Wayne State students and residents receive medical training at clinical sites throughout southeastern Michigan.

Throughout the past decade, the training campus of the Wayne State University School of Medicine has expanded, primarily in southeastern Michigan. Now, nearly every region in the state has been incorporated into the WSU teaching program.

The changing health care environment and focus on outpatient care has forced shifts in medical training--particularly for Wayne State University, the fourth largest medical school in the nation. With more patient care taking place in clinics, physician offices and ambulatory surgery settings, WSU began to outgrow its primary clinical training site, the Detroit Medical Center (DMC), more than 10 years ago. At that time, WSU partnered with the OHEP Center for Medical Education to help coordinate its medical education efforts in multiple specialty sites.

OHEP, formerly known as the Oakland Health Education Program, coordinates medical education programs, ensuring that all medical students, residents and fellows have productive learning experiences. Through the help of OHEP, WSU now has major training partnerships with institutions including Oakwood, St. John, St. Joseph Mercy-Oakland, Bon Secours, Providence, North Oakland Medical Centers and Detroit Medical Center hospitals.

"We want to be the medical school for the entire greater Detroit area," said John Crissman, MD, dean of the Wayne State University School of Medicine. "In order to do this, we are strengthening our relationships with all OHEP partners to expand and formalize WSU teaching programs throughout our community."

"OHEP is a great help to us," said John Malone, Jr., MD, associate dean for medical center relations. "It allows us to educate our students and residents all over the community, with common teaching standards." In this way, WSU's academic mission is stretched throughout Michigan's hospital systems.

Liborio Tranchida, MD, associate chair of internal medicine and education coordinator for the department, has cemented partnerships and established systems to ensure that the chiefs of the medical staffs at each OHEP hospital are responsible for teaching supervision within their hospital. "I have been here for 40 years and I have never seen a better relationship between Wayne State and the community hospitals," he said.

"The crux of the matter is clear. We need community hospitals. We utilize them efficiently, we reward them with sub-specialty training and medical assistance, and through all this, we have been successful in raising the level of education throughout southeastern Michigan and beyond," said Dr. Tranchida.

This education is provided in three important areas: medical student training, graduate medical education (residency and fellowship programs), and continuing medical education. The WSU-OHEP consortium, the largest community-based medical education consortium in the midwest, has created stronger programs in each of these important areas.

Medical students have expanded options
With more than 1,000 students, the Wayne State University School of Medicine requires multiple hospital sites to accommodate its clinical training needs. Currently, half the clinical education of third and fourth-year medical students takes place through the Detroit Medical Center, and half takes place at other sites. Robert Frank, MD, associate dean for academic and student programs, explains that new curriculum objectives require all students to complete extended rotations in physician offices to learn about continuity of care. Demands such as these are taking students out of inpatient settings and moving them to outpatient clinics and offices.

This is great news for community teaching hospitals and physicians who seek closer affiliations with the WSU School of Medicine. Dr. Frank explains why WSU programs are beneficial to hospitals. "First, teaching hospitals get their residents from medical schools. So, if a student has a good experience, he or she may choose to apply for a residency there. Secondly, academic affiliations add value to hospitals and the patient care they provide. And finally, there is a genuine feeling among many physicians that they have an obligation to contribute to the future of medicine through teaching and education."

The hospital programs are also beneficial to Wayne State students, and as the programs have become more formalized through OHEP, the quality and consistency have increased substantially. Evaluations, including results of steps II and III of the USMLE exams, have shown that students do equally well, whether they are from DMC hospitals (Wayne State's traditional academic partner) or community teaching hospitals. "This means that all of our approved hospitals have outstanding performance as teaching hospitals. They really are doing a great job, in the DMC, and throughout other regions of Michigan," Dr. Tranchida noted.

When Dr. Tranchida set out to establish internal medicine programs throughout the community, he called the chiefs of the medical staffs at all the major hospitals. "I found that almost all of them had been my students at some point," he said. "I was happy to find our Wayne State alums in high-level positions throughout the community; plus, as a bonus, these former students were also the most committed to educating future physicians."

The return benefit for providing medical student training is sub-specialty training for the house staffs of participating hospitals. Wayne State faculty members now provide sub-specialty training sessions for residents who may not have diverse exposures. Another positive side effect, according to Dr. Tranchida, comes in the form of relationships. "The residents get to know the WSU faculty, while we get to know the people who are training our students."

As more hospitals join OHEP and recognize the importance of medical training programs, Wayne State medical students continue to benefit from having a variety of choices that match their medical interests. "There is now a working structure in place. The educational programs are well-organized, well-supervised and constantly improving in quality. No matter what happens to any one particular hospital or hospital system, the education of our students is guaranteed," said Dr. Tranchida.

WSU sets standards for residency/fellowship programs
While the educational programs at Wayne State are expanding in community coverage, they are also rapidly advancing in reputation and stature. Several key hospitals have recently approached Wayne State to request WSU residency programs at their facilities. 

Dr. Malone, who is in charge of graduate medical education, said WSU is currently formalizing relationships with Bon Secours Hospital, which will become the first hospital to own a residency program that is managed by WSU. "This will be the first official WSU residency program that is outside our traditional campus. It will be staffed by Bon Secours physicians, but it will meet WSU standards, criteria and evaluation," he said.

Extending that logic, administrators at the School of Medicine have gathered hospital and OHEP support for a Southeast Michigan Fellowship Program to be managed by Wayne State. "This is a major change that can really benefit everybody involved," said Dr. Malone. Currently, fellows are recruited by and accepted to individual hospitals for intense specialty training following residency. This is difficult for fellows, who must apply to many institutions which are highly specialized.

"I propose that fellows be accepted into a general Wayne State program. Then Wayne State could place fellows in the most appropriately matched hospitals. That would allow fellows to rotate through several hospitals in order to be well-rounded and broadly trained," said Dr. Malone. For example, a physician could be accepted into a Wayne State orthopaedic surgery fellowship, and then custom design the program, utilizing all the institutions that have partnerships with WSU. Ideally, a fellow could rotate through one consortium hospital for orthopaedic trauma, another for hip reconstruction and still another for sports injuries, for example.

"This type of program diversifies the base of support and allows fellows to have comprehensive training with many partners as they rotate through different hospitals. It eliminates duplication and increases collaboration among many disciplines and many institutions," said Dr. Malone.

OHEP fully supports this cooperative effort, which meets its goals of reducing program duplication, promoting effective use of resources, and advancing quality education. Ernest Hammel, PhD, executive director of OHEP, said, "As the economy of medical education changes, the necessity and desire for a unified program is growing. All OHEP partners are stakeholders in this, so even though hospitals will collapse their individual fellowship programs and allow Wayne State to act as home base, the hospitals still flourish from the benefits of a unified program."

Ongoing training offered to academic physicians
The WSU-OHEP Consortium also provides continuing medical education (CME) activities to augment and complement the teaching programs of the member institutions. With review courses, administrative lectures, and specialty seminars, more than 7,000 physicians in southeastern Michigan participate in CME activities each year, and even more will take advantage of these opportunities in the future as distance-learning programs are developed.

Dr. Tranchida (third from right) is nurturing educational partnerships with OHEP institutions and increasing WSU's presence in teaching hospitals.

A new effort, called the OHEP-WSU Partnership Grants Program, nurtures graduate medical education in the way of research. It provides seed money for collaborative research projects that are conducted by residents at consortium institutions. The first three projects have already been funded and the research is underway. The research can be basic or clinical, but the fundamental requirement is that the work must be multi-institutional. 

In describing the consortium's research effort, Dr. Hammel explains how resident physicians can benefit from research training and experience in collaborating with others. "First, the OHEP research workshop series provides basic research tools that doctors need to analyze the health status of their patient populations and their communities. Second, the new grants program provides resources to help residents refine their skills in conducting research," said Dr. Hammel.

As national physician and health care groups seek cohesion on medical matters, the WSU-OHEP consortium is providing cohesion to medical professionals in the state of Michigan. "By creating a central governing place for medical education, we can ensure that our students, residents, faculty, and community physicians are well-trained and well-informed," said Dr. Crissman. "That's part of our mission as an academic medical center. We translate research into patient care, we train the physicians of the future, and we provide a great benefit to our communities," said Dr. Crissman.

Thanks to the partnerships between Wayne State University and OHEP hospitals, that faculty involvement reaches far beyond the confines of the university campus and makes a positive impact in regions across the state. 

Dr. Tranchida predicts, "If we continue to work in this direction, WSU and OHEP will surely comprise one of the largest educational consortiums in the country."