving more joy and gratification from my patients and learners than I ever gave them.”
Erin DeLaney, M.D., assistant professor, vice chair of clinical affairs and quality, medical director of UAB Family and Community Medicine – Highlands, where VonDer Pool recently practiced, said her legacy will continue for years to come.
“Dr. VonDer Pool has made a significant contribution to the field of family medicine through her decorated career. She is a rare gem in primary care – practicing full-spectrum family medicine with an emphasis on women’s health and obstetrics. Not only did she provide her patients with genuine and excellent care she was able to teach the next generation of primary care physicians through her superb knowledge and art. Her legacy will live on through the lives of all those she met and cared for – patients, colleagues, students, residents and friends. Few will be missed as much as Dr. Beverly VonDer Pool.”
That’s a Match! Department Welcomes Two New Sports & Exercise Medicine Fellows
Wednesday was Match Day across the country for aspiring sports and exercise medicine physicians and two new fellows, Anthony D’Onofrio, D.O., and Jesse Gettinger, M.D., officially joined the UAB Sports & Exercise Medicine Fellowship.
Sponsored by the Department of Family and Community Medicine, the ACGME-accredited fellowship combines comprehensive sports medicine training with opportunities in exercise and lifestyle medicine and family medicine practices. It is part of the UAB Sports & Exercise Medicine program, a partnership between the departments of family and community medicine, orthopaedics and physical medicine and rehabilitation.
Unlike many other fellowships, UAB’s Sports & Exercise Medicine Fellowship is a two-year program and includes the opportunity to earn a Master of Science in Exercise and Nutrition. That degree, combined with the hands-on clinical experience fellows receive in UAB's family medicine clinics, prepares fellows to be well-rounded physicians, well versed not only in sports medicine but in exercise, nutrition and family medicine.
UAB fellows also get the opportunity to work directly with athletes at every level, from youth sports to UAB student-athletes to some of Birmingham’s most competitive professional teams, as the UAB Sports & Exercise Medicine program provides on and off-field care for the Birmingham Legion FC, Birmingham Bulls hockey, Birmingham Vulcans Rugby and others. This year's fellows will also join as the UAB Sports & Exercise Medicine program cares for athletes in The World Games 2022, which will bring thousands of elite athletes to Birmingham.
“The combination of opportunities we are able to offer at UAB makes for a really unique and rigorous fellowship program, and we are so excited to welcome Drs. D’Onofrio and Gettinger to that experience,” said Ian McKeag, M.D., M.S., assistant professor and director of the fellowship program. “Both of them really stood out during the interview process and I am thrilled that they will be joining us in Birmingham.”
D’Onofrio completed his medical education at Lake Eri College of Osteopathic Medicine and his undergraduate education at Saint Vincent College in Pennsylvania. He received several scholarships and awards in medical school, including the Michael J. Feinstein, D.O., Family Medicine Award for dedication to primary care. He is a member of the American Academy of Family Physicians and the American Medical Society for Sports Medicine.
Gettinger is an alumnus of the UAB Heersink School of Medicine, where he graduated in 2019, and earned his undergraduate degree from the University of Alabama. He is a member of Alpha Omega Alpha, a national medical honor society, and the American Medical Society for Sports Medicine. While in medical school, he received a research grant from the Infectious Disease Society of America for a summer project, among other honors.
The new fellows will join the UAB Sports & Exercise Medicine program this summer. Matthew Miesch, M.D., and Christian Muller, D.O., are currently fellows in the program. You can learn more about their work and the Sports & Exercise Medicine Fellowship here.
“Exercise is Medicine” Program Helps Patient Move Toward Healthier Lifestyles
When Jeremy Pritchett first visited the family medicine clinic at UAB Medicine’s Hoover location, he was thinking mostly about his kidneys. He had just had a kidney stone and Sumayah Abed, M.D., a practitioner at the Hoover clinic and assistant professor in UAB’s Department of Family and Community Medicine, was running follow-up tests.
However, in talking with Abed, Pritchett realized that he wanted to be in a bit better shape – stronger both for himself and for his family. At the time, Pritchett’s wife, Sarah, was pregnant with their second child.
“Part of my motivation, around the time I started seeing Dr. Abed, was that I did not like how I felt trying to play with my older son, who is four years old,” Pritchett said. “I didn’t feel like I had enough energy and I knew I would only need more as our second came along. I wanted to make changes to keep up with them and enjoy things with them long-term.”
Abed referred Pritchett to the department’s Fitness, Lifestyle and Optimal Wellness, or FLOW, program, designed for patients who want to take steps toward a healthier lifestyle. Patients meet with a provider for a thorough evaluation, examining the patient’s health history, physical activity level, diet and nutrition, sleep quality, stress, personality traits, blood metabolic panels, body composition, metabolic rates and cardiac fitness.
Based on those results, providers recommend resources and design a personalized plan for each patient, including educational, dietary and exercise programs. Among the options is a partnership with the Birmingham YMCA, called “Exercise is Medicine.” Patients in the Exercise is Medicine program receive a free two-month membership to the YMCA of Greater Birmingham, which allows them to visit any YMCA in the region and meet with a personal trainer to develop a consistent exercise plan. As of late fall, 33 patients were enrolled in the program, which is being piloted out of the family medicine clinic at UAB Hospital Highlands and aims to both help patients facing chronic illness and prevent chronic problems before they start. Both the Exercise is Medicine and FLOW programs are part of the UAB Grand Challenge, which supports projects tackling large, complex programs, including a Healthy Alabama 2030 initiative aimed at raising the state's health care rankings.
Dan Pile, president and CEO of the YMCA of Greater Birmingham, said preventative health measures like the Exercise is Medicine program “are key components of the YMCA’s mission.”
“As part of the public health system, we are uniquely positioned to confront health inequities by partnering with UAB Medicine. When we receive a medical referral, we know we will be working alongside individuals who need a great deal of support,” Pile said.
“Access to affordable programs that promote lifestyle changes and physical activity is a bit of a challenge for many,” he said. “Our open to and serving all policy ensures full access to the Y regardless of one’s ability to pay. We are more than a gym and swim. We make sure this experience is available to the entire family.”
Mickal Thomas, associate executive director at the YMCA of Greater Birmingham and leader of its personal training program, said most patients come in hoping to lose weight or get more active.
“We put them through an orientation to our equipment, including cardio and strength equipment, and keep in contact with them at least once a week,” Thomas said. “The benefit also extends to any location and to their families, which takes away some barriers, such as availability or child care. That really helps us make it accessible for more people.”
Pritchett decided to give it a shot. He started his complimentary YMCA membership this summer after working with Ian McKeag, M.D., M.S., assistant professor, director of the Family and Community Medicine Sports and Exercise Medicine Fellowship and a physician with the FLOW program. Pritchett and McKeag developed a weight loss and exercise plan, setting goals for weight loss and muscle building.
It worked. Pritchett started going to the gym three times per week and he hasn’t stopped, even when his complimentary membership ended. He became a full member of the YMCA in the fall and hasn’t looked back.
“I grew up playing sports, and ran and lifted weights at times, but I had gotten into a longer rut than usual,” Pritchett said. “The team at the Y introduced me to HIIT training (high intensity interval training) and I go with a friend on Mondays, Wednesdays and Fridays early in the morning.”
At the time of the interview, Pritchett had lost about 36 pounds and was closing in on his goal weight. He had also started meeting with clinical dietician Caroline Cohen, Ph.D., R.D., L.D., assistant professor family and community medicine, to talk about dietary choices.
“I’ve never been one to look for a diet to lose weight, I’m more interested in changing my mindset for a new lifestyle,” Pritchett said. “Dr. Cohen confirmed the direction I was going and gave me some ideas for snacks and substitutions.”
“Having the support from each of the doctors has been a positive. It helps having someone to encourage you when things get difficult and to let you know when you are doing well,” he said. “Having that positive reinforcement really keeps you motivated.”
The team approach – including support from physicians, dietitians and trainers and staff at the YMCA – gives patients holistic support as they work toward a healthier lifestyle. Patients, especially those facing chronic illness, can also choose to partner with a medical student in UAB’s Dynamic Health student organization. The organization pairs medical students with patients, and students work to keep patients informed, support lifestyle modifications and serve as a resource for patients through follow-up appointments.
“Oftentimes, patients are diagnosed with chronic conditions such as hypertension or diabetes and would like to make lifestyle modifications but are left without proper guidance,” said MS3 student Chibuike Obinwa. “The aim of our organization is to bridge that gap and make sure that patients within our local community are not only well informed about their disease process but have the tools they need in order to make better health choices.”
“We wanted to partner with the YMCA because we felt that our mission to improve individual and community health through nutrition, exercise and disease education was very closely aligned with the YMCA’s mission to build a healthy spirit, mind and body for all.”
If you are interested in getting involved with the FLOW program and Exercise Is Medicine, you can find out more here.
Strengthening America’s Healthcare System: 5 Key Points from Asif’s Discussion With “The Hill”
On Tuesday, Irfan Asif, M.D., professor and chair of the Department of Family and Community Medicine and associate dean for primary care and rural health in the UAB Heersink School of Medicine, joined other health care leaders to discuss strategies for improving access to health care in the United States.
Hosted by the Washington D.C.-based media company “The Hill,” the “Strengthening America’s Healthcare System” virtual panel included Asif; C. Virginia Fields, founder and CEO of Black Health; and Melissa Schulman, senior vice president of government and political affairs at CVS Health. Three lawmakers – Sen. Debbie Stabenow (D-MI), Rep. Robin Kelly (D-IL) and Rep. Brad Wenstrup (R-OH) –joined the segment separately.
Here are five strategies for improving access to care that Asif highlighted during the discussion. You can view the full discussion below or on The Hill site.
Growing the Primary Care Pipeline
In Alabama and elsewhere a shortage of primary care physicians, particularly in rural or urban underserved areas, makes it more difficult for patients to access timely, high-quality care.
“Access to health care is a major issue,” Asif said. “Some of the things we need to think about are how we can increase the pipeline of folks that are able to increase access and the pipeline of primary care providers that are able to [provide care].”
Programs like the department’s Comprehensive Urban Underserved and Rural Experience, or CU2RE, are designed to do exactly that, by providing support, training, clinical experience and other resources specifically for medical students who want to pursue a career in primary care and practice in underserved areas. CU2RE also supports and hopes to grow pipeline programs that reach students in college, high school and even earlier to build interest in primary care and family medicine.
Reform the Payment Model
Looking at the business side of American health care, Asif emphasized the importance of moving from a fee-for-service model to a capitated or value-based model.
In a capitated model, providers are paid a fixed amount per patient by an insurer or physician’s association, regardless of how often that patient seeks care. In a value-based model, providers are paid based on improvement in patient health outcomes and the quality of care they provide.
“If we have a fee-for-service model, we are not actually incentivizing providers to prevent disease, and we are incentivizing people to go into professions where they are treating disease rather than trying to prevent it,” Asif said. “We need a system where primary care is incentivized. I think that is the backbone of what we need to work toward.”
Capitated or value-based payment systems, Asif said, might compel more physicians to pursue primary care and family medicine as specialties, helping to address current shortages of primary care providers in the U.S.
Utilize Digital Tools
Asked to reflect on how COVID stretched and reshaped the health care workforce, Asif pointed toward one silver lining in the increase use of telemedicine.
“COVID has allowed us to do some unique things and through telemedicine we have been able to extend more access to people in other parts of the state or country,” Asif said. The department expanded its telehealth offerings during the pandemic and has continued to offer telemedicine as a quick and convenient option for patients. Medical students also receive training in conducting telemedicine appointments.
However, Asif also pointed out, telemedicine can also create new types of disparities, such as gaps in access to fast, reliable internet. Addressing those needs is another way to improve access to care.
Team-Based Care
Every member of the panel raised the importance of team-based care, thinking about the whole team of providers who can help patients, including physicians, nurse practitioners, physician assistants, pharmacists, psychologists, behavioral health specialists, nutritionists, social workers and many others.
The Department of Family Medicine emphasizes a team-based approach both in the care offered to patients and in educational and clinical programs designed for medical students. Medical students are taught from the beginning about the importance of working within a care team, and see firsthand in clinic how much person on staff contributes to patient care. In addition to numerous physicians and advanced practice providers, the department has a clinical dietician, Caroline Cohen, Ph.D., R.D., L.D., on staff as well as a clinical health psychologist and clinical scientist, Kaylee Crockett, Ph.D.
Kala Dixon, Ph.D., leads the department’s Office of Interprofessional and Continuing Education, which aims to educate students in multi-disciplinary patient care that works across various health care professions.
Meet Patients Where They Are
Asked how to reform the health care system benefit more Americans, Asif focused on the importance of training providers in the communities where they are going to live and work.
“Often, training happens in places with access to a big medical system, but we like to get out into rural and other parts of the state to provide training, so that [faculty, staff and students] get to know those communities and become part of those communities," he said. "As someone who is serving in that community, they start to understand issues that patients commonly face and can address those issues firsthand."
Family medicine students at UAB can complete clerkships or residencies in many different parts of Alabama and in both rural and urban underserved communities. Opportunities include the Cahaba-UAB Family Medicine Residency in Birmingham, hosted by the Federally Qualified Health Center (FQHC) Cahaba Medical Care; the Selma Family Medicine Residency, family medicine programs in Huntsville and Tuscaloosa, and many more.
Students can also enroll in the departments Pathway Program, a four-week elective experience in rural ambulatory medicine for MS1, MS2 and pre-matriculation students. Students work directly with preceptors practicing in rural areas of Alabama, focused on areas with a population of 25,000 or less. Students in their third or fourth year of medical school can enroll in Rural Medicine Selectives and Rural Medicine Electives, clinical experiences in a rural family medicine practice facilitated by community volunteer faculty.
A Framework for Enjoying the Holidays While Not Putting Mental Health on the Backburner
The holiday season can be full of tradition, time with loved ones, and space to rest and look forward to a new year. The season may also bring up feelings of loss, stress, and exhaustion.
For many, those feelings might be heightened this year as they cope with grief and worry brought on by the COVID-19 pandemic.
How can we enjoy the holidays while also prioritizing our mental health? Kaylee Crockett, Ph.D., clinical psychologist, scientist, and assistant professor for the Department of Family and Community Medicine, is sharing tips on how to apply an evidence-based psychotherapy approach, Acceptance and Commitment Therapy (ACT, pronounced “act”), as a way to prepare and get the most out of the holiday season.
“ACT offers a framework for centering acceptance, mindfulness, and personal values that may help direct us through the season, no matter what feelings show up,” she said.
Acceptance: Thinking and Feeling
Crockett notes that many negative thoughts that surface during the holidays can be traced to rigid thinking.
“ACT focuses on flexibility in thinking and feeling. It encourages stepping away from those thoughts such as, ‘I should be happy because it’s the holidays,’ or ‘I should be spending time with a loving family,’ or ‘If I do not find the perfect gift, then I have failed’, or those feelings of tensing up or tuning out at the mention of the holidays,” she said.
Rigid thoughts or beliefs create tension and stress because they do not allow room for error or nuance. Crockett stressed that it is ok to have those types of thoughts and acceptance can help navigate with them in a healthy way.
"The key is movement towards acceptance—approaching experiences with openness and curiosity,” Crockett said. “When you notice a rigid thought show up this season, practice stepping back from that thought and noticing what feelings are showing up with acceptance and compassion.”
Mindfulness
ACT also emphasizes the importance of mindfulness or being present in the moment.
“Mindfulness can help us savor pleasant experiences. However, many of us miss these opportunities as we get caught up thinking about the past or worrying about the future.” She also noted “We may also avoid staying present in the moment because we find it painful to sit with uncomfortable thoughts or emotions. Instead, we may busy ourselves with distractions that are not fulfilling such as getting lost on social media, isolating, or worrying.”
To avoid getting swept up in a negative thought pattern or behavior, Crockett recommends “tuning in” to inner thoughts and experiences without judgment and to do your best to make intentional decisions about behaviors following a negative thought or feeling.
Connecting with Values
A final way to use ACT is to apply your personal values to the experiences of the holiday season.
“Values are not achievable goals, but broad concepts that help direct goal-setting,” Crockett explained. “We tend to experience distress when our behavior is inconsistent with our values. For example, many of us buy gifts for the holidays. If generosity is a personal value, gift-giving can be a fulfilling activity. If saving for the future is a value, over-gifting may feel distressing.”
Because values are different for every person, Crockett recommends writing a list of what is most important to you and allowing the list to help you make decisions about how to spend time and resources this holiday.
“Values are personal. Sitting down with loved ones and reviewing what’s most important to each other this season can be a way to connect and make sure activities are planned to help everyone feel fulfilled.”
ACT resources are available from the Association for Contextual Behavioral Science “For the Public” webpage. Crockett also recommends the free app “Mindfulness Coach” to help those new to practicing mindfulness get started.
Holiday Video 2021
Happy Holidays from the Department of Family and Community Medicine!
Serving the State: An Interview with Statewide AHEC Director Michael Faircloth, M.D.
Michael Faircloth, M.D., grew up in a small, rural town in Alabama. His brother was born with Down syndrome and the care he received, even in a town with few resources, inspired Faircloth to put his interest in science to use in service of others: he decided to go to medical school to become a family medicine physician.
“For me, it was looking at the challenges that he [his brother] had throughout his life growing up in a small town with that disability-- but also seeing the good care that he got from the caring physicians and others that weren’t in medicine-- I think that fostered in me the want and need to pursue that as a career,” Faircloth said. “And medicine became what I wanted to do because I saw what a difference it made for him and my family. And I wanted to be able to, in some ways, affect others in the same positive way.”
That desire to serve others through medicine has sustained Faircloth for thirty years as he moved throughout the state practicing medicine. He began at UAB in medical school, moved into private practice, and returned to UAB in 2008 to work as the assistant director of Student Health Services. From that first leadership position, Faircloth has dedicated his career to advancing medicine in both rural and urban areas while at UAB.
Faircloth currently serves as an associate professor for the Department of Family and Community Medicine, medical and lab director for UAB’s Division of Student Health Services, and program director for the Alabama Statewide Area Health Education Centers (AHEC). AHEC, made up of the program office housed within the Department of Family and Community Medicine and five regional centers across the state, works to increase the number of health care workers from rural and underserved areas.
Though his time is split between these three areas, Faircloth never stops working until the job is done. Faircloth also serves on several task forces for UAB, including the Incident Command Committee for UAB which is tasked with responding to medical and community crises and the UA Health and Safety Task Force. He credits success to the importance of the work and the talent of his team members, but his selflessness and work ethic also move each organization’s missions forward.
Faircloth and the organizations he leads faced many challenges during the COVID-19 pandemic, but Faircloth said the pandemic’s hardships also spurred a lot of good work in communities that needed it most. He joined us recently to reflect on the progression of the pandemic and his own work and goals.
How did you get involved with AHEC?
Faircloth: “I first heard about AHEC in 2012 when it was coming to Alabama. There was a regional office in Brewton, Alabama where I grew up. So, I talked to the folks that were the leaders at that time. Each AHEC has to have a governing board, and since I was at UAB it made sense to me to be that UAB representation on the board. Being on the governing board was my first experience with AHEC, and I would go to their quarterly meetings and that sort of thing until Cindy Selleck, the director at the time, retired and I took over the position of director.”
What drew you to AHEC? Why did you want to be involved?
Faircloth: “I think we all go into medicine to take care of people. And AHECs, in most states, by serving the underserved and rural areas and disadvantaged folks can do more than I or others could do from here campus for the wider population of the state. We can do a lot here on campus, but AHEC adds to the reach we have here at UAB and in the Birmingham area. I liked the idea of serving Alabama, and it helped me to not feel isolated from the rest of the state. Certainly we see students from all over here, but I wanted to know I was making a difference for the community and the state. And AHEC was a way to do it, and to get back to why I went into medicine in the first place, to serve the population in whatever way I can.”
How did AHEC have to pivot during COVID-19? How did you handle those changes?
Faircloth: “The basic mission of AHEC is to recruit, train, and retain a health care workforce. And that's all healthcare workforce-- nurses, doctors, physical therapists, etc. And that can be interpreted quite broadly, but with COVID, we did have to pivot because of the needs in the state, which were initially testing sites before the vaccines were available. Making safe testing available through local community health care workers and resources was our best effort to maintain what our mission really was. We focused on underserved rural and urban areas because the challenge was greater to get testing done in those areas. We collaborated with the Alabama Department of Public Health (ADPH) and others to get that done. Once the vaccines became available we pivoted again to not just testing, but also to providing vaccines. Again, particularly in those areas where it was important to make sure that we were going to the gaps, where it just wasn't available or there were challenges. We're still trying to cover those areas where there are gaps. So we did have to pivot. We continued to be true to our mission and continue those things.”
The AHEC team, along with their partners across the state, administered more than 8,500 COVID tests and have given hundreds of vaccine doses to small rural and urban underserved areas in 2021. Efforts were made to reach often forgotten populations, like door-to-door vaccine events for the homebound or those without transportation. The statewide organization that Faircloth leads was also honored with the Community of Hope Health Clinic's 2021 "Corporate Volunteer of the Year" award.
How did UAB Student Health have to adapt during COVID? What did that look like for you?
Faircloth: “At Student Health Services, our mission is to serve the entire student population on campus and provide their primary care. I think of us as their medical home during college. When the pandemic hit, we had to provide more testing but also continue to address their primary care needs. We had to suddenly implement telehealth, which we would eventually have done but we did it sooner than we thought we would. So that was a challenge, but our team worked to do it very efficiently.”
How did the Incident Command Committee assist UAB in responding to the COVID-19 crisis?
Faircloth: “Our responsibility here on the campus task forces or committees is to provide the best information to leadership so they can make good decisions and continue getting current, useful, and accurate resources. Initially we were meeting daily, but now it is weekly and as needed. I'm so thankful that we have world renowned experts in public health and infectious diseases on this campus. That allowed us to-- while we didn't have a crystal ball, but at times it's sort of felt like it because of the things that we were we were able to get ahead of-- make the best decisions because we could depend on these folks’ expertise.”
While the pandemic brought many changes, Faircloth noted that the work was made easier by the collaborative environment among leaders and decision makers across the institution.
“There was not one time when I picked up the phone with a need or to ask for something and didn’t get it,” said Faircloth. “I just want to recognize Student Affairs, Family and Community Medicine, the UAB Medicine enterprise, and so many others who allow me to do this job that I couldn’t do without their support.”
As the pandemic eases, Faircloth is ready to continue AHEC’s mission of improving access to health care to Alabamians across the state. As he said, “that’s what we’re here for, to improve the lives of these folks and to take care of Alabama citizens.”
To learn more about AHEC’s work, visit their website.
UAB Hoover Family and Community Medicine, Providers Honored for Excellent Patient Experience
The Department of Family and Community Medicine has won several awards in 2021 for provider and clinical excellence. We are proud to honor the outstanding work of our teams across our clinics.
The Hoover UAB Family and Community Medicine Clinic was recognized by UAB Medicine’s patient experience team for providing an exceptional patient experience in their Level 5 clinics.
Patient experience is a critical part of patient care. The most important components of patient experience include ease of scheduling appointments and check-in, excellent communication, and quick access to information from health care providers and staff.
Hoover FCM staff enjoyed snack baskets, Steel City Pops and a Chick-Fil-A lunch to celebrate their hard work, and received a “Recognized for Excellence in Patient Experience” sign to display in the clinic waiting room.
The Hoover Family and Community Medicine Clinic excels in many factors of patient experience, including the teamwork required to help patients and provide seamless care. The clinic’s certified clinical medical assistants, Lovie Robinson, Clara Layow, and Jaqueline Rodriquez, work closely with each doctor to provide care as a pair.
“When you see Dr. Davuluri, you're going to be talking to Lovie, and you know that when you're talking to Lovie, you're going to be seeing Dr. Davuluri, because they're a team. That gives a lot of ownership to the CCMA’s,” said Annie Shedlarski, R.N., MSN, CNL, and manager of the Hoover Family Medicine Clinic and Hoover Primary Care.
The CCMAs let patients know that they'll do everything they can to accommodate them during the visit, and give them information after a visit or for their next appointment.
“We take care of you… that closed loop communication and that whole customer service philosophy is what gives us very high scores.” Shedlarski said.
Access and communication with patients are the top priorities for the faculty and staff.
To gather feedback from patients, the clinic uses a survey service called Medallia. Medallia automatically sends patients a few short questions about their experience at the clinic. It tracks several metrics related to the patient experience, including satisfaction with clinic staff, satisfaction with the care received and ease of check-in.
The UAB patient experience team uses five level tiers. Level 5, which Hoover FCM achieved, is the highest level. Shedlarski said the clinic reached this level because of an incredible team that delivers 100%.
“When you come to your doctor, you don't want to feel like you're one in a million. You want to feel like someone actually wants to listen to you, the doctors want you to know they care and they want to do what's right for you,” she said, “You want to feel like they're welcoming you.”
“We provide the speed and respect and we care for the patients just like we would care for ourselves or our team members or family members and I think that's patients see that and recognize that experience,” said Sameera Davuluri, M.D., assistant professor and medical director of the Hoover FCM clinic.
Individual Family Medicine Providers Also Recognized for Exceptional Patient Experience
UAB Medicine recognized two UAB FCM care providers for Excellence in Patient Experience, including Erin W. DeLaney, M.D., assistant professor, vice chair for clinical affairs and quality, ambulatory medical quality officer and medical director of Family and Community Medicine – Highlands, and Kimberly M. Fagan, M.D., associate professor and sports medicine division chief.
Irfan Asif, M.D., professor and chair of the Department of Family and Community Medicine and associate dean for primary care and rural health, said that the clinic and individual awards reflect the department’s commitment to providing excellent care in every patient interaction.
“High-quality family medicine provides a patient-centered approach with highly accessible, integrated care, by interprofessional teams,” Asif said. “Our team focuses on delivering the best possible experience for patients, communities, and populations. We are honored to receive awards for our patient experience and will continually strive to deliver the best services possible within our patient-centered medical home.”
Story by Kenia Hernandez
National Rural Health Day: These Medical Students Are Ready to Serve the Rural Areas That Shaped Them.
When they look toward their future in medicine, UAB Heersink School of Medicine students Carla Brown and Ellie Pitchford both envision practicing medicine in rural communities similar to the ones that shaped them.
Growing up in Batesville, Miss., Brown, who will study at UAB’s Tuscaloosa campus, saw how people in the small, rural town cared for each other, but also how they struggled to access high quality, timely medical care, particularly if they needed to see specialists or were facing an emergency.
“We have one or two family medicine physicians who I have known my whole life, and a small hospital that has threatened to close several times. We do not have a lot of specialties; they just got rid of labor and delivery,” Brown said. “Growing up in that environment, I have seen several people in life-or-death situations need to get to the nearest hospital with specialists who can treat them and unfortunately pass before they can make it there.”
Raised roughly 200 miles away in Scottsboro, Ala., Ellie Pitchford noticed similar trends as friends and family sought medical care.
“My grandparents often had to travel 45 minutes to see their primary care provider,” said Pitchford, who lived in Scottsboro until age 21, when her family moved to Birmingham. “There is also a significant lack of mental health resources in rural communities, something that I would like to address as a provider and make available to my patients.”
Both Brown and Pitchford are MS1 students and members of the latest cohort of the UAB Department of Family and Community Medicine’s Comprehensive Urban Underserved and Rural Experience program, or CU2RE. Launched in 2020, CU2RE is designed to enhance the recruitment, training and retention of medical students dedicated to serving as family medicine physicians in underserved rural and urban areas of Alabama.
The program recently admitted a second cohort of 16 students, Brown and Pitchford among them, after kicking off with an inaugural cohort of eight students in 2020. Students, who can choose between an urban underserved and rural medicine track, remain in the program throughout their four years in medical school. They are paired with a dedicated mentor and complete web-based modules, monthly early clinical exposure experiences and an intensive summer program during their first two years, along with a four-week Family Medicine Clerkship in their third year and a four-week Family Medicine Acting Internship in their fourth year.
“Our goal is to provide CU2RE students with early, hands-on clinical experience and a unique curriculum that will better prepare them to serve patients in these areas of critical need – both in rural and urban underserved communities,” said Jill Marsh, M.D., assistant professor and director of the CU2RE program’s urban underserved and rural pathways. “The students learn to be a personal physician for their panel of patients through mentorship and clinical exposure, but they also learn about how to assess and address the non-medical factors that are crucial to truly transform long-term health outcomes for their patients.”
For example, students learn how to collaborate in interprofessional teams, how to address a patient’s social determinants of health, how to measure the quality of care delivery, how to adjust their care approach based on the unique cultural and linguistic needs of their patients, and how to use nontraditional methods of connecting with patients, such as telehealth.
“We want to ensure that, no matter where they live or what their situation, patients can access excellent care from physicians who are prepared to meet them where they are in life and location,” Marsh said.
Brown said she was especially drawn to the early clinical experience and mentorship that the CU2RE program offers.
“I am excited about getting a lot more hands-on experience early in medical school and about the mentorship aspect of the program,” Brown said. “I did not really have a lot of guidance getting to medical school, so it was very important to me to find that here. I am also excited to be with others who are interested in primary care and family medicine, to bounce ideas off each other and share experiences that might be different from those I have had.”
Pitchford, who will study at the Huntsville campus, said she applied to CU2RE because she is “hungry for clinical opportunities to start serving people now, instead of having to wait.”
“Growing up, I always saw the doctors [in Scottsboro] use medicine as a way to serve people and that is what attracted me to medicine,” she said. “If I am going to spend all of this time in school, I want to come out of it able to serve people and serve some of the most vulnerable populations, including rural people.”
Both women believe that an influx of family medicine and primary care physicians, supported by programs like CU2RE, can help solve some of the problems patients face in rural areas.
“I saw a lot of health disparities in my community, which really made me want to practice in a similar area,” Brown said. There are a lot of different challenges, she said, from gaps in health literacy that keep patients and providers from understanding the patients’ concerns and how to treat them, to logistical challenges like transportation to and from appointments.
“Providers in rural areas have to understand where patients are coming from, what challenges they face,” Brown said.
Pitchford also wants to make one thing clear to her classmates and fellow aspiring physicians: providing care in rural communities is challenging, meaningful and valuable work.
“I think sometimes there is this expectation or bias that medical students who are interested in rural medicine are limiting themselves or taking the easy route,” she said. “I want people to be encouraged. You are not limiting yourself in rural medicine. Medicine is all about serving the patient and you will do that every day.”
Preventing Diabetes Before It Becomes a Diagnosis: Diabetes Awareness Month
One in 10 Americans has diabetes and more than 88 million have prediabetes. With an often-irreversible diagnosis and lasting health implications, diabetes is a disease that can be prevented with the right strategies and support. For National Diabetes Awareness Month, two providers in the Department of Family and Community Medicine are sharing tips on how to prevent diabetes altogether.
Caroline Cohen, Ph.D., R.D., and Ksenia Blinnkova, M.D., MPH, are both assistant professors with the department. Cohen, a registered dietitian, regularly counsels patients on how to manage their health through personalized dietary plans. Blinnikova sees patients with diabetes management needs and specializes in weight management as part of her primary care practice. Both providers work with patients to avoid a diagnosis of diabetes and to support those living with the disease.
Here are their top four tips for preventing diabetes.
Know Your Risk Factors
Blinnikova noted that one in three people in the U.S. have prediabetes. Patients with pre-diabetes have a hemoglobin A1C, an indicator of blood sugar control, range between 5.7-6.4% and a high chance of developing diabetes. However, prediabetes can be reversed before a diabetes diagnosis occurs.
“Lifestyle modification is the basis for blood sugar management and avoidance of a diabetes diagnosis,” she said. “Making small diet changes and introducing regular exercise can help delay the onset of diabetes or even reverse a patient’s pre-diabetic blood sugar range.”
Blinnikova recommends that patients with elevated blood sugar levels, family history of diabetes, or a history of gestational diabetes talk with their primary care provider about their risk of developing diabetes.
Eat with Diabetes Prevention in Mind
“Patients should understand the role of nutrition in preventing chronic diseases like diabetes,” said Cohen. “The type, amount, and timing of the foods you eat all play a critical role in how you feel and in your blood sugar management. You can work with a registered dietitian to gain a better understanding of how a balanced diet impacts your health and can improve your overall lifestyle.”
Patients at risk for developing diabetes should eat a diet high in fiber, limit sugar-sweetened beverages, and choose poultry or fish over red or processed meats.
Find Support Through Prevention Programs and Your Primary Care Provider
According to Cohen, interested patients can enroll in the Diabetes Prevention Program (DPP). The DPP provides education and resources to people who are interested in making lifestyle changes related to nutrition, exercise, and behavioral health, she said.
Blinnikova also encourages patients to seek out support groups and to talk with their primary care provider about diabetes prevention.
“Patients can get specific recommendations on dietary modification and prescriptions for exercise from primary care providers,” Blinnikova said. “Those conversations are a great starting point on a patient’s journey to healthier living.”
Maintain a Healthy Weight and Exercise Regularly
Cohen and Blinnikova also encourage patients to maintain a healthy weight.
“Obesity increases the risk of developing diabetes,” Cohen said. “Research indicates that those with obesity can significantly reduce the risk of having type 2 diabetes by losing just 7-10% of their current weight.”
Blinnikova talks with her patients about integrating regular exercise into their daily lives to maintain a healthy body-mass index (BMI), even if they need to start small.
“For people that have not been exercising, I recommend starting with 5-10 minutes a day and slowly increase intensity and duration,” she noted. “Chose what you enjoy doing- whether walking, jogging, biking, or other activities – and keep moving. Every minute counts!”
The UAB Department of Family and Community Medicine employs a comprehensive approach to healthy lifestyles. With an on-site dietitian, behavioral health specialist, sports medicine providers, and weight-loss specialists, the department’s clinics are available to work as a team to encourage patients and help them avoid a diabetes diagnosis and reach healthy living goals. For patients wanting to make lifestyle changes, the Exercise is Medicine (EIM) program is a great first step toward reaching health goals. EIM gives patients a discounted membership to a local YMCA and provides specific recommendations for starting an exercise plan that is accessible and effective for them.
Learn more about Exercise is Medicine and other departmental resources here.
Special Topics Course Introduces Students to Key Procedures in Family Medicine
Held from Oct. 19 to 22, the course included sessions on ultrasound use in primary care and sports medicine, joint injections, women’s health and wound care. Providers from the Department of Family and Community Medicine, the Cahaba-UAB Family Medicine Residency, the Gadsden Regional Medical Center Family Medicine Residency and the St. Vincent’s Family Medicine Residency (Christ Health Center) taught the four sessions, which totaled about 20 hours of hands-on learning for students.
“We wanted to offer procedures training that students would not be able to access on their own,” said Assistant Professor Ksenia Blinnikova, M.D., MPH, who led organization and curriculum planning for the Special Topics course. “Students got a lot of hands-on experience and they also got to see the full scope of family medicine in the breadth of the topics.”
“This was a good opportunity for students to learn more about family medicine and about different residency programs in the area.”
MS2 student Claire Wilson said all four workshops were helpful and rewarding.
“It was especially helpful to get to meet with the residency programs in Birmingham and learn from residents, learn about women’s health procedures to prepare for clinical rotations and have a wonderful preview of the musculoskeletal system and different relevant pathologies,” Wilson said. “The ultrasound workshop and joint injection workshop were really well done and targeted at clinical skills that are more up and coming which was exciting.”
Students practiced using ultrasound in diagnosing and treating injuries and performing joint injections, and learned about colposcopy, endometrial biopsy, IUDs and OB laceration repair in the women’s health session, led by faculty from the Cahaba-UAB Family Medicine Residency.
“Students had the opportunity to not only learn about these topics but also gain hands-on practice,” said Mojica Catarina, associate residency program coordinator at Cahaba Medical Care.
Bradley Green, M.D., a faculty member with the Gadsden Regional Medical Center who helped teach the joint injection session, focused on treatments for the knee and shoulders.
"It was great working with the medical students for the joint injection course. Everyone was engaged and we all had a blast practicing with the knee and shoulder injection models,” Green said. “Procedures are an important part of family medicine, so we're happy to share a bit of what we do every day."
On the last day of the course, students learned about wound care and use of an Unna boot, a gauze dressing filled with zinc paste. The dressing is used to treat venous stasis ulcers, wounds on the leg or ankle caused by damaged veins.
Cleon Rogers, M.D., who taught the workshop, said he sees similar wounds every day at his practice with Christ Health.
“Venous statis ulcers can really isolate people from their community, because they cause wounds that have an odor and that drain. People don’t feel comfortable going out or going to work,” Rogers said. He talked to students not only about wound care, but about the importance of recognizing the stigma that might come with some wounds.
“We really want to train them not only to treat the wound, but to help patients integrate back into society and overcome social stigma and disenfranchisement. Left untreated, these wounds can cost people their job,” he said, noting that venous statis ulcers typically do not feature in medical education, leading to misdiagnosis, delayed treatment and further frustration for patients.
As future physicians, students must learn to advocate for their patients in those cases, Rogers said, and start treatment early to maximize success.
“We at Christ Health are happy to be part of providing that education, especially for students who will provide primary care to underserved and disenfranchised communities,” Rogers said.
Dalton Frederick, also an MS2 student, believes what he learned during Special Topics week will help him as he moves forward in his medical education.
“We can learn a lot of things in a classroom, but it is very rewarding to be able to apply those things in practice with the help of all the residents and physicians that helped make the Special Topics week possible. Covering women’s health, ultrasound, MSK joint injections and wound care, we learned valuable clinical knowledge helping us go forward.”
Becky Reamey, Ph.D., to Serve as Alabama Statewide AHEC Associate Director
Alabama Statewide Area Health Education Centers (AHEC) Program announces the appointment of Rebecca A. Reamey, Ph.D., to fill the position of Associate Director upon the retirement of Glenda Stanley. Reamey joins Alabama AHEC at an auspicious time as the organization transitions back to normal operations after many months spent in COVID-19 relief. It has been a period of great growth in terms of increased outreach and potential for the development and fostering of diverse partnerships upon which Alabama AHEC hopes to capitalize in the coming months.
The“Alabama AHEC is a valuable part of the state and the mission of UAB. It plays a pivotal role in creating a future pipeline of healthcare professionals that will ultimately address some of the major healthcare issues found in our state,” said Irfan M. Asif, M.D., professor and chair, UAB Department of Family and Community Medicine, and associate dean for primary care and rural health in the UAB Heersink School of Medicine. “We are honored to have Dr. Reamey join the team in her new leadership role. She brings a wealth of experience and a passion for education and research.”
Reamey holds a Ph.D. in Higher Education from The University of Alabama, with an emphasis on student development with interest in leadership and workforce development. Her postdoctoral appointment was at the Center for Community-Based Partnerships in the Division of Community Affairs at UA. In addition, she holds a Master’s degree in Communication Management from UAB. With more than 18 years of experience in curriculum design, program management, leadership development and teaching, her research interests focus on program evaluation and outcomes.
For the last four years, Reamey has worked to improve health outcomes and research throughout the Deep South as the Center for Clinical and Translational Science (CCTS) Training Academy co-director. Through the development of training initiatives, she has helped to ensure that the next generation of healthcare researchers gain the skills needed to lead teams, conduct research, write grants and develop careers as researchers. As part of her role, Reamey helped to establish the Family Medicine Faculty Development Fellowship, leading the scholarship and research modules.
As the Deputy Director of the Center of Outcomes and Effectiveness Research and Education, Reamey has been able to connect outcomes researchers to form interdisciplinary research teams and facilitate educational opportunities regarding outcomes research methods. In addition, she currently serves as an assistant professor in Infectious Diseases where she has participated in various COVID-19 projects that include the Alabama Comet/RADx-Up grant that, in turn, partners with Alabama AHEC and the COVID-19 Collaborative Outcomes Research Enterprise (CORE).
As a native of Alabama and member of the Blackburn Institute, Reamey has great familiarity with the adverse conditions facing our state, and the diverse nuances to consider in addressing those conditions, as relates to public health, accessibility to care, and health education in Alabama’s rural and underserved communities.
On behalf of the Alabama AHEC leadership, its staff from the Program Office and five regional centers, network and community partners, and the UAB Department of Family and Community Medicine, we welcome Dr. Reamey to her new appointment and expect great developments in the coming months because of the broad and unique experience she possesses.
Written by Allison Abney
Q&A: 5 Questions for UAB’s Sports and Exercise Medicine Fellows
Fall sports are in full swing in Birmingham, and UAB Sports and Exercise Medicine fellows Matthew Miesch, M.D., and Christian Muller, D.O., are in the middle of it all, whether courtside in Bartow Arena, on the sidelines at high school football games or at the ice rink with the Birmingham Bulls.
Miesch and Muller are in the first year of the two-year UAB-Cahaba Sports and Exercise Medicine Fellowship, which is supported by Cahaba Medical Care and the UAB Department of Family and Community Medicine. Fellows receive comprehensive training in all areas of sports medicine, including sports cardiology, ultrasound, concussion management, exercise as medicine and more, while also completing a Master’s of Science in Exercise and Nutrition.
Joined by providers and faculty members, fellows provide sideline coverage at a huge range of sporting events all over Birmingham, including youth and high school sports, UAB varsity and club teams and professional teams such as Birmingham Legion soccer, Birmingham Bulls hockey and Vulcan Rugby. They will also be part of the UAB Sports and Exercise Medicine team providing medical coverage for both athletes and spectators at the 2022 World Games in Birmingham.
We caught up with Miesch and Muller ahead of UAB men’s basketball’s first home game on Monday to learn how the fellowship is going so far.
Q. What drew you both to sports medicine?
Muller: I swam for more than 14 years, including in college for the University of Buffalo. I love being in sports environments, dealing with athletes and coaches. Athletes typically have a special kind of drive. If they do get injured, they work very hard to get better and to come out stronger on the other side of the injury. They make for exciting patients and are just a lot of fun to work with.
Miesch: I was raised around a lot of sports – basketball, baseball, football, etc. – and played a few years of college baseball before going to medical school. I love that, as sports medicine providers, we get to be out in the community, on the sidelines, enjoying all sorts of matches and games. I wanted to choose a profession that would not feel like “work” every day because I enjoy it. For me, sports medicine offers that. The teams that we cover are a breath of fresh air, and we get to spend lots of time outside, at great events, with great teams and coaches. I love that environment and the sense of teamwork and camaraderie that comes with athletics.
Q. What sports are you covering right now?
Miesch: Along with professional teams like the Legion, Vulcan Rugby and the Bulls, we are working with a lot of UAB varsity athletics teams, including football, basketball, volleyball, men’s and women’s soccer and cross country, as well as UAB club sports. We just finished up a club lacrosse tournament, for example. We also cover high school football every Friday night, which is a lot of fun. Going every week, you really get to know the athletes and their families. At all of the high school and club events, Christian or I serve as the primary attending physician on the sidelines, which gives us really great experience in that leadership role.
Q. What have been some of your favorite parts of the fellowship so far?
Muller: I knew that I was going to have a great experience working with the current staff. Dr. [Ian] McKeag [assistant professor and fellowship director] was a big reason I came to UAB. I really enjoyed meeting him during our virtual interviews and he is a very easy person to work with. He creates a productive, friendly learning environment, where it is easy to discuss and ask questions. I love all of the hands-on work that we have been able to do, and the trust placed in us as they continue to let us step into leadership roles. We get to make a lot of calls and decisions, and are really able to make a difference.
Miesch: I agree with all Christian said, and I have also really enjoyed the procedures we have learned to do, particularly ultrasound procedures. Ultrasound is a huge aspect of the sports medicine fellowship and I think it is a big part of our niche as nonsurgical sports medicine physicians. We also gain experience reviewing hundreds of CT scans and MRIs, but ultrasound is fairly unique in its use in sports medicine and mastering that really increases our value when we step into practice.
Q. What types of ultrasound treatments or services are you able to provide?
Muller: One of the most common uses is for joint injections, injecting corticosteroids, hyaluronic acid or gel injections, or PRP [platelet-rich plasma] injections to promote healing and joint function. We can also use ultrasound to diagnose rotator cuff tears or muscle injuries and identify fluid collections or even fractures. It can be both therapeutic and diagnostic and can be done on site, so that the patient does not have to go to another clinic for an MRI or CT scan.
Q. UAB basketball is about to tip off. What are you looking forward to?
Muller: I have not worked with the team much yet, but I’ve heard a lot of good things. I am excited to experience the energy in Bartow – you can probably feel it on your skin when you are there with the crowd. I am looking forward to experiencing that and watching the team play.
Miesch: It’s just great to be right there on the sidelines, really getting to know these Division I athletes and understand how to treat them and help them be their best. I also enjoy being around Dr. [Heath] Hale and Dr. [Amit] Momaya and watching how they interact with the team and the coaches.
Telehealth and Nutrition Counseling: Pandemic Reveals Advantages to Talking About Nutrition Virtually
According to the Center for Disease Control and Prevention (CDC), use of telehealth visits increased 50% at the beginning of 2020. The COVID-19 pandemic has changed the way that many providers offer care, and it has created new ways for patients to connect with care teams from their homes.
While telehealth presents certain challenges, such as connectivity or access, it has broadened the ability for specialists and other care providers to reach patients who might not ordinarily make it to an urban area for a one-on-one visit. One provider in the Department of Family and Community Medicine believes this new pandemic precedent improves her ability to work with patients during nutrition counseling appointments.
Caroline Cohen, Ph.D., R.D., assistant professor and clinical dietitian, has found several advantages to having her nutritional counseling sessions via telehealth visits. Patients are able to show her their kitchens and the types of foods they can easily integrate into meal plans, and Cohen can quickly give resources by sharing her screen with patients. Cohen is also able to look at patients’ nutrition tracking apps which help facilitate individual recommendations for their nutrition plans.
“Telehealth visits give me increased access into a patient’s world,” noted Cohen. “This can really help with providing individualized dietary interventions and maximize the benefit of nutrition counseling.”
Nutrition counseling appointments allow for individualized conversation about health goals related to weight management, sports nutrition, and dietary management of chronic diseases, such as diabetes, heart disease, cancer and more. Cohen is also available for counseling surrounding pregnancy and lactation nutrition needs. She works with patients of all backgrounds and ages to counsel them on the best ways to integrate optimal nutrition into their diets.
For more information about nutrition services or to schedule an appointment, visit the UAB-Highlands Family Medicine portal.
Storytelling in Medicine Gives Students Opportunities to Reflect, Provide Better Care and Advocate
Claire Wilson was experiencing a number of changes in her personal life. During her first year of medical school, a stressful and stretching time by itself, Wilson was managing family challenges and working through her own reactions to COVID-19 as an emerging medical provider and the racial injustice conversations happening around her as a multiracial woman.
At the same time that the world was reckoning with widespread outcry after the killing of George Floyd by a Minneapolis police officer and dealing with the growing impact of the COVID-19 pandemic,It was a time marked by protests, personal reflection and increasingly honest storytelling surrounding racism in America, and Wilson’s own story began to unfold in a way she never imagined.
Months after these experiences, Wilson opened up to share her story with peers and mentors as part of a practical summer anti-oppression experience led by the Department of Family and Community Medicine’s Office of Identity, Inclusion and Collective Conscience (I2C2). I2C2 works to celebrate diverse identities, support inclusion and belonging of multiple stakeholders, and increase understanding and action around achieving health equity and social justice. Brandi Shah, M.D., MPH, director of I2C2, and Shyla Fields, program manager, work closely with U2P students to cultivate brave spaces for the students to learn how to elevate diverse voices and recognize and address social determinants of health in primary care and broader community.
A child of a multiracial family and resident of Birmingham, Wilson created a digital story during the culminating mini-storytelling workshop of the summer I2C2 program. The students were challenged to explore their and reconcile their own lived experience and personal connections to present-day anti-oppression and social justice issues that they learned about during the week. Wilson’s digital story demonstrates the brave and clear voice of a burgeoning physician committed to health justice, as well as the accessible skills-building of digital storytelling for health, all while weaving personal history into the critical conversations she is having as part of the CU2RE Urban Underserved Pathway (U2P) program.
I2C2’s week-long anti-oppression course took U2P students on tours of Birmingham and Montgomery Civil Rights locations, integrating the story of the southern cities into the broader story of the impact of racism, intersecting social determinants, and health inequity. The group focused on the complicated history of race and medicine, and how the students' own stories, past and future, could contribute to healing and equity. Shah and Fields provided creative support and mentorship for the students as they grew new understanding of each other and their practice community to engage in courageous self-reflection and personal and professional story sharing.
“Spending an intentional, mutually-enriching week with the inaugural CU2RE medical student cohort—and my emerging colleagues—provided some of the rejuvenating transformative power that sustains me in my own career,” said Shah. “I am grateful to the entire group for bringing all of themselves to the experience, and especially grateful to Claire for encapsulating the experience in her equally transformative digital story and reflections.”
Wilson shared her digital story and took time to reflect on her personal storytelling journey.
Q. What does storytelling in medicine mean to you?
A. “The practice of hearing and telling stories (even data driven stories) is, in my opinion what “makes the magic happen”. This is how we as medical professionals facilitate relationship and meaningful connection with our patients, which our curriculum teaches is the most fundamental skill to have as a physician. I think storytelling in medicine is at the heart of both the science and art of medicine.”
Q. How did the week of I2C2 summer programming meet your expectations as a U2P student?
A. “I2C2 brought an essential component to the U2P summer program. The week helped bridge gaps between classroom knowledge and real-world challenges and provided experiential context for many of the concepts that U2P focuses on, like racism in medicine and health equity. The program added important context to our medical education and connected us to the community.”
Q. What moments, activities, conversations, reflections stood out and why?
A. “One of the most impactful moments of the week for me was the spontaneous meeting with a member of the NAACP in the Civil Rights District and hearing her share stories of her experiences in Birmingham, growing up during the Civil Rights movement. It truly brought history to life and illuminated the importance of furthering the work of equality and equity in my generation. This visit was followed by a tour of the murals painted throughout the city after the violence and unrest of the summer of 2020. It was an eye-opening juxtaposition of what it looks like to be an activist then versus now. We also took a tour throughout Birmingham that included student research on different historical sites throughout the city. It was special to see the legacy of the city through the eyes of my fellow students.”
Q. The culminating activity of the week was a mini-workshop about using digital storytelling to reflect on your experience and raise awareness for change. Reflect on your experience of creating a digital story for this purpose.
A. “I thought the digital storytelling was an appropriate culmination of the week. It provided an opportunity for free expression, reflection, creativity and most importantly, was another opportunity to be radically honest with our colleagues. In a professional culture that is often fraught with burnout, high expectations, and perfectionism when the nature of medicine itself is inherently artistic and imperfect, I was thankful to have the opportunity to let my personal story and experience of the week be expressed authentically.”
Q. Overall, how did the week's programming influence you personally and professionally as you think about your career trajectory?
A. “After reflecting on all the experiences the week provided, I am more determined now to be a member of the medical community that values advocacy and healthcare policy reform. In addition to serving the underserved (especially in Birmingham), I hope my career affords me the opportunity to sponsor and support reform that affords more space for patient—doctor storytelling and reintroduces humanism and art into the culture of medicine that grows increasingly sterile, profit focused, and abbreviated.”
Q. What does an office like I2C2 provide for you as a medical trainee and other ways to meet your needs?
A. “I2C2 is a place I can ask questions about policy and advocacy, engage with the community and physician mentors, and reflect on my experiences safely. It’s a great place to find resources, support, and explore what the medical community is learning and unlearning together.”
Wilson’s digital story is available for viewing here or above. Learn more about I2C2 and their work by visiting their webpage.
Sports and Exercise Medicine Fellows Provide Comprehensive Coverage to Local Teams
Student athletes are back and ready for a new season and the Sports and Exercise Medicine fellows at the University of Alabama at Birmingham are ready to provide the care they need.
The UAB-Cahaba Sports and Exercise Medicine Fellowship is a two-year program supported by Cahaba Medical Care and the UAB Department of Family and Community Medicine. Fellows gain hands-on experience in sports medicine training as they diagnose and manage illnesses and injuries and provide coverage for professional, collegiate and high school athletes.
UAB Sports and Exercise Medicine fellows Matthew Miesch, M.D. and Christian Muller, D.O., are the sole physicians for Ramsey and Bessemer High Schools, respectively. They work closely with coaches, student athletes and parents at each school, participate in training room clinics and are on the sidelines during the games. For injured athletes, they provide non-surgical evaluations and treatment of these athletes with the goal to restore them back to their pre-injury performance level. In addition to Ramsey and Bessemer, the program works with UAB club sports, Vulcan Rugby Birmingham Legion and the Birmingham Bulls.
Along with helping student athletes, the partnership gives Miesch and Muller firsthand knowledge and experience of what can occur during the games and allows them to develop relationships with players and coaches.
“You have to get continuity with a team meaning you want to follow them along not just for one game not for two games but a whole season,” Miesch said. “You get to know the players you work with and the athletic trainers you develop good relationships with.”
The fellows can also help families get the care that they might not normally be able to access.
“The parents are so thankful that we’re there, and for the easy, convenient access to care,” Miesch said. “That’s the biggest thing I take home from this partnership. I’m able to go to them instead of them coming to me and that’s such a huge advantage for the families.”
The UAB SEM fellows strive to help athletes excel in their sporting activities and everyday lives. UAB is invested in cultivating a stronger community and brighter future by ensuring the students have the most excellent care possible.
“There’s such a variety of healthcare opportunities within the community and I’m glad to be part of helping make a difference for those that need it,” Muller said. “We have a bunch of really great athletes at all stages of life and athletics that I enjoy taking care of and watching them grow.”
This partnership makes high school football safer each time teams take the field, and makes it possible for student athletes, no matter their economic background, to receive excellent care and keep chasing their dreams on and off the field.
Written by Kenia Hernandez
Glenda Stanley Retires After 20 Years of Serving AHEC
Glenda Stanley, MA, Associate Director of the Alabama Statewide Area Health Education Centers (AHEC) Program retired in October. Stanley has served the National AHEC Organization for over 20 years.
“AHEC has been like my family, I have worked with so many fun people through the years,” Stanley said. “AHEC has a tendency to attract like- minded people.”
Over the course of her career, Stanley has served in various roles within the National AHEC Organization including periods in Florida and her home state of Kentucky before joining Alabama Statewide AHEC Program. The Mission of the Alabama Statewide AHEC Organization is to recruit, train and retain a healthcare workforce for Alabama. The AHEC Organization provides accredited education programs to support the needs of practicing healthcare students in rural and underserved areas.
Stanley first worked with AHEC as a student back in the 1970s at the University of Kentucky, completing an interdisciplinary team experience in a rural area. Stanley was with four other health profession students and says she is a product of the AHEC system. Stanley began working with AHEC in 1993 as a student coordinator in Kentucky and served most recently as a Center Director in Florida before joining the Alabama Statewide AHEC Program.
“I was drawn to public health because I wanted to give people an opportunity a better life,” Stanley said. “I felt like the key to improving people's lives was education.”
While at AHEC Stanley strived to implement programs, services and activities that helped underrepresented and rural Alabamians build careers in the health professions by developing partnerships and facilitating resources with other organizations.
Stanley has dedicated her time to countless efforts to improve the health and access to care for citizens in rural and underserved populations in Alabama.
“Education is just interwoven in everything that I believe in,” Stanley said. “A good education can change not only the student's life, but a whole generation. It provides another asset to the community.”
The goal of AHEC is to provide resources that give students in rural and underrepresented areas an opportunity to train as a health professional - that opportunity can change their quality of life, transform their future and uplift their communities.
The Alabama Statewide AHEC created the Alabama AHEC Network to initiate a coalition of community partners from the entire state by providing community-based training to the teams involved with COVID-19 testing in rural Alabama. AHEC has focused on testing and vaccinating rural and underserved areas and populations, In response to COVID-19, AHEC produced the playbook “How to Establish a Community-Based Vaccination Site for the Moderna COVID-19 Vaccine”. This playbook allows organizations to follow a series of steps and establish vaccination sites in the state where health care accessibility is limited. A UAB medical student led group, Equal Access Alabama (EEA), has partnered with AHEC to deliver vaccines primarily in the Black Belt region by going door to door with doses.
“AHEC was able to respond quickly; we've provided vaccinations in churches, the workplace, and all over the state,” Stanley said. “I'm very pleased that it also created a community health worker training program statewide, so we have community health workers deployed all over the state.”
Despite the COVID- 19 pandemic, AHEC continued to grow with Stanley’s quick efforts to adapt and reimagine the vision of how the organization might continue to serve Alabama. Stanley and her team were able to acquire and administer the funding that has made AHEC’s new vision attainable.
She advises health professionals and community members to show up, do their part and come together for something better. The rewards, she said, are well worth the effort. Looking back at her career, she is most proud of the way she has been able to help students, such as those in the Rural Health Club, which offers the opportunity to educate students regarding rural health issues in Alabama through volunteering, shadowing and workshops.
“While at UAB I've been most proud of our Rural Health Club, the student chapter of the Alabama Rural Health Association, so many of our students have been admitted into medical school, dental school and nursing school, the whole the whole range of health professions,” Stanley said. “I've had the privilege of being the faculty advisor for six years.”
In Stanley’s experience, the most rewarding part has been impacting one student at a time, and she plans to always remain a mentor for many of those who follow the path she helped pave.
Written by Kenia Hernandez
Selma Faculty Leaders Promoted to Associate Professor
faculty members from the UAB Selma Family Medicine Residency Program were promoted to associate professor in August 2021. Tiffani Maycock, D.O., residency program director, and Maria Oquendo, M.D., both received the promotion based on their achievements in resident education and patient care in Selma.
TwoOquendo reflected on the promotion and the opportunity to share her knowledge with residents in Selma:
“Teaching residents and working in Selma has been a highlight of my career, so this promotion is very meaningful to me,” said Oquendo. “I look forward to continuing the good work we are doing on behalf of UAB and the community here in Selma.”
Oquendo and Maycock are just some of the faculty members in Selma. The unopposed residency program has operated for over 40 years and offers residents a completely rural experience, one of only a few such programs in the country. Under Maycock’s leadership, residents in the program have achieved a 100% board pass rate for the last five years.
"The four aims of our program are patient care, education, scholarly activity and research, and community engagement and service. Focusing on these areas for my own professional development as well as for the program has enabled me to grow in ways I never imagined and opened my eyes to opportunities I never knew existed,” said Maycock. “With this promotion, I feel an even greater sense of responsibility and pride in teaching and practicing medicine in Selma and extending my influence beyond.”
Both Maycock and Oquendo are part of the regional faculty of the Department of Family and Community Medicine. Maycock was recently named to the board of directors of the American Board of Family Medicine and Oquendo has been honored for several research projects at state conferences in the past few years.
“We are incredibly proud of both Dr. Maycock and Dr. Oquendo,” said Irfan Asif, M.D., chair of the Department of Family and Community Medicine and associate dean for primary care and rural health. “Both of these outstanding physicians work tirelessly to provide our residents with engaging opportunities to learn and represent our department in Selma through innovative and compassionate leadership, particularly for medical students, residents and fellows.”
To learn more about Maycock and Oquendo’s work or the Selma Family Medicine Residency program, visit the UAB Selma website.
The Pandemic is Increasing Intimate Partner Violence. Here’s How Health Care Providers Can Help.
Among the hidden costs of the COVID-19 pandemic is an alarming rise in domestic violence and intimate partner violence, a form of domestic violence in sexual and romantic relationships with devastating effects that can ripple across generations.
According the American Journal of Emergency Medicine, domestic violence cases increased by 25-33% globally in 2020, compared to 2019. More locally, domestic violence calls in Jefferson County, Alabama increased by 27% in March 2020, as compared to March 2019. Parallel increases were observed in other cities around the U.S., from Portland, Oregon to San Antonio, Texas or New York City.
In the midst of Domestic Violence Awareness Month, Sumayah Abed, M.D., assistant professor in UAB’s Department of Family and Community Medicine and UAB Hoover Primary Care Clinic physician, is working to raise awareness among health care providers. She is especially concerned about the risk of intimate partner violence, which is already underreported and underdiagnosed by physicians.
“Even after recognizing the problem of intimate partner violence, victims may not get the necessary support, as many healthcare workers are unfamiliar with the policies and the resources to help them,” Abed said.
Intimate partner violence, defined as violence among current or former partners that may include stalking, physical, psychological and sexual violence, is common worldwide and affects both sexes. It is more commonly reported by heterosexual women, Abed said, but is likely to be underreported in men, transgender and gender non-conforming people and same-sex relationships.
According to the National Coalition Against Domestic Violence, nearly 20 people per minute are physically abused by an intimate partner in the United States. Intimate partner violence accounts for 15% of violent crime in the U.S., and approximately one in four women and one in nine men experience intimate partner violence.
The pandemic intensified many of the conditions that can fuel intimate partner violence. Some businesses shut down suddenly. Many families faced economic tension as well as the stress and uncertainty created by COVID-19.
“Besides the quarantine situation, the pandemic also aggravated alcohol abuse, depression and post-traumatic stress disorder,” Abed said. “All of these factors created an environment that exacerbates domestic violence.”
Assessing Risks
As the pandemic continues, health care providers should be especially conscious of those risk factors, including psychiatric illness, alcohol consumption, drug abuse and economic stress. Pregnant women are also at higher risk of domestic violence, which can also increase the risk of pregnancy-related complications, such as miscarriage, pre-term labor, and low birth weight in infants.
Additionally, children who come from families with a history of domestic violence are at a higher risk of replicating or falling victim to those behaviors in adulthood. All forms of domestic violence, including intimate partner violence, can have a devastating ripple effect in families and communities, something that family care providers like Abed are particularly concerned about. Early awareness, intervention and help can prevent generations of trauma.
What Health Care Providers Can Do
At the clinical level, prevention of intimate partner violence starts with consistent and accurate screening, Abed said. She and her colleagues at Hoover Primary Care and Hoover Family Medicine use several screening tools to detect domestic violence and intimate partner violence, including both self-reported information from the patient, physician-administered questions. They also follow the U.S. Preventative Services Task Force recommendation to screen all women of childbearing age for intimate partner violence.
Health care providers should pay particular attention to families at risk of domestic violence, Abed said, in order to protect the family and prevent future domestic violence by children in that family, who are exposed to that behavior early on.
Providers can also ask more general questions, such as, “Do you feel safe at home?”
More broadly, media campaigns, such as one launched by the World Health Organization to provide education about intimate partner violence, can also help to raise awareness and educate patients and providers. The WHO campaign aims to make that information accessible in clinics and patient settings, as well as among policymakers and researchers.
Finally, macro-level changes such as empowering women economically and creating a broad, interprofessional support network for victims can help bring about long-term change, Abed said.
“Interprofessional collaboration is key to helping victims of domestic violence,” she said. “Health care workers, social services, and legal and law enforcement officers are all essential to help victims and survivors of domestic violence.”
Anyone experiencing domestic violence or concerned about a loved one facing domestic violence can connect anonymously to a crisis counselor by texting “UAB” to 741-741 or call the Birmingham Crisis Center at 205-323-7777.
Written by Caroline Newman