20/20 – Serving the Underserved: TUC’s Unique Joint Physician Assistant, Master of Public Health Program
For the past decade, Physician Assistant (PA) has been one of the fastest-growing professions in the country. The Federal Bureau of Labor Statistics projects a growth of 30% new PA jobs for 2014-2024, roughly two times that of other health diagnosing and treating practitioners. And TUC is home to the only program in the country that takes the extra step of preparing all of its Master of Science in Physician Assistant Sciences (MSPAS) students with a Master of Public Health (MPH).
This year will mark the 50th anniversary of the PA profession. The first PA program built itself from the fast-track training that medical doctors received during World War II. Historically, there have been two models to PA education. The Duke model is built on inpatient care, and the MEDEX model emphasizes service in community clinics. But as the profession has grown, these regional differences have diminished.
For those who are deeply committed to treating patients, but don’t feel that the physician profession is a fit for them, PA rings out as a perfect fit. PAs are educated on a medical model and have the flexibility to provide many of the same services that doctors do, only with the support of a supervising physician.
Ms. Grace Landel, Director of the PA Program at TUC, explains what it was like when she was first considering the PA career.
“I remembered that I used to work with a PA,” she says. “I looked back into it, and it was like the lightbulb went off – this is what I want to do!”
The dual degree MSPAS/MPH program was the 2nd school to be founded at TUC in 2002. The original inspiration for the unique joint program was to prepare PAs to respond to acts of bioterrorism and weapons of mass destruction. But the public health program soon matured to provide the full range of a public health education, and the PA program took advantage of the MPH to better prepare its students to reach medically underserved populations.
“As clinicians we look at the individual. As a public health professional, you look at the community. The question becomes, ‘How can you take care of your patients and the community?’” explains Ms. Landel.
Ms. Le’Anna St. John, Associate Professor in the PA program, grounds the value of understanding public health in the experience of her weekly work in local clinics.
“You can see someone who’s diabetic and tell them to exercise and eat more fruits and vegetables. But what if you’re in a food desert and there’re no parks to walk in? You can say that all day as a clinician, but you have to look at the bigger picture,” says Ms. St. John.
“That’s what the rest of us had to learn the hard way, but they get to learn that the whole way along,” she continues. “And with the viewpoint that they get, they can then ask, ‘Where do you get the resources to address those needs?’”
The MSPAS/MPH program closely selects each class to find people who are ready to meet its mission of delivering community based medicine and providing access of quality healthcare to the underserved. While the academics for the dual degree program are rigorous, including 12 hour class schedules, the admissions process also looks for those whose backgrounds demonstrate a personal desire to reach out to local communities and give back.
“We have a mission, and we believe in it,” says Ms. Landel. “It’s the reason I came down here to be program director. It does take more effort, but it’s a big reward to see them get out there and serve.”
Several years ago, TUC students began organizing a basketball tournament that pitted various teams of students against each other to see who was the best. But the students grew to want more. Dr. Donald Haight, the previous Dean of Student Services and Director of Admissions, spoke with Dr. Ed Dagang, who was the Director of Admissions at the UC Davis School of Medicine, to arrange a friendly game between the two schools. The competition ended after two consecutive years with each team winning one game.
Still revved to continue the annual tradition, Touro University California invited Touro University Nevada to play the following year, and thus the Big Game was created.
Working with then Provost Deborah Blackwell, Dr. Haight coordinated with Roger Corbman, the previous TUN Director of Admissions, to make the arrangements for an annual Big Game contest, which would be held in 2010 on the California campus. The trophy, nicknamed “The Hammer” because of the Reflex hammer mounted on the plaque that was donated by Dr. Sarah Towne, would be the prize, and the game would alternate each year between the TUC and TUN campuses.
From 2010-2012, the TUN Matadors claimed The Hammer against the TUC Bulls. However, tables turned in 2013, when the TUC Bulls beat TUN at their home court and brought The Hammer home to California!
This annual contest serves to bring students closer together, as each college holds its own tournaments to send players to the intra-college “Tournament of Champions.” Though leaders have changed and students have graduated, one thing remains: Only one team at the end of the game will hold The Hammer trophy and will gain another year of bragging rights!
A look back at TUC’s 20 year history shows that one thing has stayed the same at the College of Osteopathic Medicine (COM): its mission. The school was founded on the commitment to produce doctors who are fully trained in the osteopathic approach to medicine and who address the need for primary care. These are words that people live and breathe at TUC, and they bear a deeper moment of reflection as we look both in the mirror and towards our future in the 20/20 Series.
The growing need for primary care is twofold. The successes of healthcare in the US mean that there will be a larger aging population. But longer living entails illness alongside aging. The issues that will tax our elderly will be small and constant, leading more patients to go in for basic care needs than they do surgeries. Compound these advancements with the fact that the baby boomer generation is growing older, and it becomes apparent that the current number of primary care doctors simply cannot meet the needs of these people alone without more young doctors to come in and help.
Osteopathic medicine is uniquely suited for primary care. Both look for a long-term approach to health. Osteopathic medicine trains doctors to see the entire picture of a person’s health. And it takes an investment from both parties to achieve that. Any number of factors can stand in the way of success in a patient’s primary care. As a patient, making lasting change in your life is not as easy as is writing off what the doctor asks you to do. Patients need to trust their physician and listen to take something to heart, and making sure that they are listened to is the best way to ensure that. We need doctors whom patients want to come back to see for their next appointments, and those who feel inspired to make lasting changes in the lives of others are usually those who are best equipped to do it.
Osteopathic medicine stresses the achievement of health. It considers how disease affects the entire body and then works to assist the body in its own efforts to fight disease. One of the characteristic tools at its disposal is osteopathic manipulative treatment, which restores the body by readjusting it. Osteopathic manipulative treatment (OMT) builds trust between doctor and patient and non-invasively pushes patients towards health.
At its core OMT appreciates diversity within and across patient populations. In 1892, the first school of osteopathic medicine was the first of any medical school to have an anti-discrimination policy. Principles of inclusiveness and finding strength in diversity constitute the spirit of the osteopathic profession to this day, and the benefits of that are felt especially in underserved populations.
The field of osteopathic medical education has seen a great amount of growth due to its high output of primary care and patient-based physicians. TUC COM was the 2nd osteopathic medical school founded on the west coast and the 18th in the country. Now at 44, the number of schools has more than doubled in 20 years.
To continue to address the need for more patient-based physicians, TUC COM has built its training program on leading at a state and national level. Its students are also committed. In fact, they currently compose 25% of the 2017 graduate training positions in osteopathic manipulative treatment (formally called neuromusculoskeletal medicine). And it is the same spirit of leadership that enables TUC’s doctors of osteopathic medicine to make a real impact in the communities that they go out to serve.
20/20 - Stronger Together: TUC's Spouses in Teaching and Research, Dr. Alejandro Gugliucci and Dr. Teresita Menini
For nearly 20 years at TUC, married couple Dr. Alejandro Gugliucci and Dr. Teresita Menini have published a wealth of papers, studies, and textbook chapters together. Throughout their careers, they supported each other's work, which ranges from diabetes and atherosclerosis to how yerba mate lowers cholesterol. It was in the school of medi cine at the University of Montevideo, Uruguay that they first met as students, then colleagues at the Department of Clinical Pathology and today they remain each other's best (and even bluntest) critics."There was a time when I didn't have any help, and the only help that I had was my wife," tells Dr. Gugliucci. "If I had too many classes at the time, she would go down and do my experiments, and vice versa."
Dr. Menini adds, "Sometimes he presents to me a new idea, and I just go for the weak points. He is the creative one. But I am very critical."
"Hypercritical," jokes Dr. Gugliucci, and the two laugh together.
"It happened today. Those are my rambling ideas for a grant." Dr. Gugliucci mentions, pointing to the white board. "I presented it to her, and she came up with all the missing parts. 'What are you going to do if this doesn't work? What is the future of this? Where are you going?' But when I gave her all my answers, she said okay, that's good."
Life has taken Drs. Gugliucci and Menini all over the world, but for 20 years they have called TUC their home. They first left Uruguay to pursue further education in France. Then they brought their children to Montreal where Dr. Gugliucci served as a professor. But after four years, they took the opportunity to help start a new Osteopathic Medical School at TUC. Dr. Gugliucci is one of TUC's first four founding faculty members. And Dr. Menini volunteered in the labs and founded the Medical Spanish Club before becoming a professor in 1999 with the move to Mare Island.
Dr. Gugliucci received TUC's first grant for $50,000. He became Research Director in 2004, and has seen the grants at TUC increase to several million dollars as Associate Dean for Research. Dr. Gugliucci left the Basic Science department in 2009 to start the Department of Research with the support of Dr. Michael Clearfield, Dean of the College of Osteopathic Medicine.
And it was Dr. Menini who performed TUC's first study involving students along with Dr. James Binkerd, who was teaching osteopathic manipulative treatment at the time and is now Associate Dean of Student Affairs. Together, they set out to find how a certain kind of osteopathic manipulation could help reduce stress for students. Today as Assistant Dean of the Clinical Faculty Department, Dr. Menini provides development for TUC's clinical faculty.
Drs. Gugliucci and Menini's first priority has always been teaching. And in TUC, they found a student-focused medical school where they can engage students individually.
"What I like are my labs," says Dr. Menini. "Because it's in the lab that I can have this one-to-one relationship with the students and I can see them work and think, which is the most important part in this."
And Dr. Gugliucci agrees, "It's about having an interaction with an intelligent person who's not simply waiting for you to give them the answers to the test. As a doctor, you always look for your legacy, and you're looking at the patient who comes after the doctor, that's your responsibility."
Since arriving on Mare Island in 1999, the TUC anatomy lab has been the foundation of every College of Osteopathic Medicine (COM) and Physician Assistant (PA) student’s education. In the lab, students learn what tissues are like up close, opening up the path to a hands-on approach to healing. Mr. Bruce Silverman has been the Laboratory Manager and Instructor throughout the life of the lab. For him, the space is rich with the energy of attentive and caring students.
“Before coming here, I did animal research at Marine World Africa USA for eight years,” reveals Mr. Silverman. “I did stuff people dream about doing. I got to play with all of the animals. Afterwards, I never thought that I would get a job as cool as that.”
“It’s very rewarding for students to come back and say thank you for your hard work,” he continues. “They want to be here.”
Dr. David Eliot, Associate Professor of Basic Sciences and lead instructor for the PA and COM-Masters of Science in Medical Health Sciences (MSMHS) anatomy courses, was there with Mr. Silverman at the founding of the lab. With Dr. Walter Hartwig and Dr. Barbara Kriz, they saw to its establishment, step by step. Now looking back, Dr. Eliot can see not only what has enriched his 18 years of teaching at TUC, but how all their work made it happen.
“You can’t say it was all luck because that’s what we wanted,” offers Dr. Eliot. “We found a place that fits us. They chose to make TUC a student-centered university for those who want to deliver patient-centered care.”
The air in the lab cycles 22 times an hour. The circulation enters in from the ceiling and exits through the floor, helping remove the foul-smelling formaldehyde and phenol, which are heavier than air.
Endorsing the lab, Dr. James Binkerd, Associate Dean of Student Affairs says, “It’s by far the least toxic anatomy lab that I’ve ever been in.”
Almost TUC 250 students take anatomy each year. The cadavers are from volunteers who donated their remains through University of California San Francisco’s Willed Body program. The remains are cremated locally and then scattered at sea. Although the cadavers come to TUC without names or family history, a few Touro students or faculty volunteer to go on the boat each time to pay their final respects.
What comes from the sacrifices of these donors is not lost on Dr. Eliot.
He emphasizes, “It’s valuable to have a cadaveric anatomy experience, to know what tissues are like. It’s very important to a hands-on osteopathic education.”
20/20 – Touro University California’s San Francisco and Mare Island Beginnings
As we step into 2017, Touro University California draws closer to its 20th anniversary in July. While TUC’s spirit of independence and intimate care has only grown, the school is the product of its first four years of very hard work. Every ounce of what the original faculty and students did was dedicated towards graduating the first class of 65 osteopathic students. Their commitment guaranteed the school’s first accreditation, and thus a future that we can celebrate today.
It was a tactical team of four or five professors, led by Dean and Provost Dr. Bernard Zeliger, that started that first class. The program began on August 18, 1997 in San Francisco. The Touro system had found space at the California College of Podiatric Medicine to start the new school. Classes were shared with the podiatric students, and professors would often have to highlight what material was just intended for the young osteopathic students.
But as another year of students enrolled into TUC, it became clear that the school would have to expand. The city of Alameda and the French Hospital in San Francisco were also considered before Dr. Zeliger, announced that the school would be moving Mare Island.
This was no simple task. Mare Island had been vacated by the Navy in 1996, and the location’s status as a historical landmark meant that renovations would take longer to complete. When faculty arrived on May 27, 1999, only the first floor of their offices had been remodeled. Doors were yet to be installed, even for the bathrooms. Permits weren’t secured yet to use the water, and porta potties were the only option.
As remembered by Dr. James Binkerd, one of TUC’s first professors and now Associate Dean of Student Affairs, “Each day would bring its own emergency. At one point, there was a shortage on toilet paper, and employees had to bring in their own from home. They would keep rolls locked inside their desks for fear of finding the items missing when they were needed the most.”
“But the essentials were ready for the students when they arrived,” he assures.
Dr. Zeliger had an open door policy with students, and each time that something was needed, students were ready to let him know.
Still, everyone there was willing to make due. A dining room and a ballroom were repurposed as classrooms. Lander Hall had only theater lighting, which was too dim for teaching. And that first winter, heat came from generators that would blow hot air from tubes into the classroom.
It was the frontier of Osteopathic Education. After dubbing themselves the Touro Pioneers, those first students really lived up to their names by eagerly bundling up to survive the elements indoors, all in the name of Biochemistry.
Dr. Alejandro Gugliucci, founding professor and now Associate Dean of Research, reflects on those bold early years fondly.
“We were pioneers on both sides. The students were pioneers, and the members of the faculty were pioneers,” he says. “The first class was very particular and dynamic. They had to endure a lot of things because you were just starting a program from scratch.”
The school was an attraction to educators who longed to take a different path from the mammoth institutions. And each member of the small but growing faculty was charged to build the world around them.
“Not too often do you get those opportunities,” Dr. Gugliucci confides.
Today in San Francisco, you’ll find nothing but construction and a big hole in the ground where the original TUC classes were held, right at the corner of Scott and Eddy. The podiatry school sold the building shortly after TUC left.
So too is Lander Hall a far different sight from the boarded up building with a flooded basement that TUC inherited. The military originally used parts of the building for cryptography, and much of the windows were covered to hide what was going on inside from lurking Russian Satellites. But now the building is the bustling heart of TUC’s campus.
“No one knew in Vallejo that anything was on Mare Island,” recalls Dr. Binkerd. “It’s now night and day—the impact and opportunities that have been built between us and the community.”
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