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    Puerto Rico Medical Schools Drive Diversity and Community Health

    In the aftermath of Hurricane Maria, the island's found medical school will need support from the academic medicine community.


    Editor’s note: This article was originally published in June 2015 in the AAMC Reporter. As Puerto Rico recovers from the unprecedented devastation following Hurricane Maria, the island’s four fully LCME-accredited medical schools will need support from the academic medicine community to the educational, research, and clinical programs highlighted in this article.

    Meet the Universidad Central del Caribe School of Medicine (UCC), the Ponce Health Sciences

    University, the University of Puerto Rico School of Medicine (UPR), and San Juan Bautista School of Medicine (SJBSM). Once little-known institutions, these fully LCME-accredited medical schools have overcome challenges in size, limited funding, and not being located on the mainland to successfully meet ongoing local and national health needs.

    Since their inception, these schools have made headway in recruitment and retention. And each has developed programs and initiatives that have set them apart. This, while sharing a strong bond, said Edgar Colon Negron, MD, dean of the UPR School of Medicine. “From [our] perspective, there is no sense of competition. It is our duty to be part of a bigger Puerto Rico team.”

    Students who attend Ponce Health Sciences University often are drawn there because of its small size (an incoming class of about 70 students) and close-knit relationships. Ponce, the second largest city in Puerto Rico, is in the island’s southern coastal plain region. “Everybody knows everybody. The faculty is really close. We have a strong sense of being a family within the institution,” said Dean Olga Rodriguez de Arzola, MD.

    The university started out as a medical school in 1977, but has evolved into a health sciences university that now includes programs in clinical psychology and public health, and a master’s degree in medical sciences. The institution changed its name from Ponce Medical School to Ponce Health Sciences University in 2010.

    “I think that most of us realize the importance of what we are doing for the better of our island and people. Many and probably most of us trained here and have a deep commitment of giving something back in gratitude for what we were given.”

    Carlos A. Luciano, MD
    University of Puerto Rico School of Medicine

    Student Angie Paz chose Ponce for its proximity to her family and opportunities to get involved in leadership and community programs. A bonus: “The faculty and administration of our school were so warm and welcoming, that I felt right at home with them,” she added.

    East of Ponce is the San Juan Bautista School of Medicine in the city of Caguas. Founded in 1978, the school is the only health institution in Puerto Rico that incorporates a full research program into its academic medicine curriculum, thanks to faculty commitment and research alliances with other institutions, said Yolanda Miranda, MD, associate dean for student affairs at SJBSM.

    After the first year of studies in biomedical, translational, clinical, behavioral, and epidemiology research, students enter into the Summer Research Internship Program and the Epidemiology Research Program. SJBSM currently is the only institution that has enrolled 100% of its medical students in summer research internships. “Definitively, SJBSM’s research program is one of the reasons for the students’ residency matching success during the past years,” Miranda said. SJBSM was recognized by the U.S. Department of Education. In 2015, the school received a Developing Hispanic-Servicing Institutions award with more than $5 million in funding.

    The University of Puerto Rico School of Medicine, Río Piedras, sits within the major Medical Center of Puerto Rico, which includes a pediatric hospital, an adult hospital, an oncology hospital, a trauma hospital, and the San Juan City Hospital. “This means that our students’ main teaching site is within the same sites where our faculty provide clinical services,” Negron said. “They are embedded in the daily lives of patients, doctors, and all health-related professionals.”

    Addressing local health needs

    The school’s educational program and technology are strong, said Negron, and the curriculum weaves in interprofessional activities and content on health disparities. “All of these may be the norm for big academic centers, but we do this with the budget of a small school,” he said. “[Our faculty] are willing to work for less pay but for the satisfaction of knowing they made difference in the care of patients by providing excellent medical education.”

    Students at the library of Ponce Health Sciences University
    Students at the library of Ponce Health Sciences University

    Carlos A. Luciano, MD, professor and chair of neurology at UPR, echoed this sentiment. “I think that most of us realize the importance of what we are doing for the better of our island and people,” he said. “Many and probably most of us trained here and have a deep commitment of giving something back in gratitude for what we were given.”

    A central goal of the Universidad Central del Caribe—founded in 1976—is to help address local health issues through education of future physicians, said José Ginel Rodríguez, MD, UCC president and dean of medicine.

    He noted that a prevalent public health issue in Puerto Rico is substance abuse. The pervasive problem led the university to explore the development of a Certificate in Substance Abuse Medicine (CSuAM). The UCC School of Medicine conferred the first certificates for the class of 2016. “The main goal is to provide graduates with the knowledge, skills, and attitudes to identify, assess, engage in a brief intervention, and refer a patient with a substance abuse disorder,” Rodríguez said.

    Bringing diversity to physician workforce

    Additionally, UCC focuses on recruiting disadvantaged Hispanic students who otherwise might not have the chance to go into medicine. The school is based in Bayamon, where 31% of residents are below the poverty level. The urban location is optimal as a dynamic laboratory to train health professionals, Rodríguez noted. “America increasingly has a deficit in doctors, especially with a racial or ethnic identity the same as their patients,” he said. “Institutions like UCC are thus especially important in providing opportunities for Hispanics to study medicine.”

    Deans of the four medical schools regularly meet to discuss goals and directions in medical education. “Unity is important because we have shared issues that are not common in the United States,” said Rodriguez de Arzola. She cited the challenge of keeping qualified medical school graduates on the island, for instance. “Our students are so good that they are being hired by U.S. institutions,” she continued. “Half of my students go to the mainland for residency. We want to attract students, particularly the best ones, to stay on the island.”

    These schools also have to address misconceptions in the United States about offshore medical schools. Some U.S. hiring committees are unaware that Puerto Rico is a U.S. territory, said Rodriguez de Arzola. “It’s frustrating. Every year, we receive letters wanting us to certify that we are an LCME-accredited institution.”

    All four medical schools in Puerto Rico are AAMC member institutions and are key contributors in generating diversity among the U.S. physician workforce and beyond. “The medical schools of Puerto Rico are accomplishing an extraordinary mission in providing most of the Hispanic workforce to our field,” Rodríguez said.