“In education, research, and care, academic medicine is constantly evolving to keep pace with public health challenges and meet the needs of patients and communities,” AAMC President and CEO Darrell G. Kirch, MD, wrote about the response of medical schools and teaching hospitals in addressing the national opioid epidemic. He echoed this theme in his Presidential Address at Learn Serve Lead 2016: The AAMC Annual Meeting in discussing the vital role academic medicine plays in caring for and healing their communities.
In the past year, the United States has experienced several public health crises, with elevated levels of lead in the Flint, Mich., water supply; the Zika virus; and the growing opioid and substance abuse epidemic among them. Academic medicine has responded to each crisis through patient care and research for new treatments and by educating the next generation of health professionals about new clinical care initiatives and research findings that address emerging issues.
Several sessions at Learn Serve Lead 2016 addressed how medical schools and teaching hospitals are uniquely positioned to respond to such crises. They also showed how lessons learned from these responses can inform responses to future crises.
MSU provides community-oriented response to Flint water crisis
In a local effort, Michigan State University College of Human Medicine (MSU) engaged each part of its tripartite mission to respond to the effects of a lead-contaminated water supply on the residents of Flint. At the forefront of the response was Mona Hanna-Attisha, MD, MPH, a community-engaged pediatrician who provides care in a low-income area and is director of the pediatric residency program at Hurley Medical Center. Hanna-Attisha and colleagues analyzed blood level data and published their findings in a study in the American Journal of Public Health.
As part of MSU’s Pediatric Public Health Initiative (PPHI), a partnership between MSU and Hurley Medical Center established in 2016 to address Flint’s public health crisis, MSU medical students gathered evidence-based research to assess, monitor, and work to ameliorate the harmful effects for Flint residents, especially children, who drank the lead-containing water.
Speaking at Learn Serve Lead 2016, Hanna-Attisha said of the response, “The voice of medicine became almost a megaphone for the people of Flint who had lost their voice.”
“The voice of medicine became almost a megaphone for the people of Flint who had lost their voice.”
Mona Hanna-Attisha, MD, MPH
With private funding from the Mott Foundation, MSU also partnered with local organizations, businesses, and government agencies to examine social determinants of health in Flint and reduce health disparities. This funding has allowed the college to recruit leading public health researchers who have played a critical role in exploring the health risks of consuming the water.
Preparing for the Zika epidemic
While the Flint crisis illustrates academic medicine’s engagement at a local level, the spread of Zika virus requires a global response. In a rapidly mobilized effort, the academic medicine community is responding to the epidemic by providing resources to combat the virus and investigate how it spreads.
Medical schools and teaching hospitals nationwide are conducting research that builds on existing knowledge of similar mosquito-borne viruses and has led to breakthroughs in understanding how the virus is transmitted and its effects. Other research teams are working to develop potential vaccines. Teaching hospitals across the nation have implemented preparedness efforts, including education campaigns for pregnant women and protocols to evaluate patients who have been infected by or exposed to Zika. All this in addition to treating those infected by the virus.
The AAMC and more than 40 other organizations pushed for federal funding for response efforts, aiming to support member institutions as they deal with this difficult epidemic.
Thomas M. Hooton, MD, professor of clinical medicine at the University of Miami Miller School of Medicine, speaking in a session at Learn Serve Lead 2016, discussed how academic medical centers were a key actor in the response to such crises as they are a trusted resource for expert information for both their community and the media. The trust placed in the Miller School of Medicine was a driver behind the school's response to the incidence of Zika in the Miami area and, more broadly, southern Florida. The school provided informational resources to the University of Miami students, faculty, and staff, patients, the greater Miami community, and conducted many media interviews disseminating information on the virus.
Nahida Chakhtoura, MD, MsGH, medical officer, Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National at the National Institutes of Health, added that academic medical centers also provide interprofessional care, which is critical in providing care for both an at-risk pregnant woman and her child, making them key to responding to Zika.
Public-private response to opioid and substance abuse crisis
As the world responds the Zika virus, academic medicine is fighting another epidemic here in the United States. As part of the joint public-private response to the growing rates of opioid addiction and substance abuse, medical schools and teaching hospitals have enhanced curricula to better educate future physicians about pain and addiction. Clinical innovations are providing new treatments for patients experiencing chronic pain, as well as those suffering from addiction. And researchers are looking into the science of addiction and using new knowledge to develop novel pain treatments.
AAMC-member institutions have also partnered with local governments, law enforcement, community organizations, and other health professions schools to combat the rise in substance abuse through outreach programs, provider training, and care for those dealing with addiction.
Many examples of the ways medical schools and teaching hospitals were creating these partnerships, enhancing curricula, providing patient care, and conducting research on topics tied to substance abuse and pain management were discussed at a session at Learn Serve Lead 2016. At the session, Wilson Compton, MD, MPE, deputy director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health, highlighted examples of promising research at a number of institutions, including Stanford Univeristy School of Medicine's investigation into potential non-addictive pain medication and a Yale University study that NIDA is attempting to replicate on the benefits of enhanced use of buprenorphine in emergency departments. Compton also noted that it was the role of academic medicine to ensure that the next generation of physicians would not exacerbate the epidemic saying, “We need you to teach residents and medical students how to write opioid prescriptions more judiciously.”
Lessons learned: Readying for the next crisis
With each of these, like with many past crises, medical schools and teaching hospitals have worked across their mission areas to provide education, care, and research. In examining academic medicine’s role in these public health crises, panelists at Learn Serve Lead 2016 also offered takeaway lessons that can be applied to preparing for and responding to crises in the future. Speakers also illustrated how academic medicine has evolved in its actions to address current public health challenges—and will continue to adapt to meet future crises—through new curricula and research and the development of new treatments.
Hanna-Attisha encouraged educators to ensure that their students and residents engaged with the communities they hoped to serve. "You cannot do community medicine in ivory towers," she said.
Robert Harrison, MD, MPH, clinical professor of medicine at the University of California, San Francisco Division of Occupational and Environmental Medicine, outlined four experiences he had personally benefited from and that he thought would prepare the next generation of physicians to address future public health crises—having an inspired educator, a mentor, receiving hands-on education and experience in medical school, and being able to conduct research into public and environmental health while a student.