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Now in its second year, the Comprehensive Urban Underserved and Rural Experience, or CU²RE, program has expanded rapidly, earning $5.2 million in supplemental funding and attracting a growing number of students committed to serving the people of Alabama through primary care.

The CU²RE program welcomed its second cohort at the end of 2021, accepting 16 MS1 students. They join an inaugural cohort of eight MS2 students who began the program in 2020 after the department was awarded a $7 million grant from the Health Resources and Services Administration. Supported by the grant, CU²RE aims to enhance the recruitment, training and retention of medical students dedicated to serving urban underserved and rural populations through family medicine and primary care. CU2RE students and faculty during a summer dermatology workshop.

While the first cohort focused on the Urban Underserved Pathway, or U²P, emphasizing primary care and health equity in urban areas, the second cohort also welcomed students to a new Rural Pathway, which will emphasize primary care in rural areas of the state, providing hands-on experience and training in the unique challenges facing rural patient populations.

As this pathway expands placement of students around the state, the $5.2 million in supplemental funding, awarded by HRSA in August, is providing resources to support them. The funding is being used to increase educational activities for medical students, redesign the family medicine clerkship curriculum across all UAB regional campuses, provide CU²RE students with stipends to offset medical education costs and implement new faculty, staff and student development initiatives.

To allocate the funding, Irfan Asif, M.D., department chair and associate dean for primary care and rural health, asked campuses and family medicine residency programs throughout the state, including those in Huntsville, Tuscaloosa, Montgomery and Selma, to submit requests for resources needed to fulfill the goals of the HRSA grant. CU²RE leaders went through every request and, working within the parameters of the HRSA grant, allocated funding for several new initiatives aimed at increasing the number of students who will enter family medicine and primary care. These include:

• Pipeline programming designed to support the Huntsville Pre-Medical Internship for college students interested in rural medicine, create a new Tuscaloosa Pre-Medical Internship, and create an Early Assurance Program with Alabama A&M and Oakwood University, allowing students to obtain resources for MCAT preparation and registration.
• Simulation training labs and equipment, which will give students the space and equipment needed to practice skills they will use every day as a physician.
• Point-of-care ultrasound (POCUS) technology and training, allowing family medicine and primary care physicians to use ultrasound technology in-clinic, reducing costs and improving access for patients while allowing for rapid, real-time care.
• Faculty development courses for point-of-care ultrasound, simulation and courses with the Society of Teachers of Family Medicine.
• Housing, transportation, materials and equipment support for the Huntsville Rural Pre-Medical Internship
• Scholarship and stipend support for Integrated Residency and CU2RE students

With those allocations, the HRSA supplemental funding will provide tangible support to both students and faculty and expand the CU²RE program’s reach around Alabama

“In many ways, the supplemental funding has allowed us to accelerate some of the work that I originally saw as 3-5 years away in the CU²RE program,” Asif said. “Growing the program from eight to 16 students is fantastic and that growth, along with the resources from the supplemental funding, is giving us many opportunities for collaboration around the state.”

What’s Next

As part of the work related to the new supplemental funding, the department will assemble a task force of leaders from all Heersink School of Medicine campuses to create new clerkship objectives, experiences, and educational offerings. This group will form the Family Medicine Clerkship Redesign Task Force. The task force will focus on implementing educational curricula for medical students related to POCUS, simulation training, gamification of family medicine educational content and more.

“We have invited people from around the state to come together to think about curriculum design, faculty development and how we want to teach our curriculum,” Asif said. “That is really the next phase of the use of this funding.”

More broadly, leaders also hope to continue to expand the CU²RE program’s reach by developing partnerships throughout the state and building up pipeline programs, designed for high school and college students interested in primary care and health equity, with a passion for serving underserved communities.

Building a Pipeline

Pipeline programs, designed to educate and encourage students to pursue a career in medicine, are a major part of the CU²RE program and the department’s goals. During the 2020-21 academic year, the department participated in several pipeline programs aimed at high school and college students, including:

The UAB Heersink School of Medicine Virtual Immersion Pre-Med Program: The department provided curriculum content for the VIPMed program, which connects pre-med students, particularly those from underrepresented populations, to UAB medical education leaders, hands-on training and other resources.

The UAB Summer Health Professions Education Program (SHPEP): CU2RE students participated in a session of the summer 2021 program, discussing the medical school application process and answering questions from undergraduate students. Assistant professor Sameera Davuluri, M.D., medical director of UAB Family and Community Medicine – Hoover, also participated in a longitudinal case study during the program.

These programs helped to introduce more than 60 undergraduate and pre-medical students to the UAB Heersink School of Medicine, previewed topics, including health disparities, that students will focus on in medical school, and provided resources for the application process.

The Department of Family and Community Medicine’s UAB Hospital-Highlands and Hoover clinics are starting a partnership with the UAB Evelyn F. McKnight Brain Institute to help patients better understand how lifestyle decisions affect brain health. The Brain Health Initiative will work with participants to prevent cognitive decline and work toward healthier habits. Our communications team was asked to help share about the new program and encourage the community to get involved.

Program team members Tiffany English, R.N., and Pamela Bowen, Ph.D.

Since I came to work at the UAB Heersink School of Medicine, I have learned a lot about working toward a healthier lifestyle from the family medicine providers I interact with on a daily basis. They care about helping patients when they are sick, but they also care about preventing illness and improving quality of life. I know that my habits of drinking more water, walking 30 minutes a day and being more aware of the foods I eat (or don’t eat) are a direct result of their advice and care.

As a communicator in health care, it can be challenging to put yourself in a patient’s shoes. Some of the folks we talk to are facing incredibly difficult situations or the worst parts of their health care journeys. It is important to keep in mind what they are experiencing and what the process is like for them. When we heard about the new brain health program, it seemed like a great opportunity to experience and share the patient side of the story.

The program, led by Principal Investigator Ronald Lazar, Ph.D., professor and the Evelyn F. McKnight endowed chair for learning and memory in aging in the Department of Neurology and director of the Evelyn F. McKnight Brain Institute, is open to any UAB patient who was 18 years old, generally healthy and staying in Birmingham for at least a year. I was a little shocked that I fell into the criteria – I don’t think about brain health much as a young, fairly healthy person – but I decided to give it a try and see what I could learn so that we could share the experience with potential patients.

The program centers around the idea that brain health and cognition can be maintained and improved before an issue or diagnosis arises by introducing a primary care agenda for brain health. Providers hope to encourage and introduce healthy habits such as getting regular exercise, eating a healthy diet and other lifestyle improvements and to remind patients that our brains need regular care and “maintenance measures” just like our heart or lungs.

Here’s how it works.

Arrival and Intake

Because I am already a patient with the Department of Family and Community Medicine, my provider was able to quickly refer me to participate in the program. Any current patient with UAB family medicine who meets the criteria can be referred to the program at no cost.

When I arrived at the clinic to begin the process, I was greeted by Pamela Bowen, Ph.D., CRNP, FNP-BC, BBA, associate professor in the UAB School of Nursing and scientist for the Evelyn K. McKnight Brain Institute, and Tiffany English, a UAB nurse practitioner student.

Erin Slay-Wilson, M.A.

The initial intake lasted about 30 minutes and included questions about my health background, any current issues I was facing and a finger prick to record my cholesterol and glucose levels. I was also weighed and had my blood pressure taken, but many patients will not have to do this if they’ve had an in-person visit within the last year.

When asked about the process of the program, Lazar said the Highlands clinic provided a good platform for the collaborative pilot program.

“This is a pilot study, which means we would like to evaluate this small-scale preliminary program to evaluate the logistics, time, needed resources, challenges, and strengths of the program to improve upon the design of the program before launching a larger project,” said Lazar.

The program team hopes to learn throughout the first year and talk with participants to find out what works and what can be improved, all in hopes of improving the way that individuals see their role in maintaining and promoting brain health.

“The brain is the part of the body that defines us as human, with the ability to function effectively in our everyday world,” noted Lazar. “As we age, there is some decline that is normal, but if left unchecked, then there is little we can do. Most cases of cognitive decline and dementia, however, can be delayed and even prevented if we take charge of how we take care of ourselves. We would like for participants to value and incorporate health promotion strategies into their daily lives.”

Goal Setting

After they collected all of my information, the team calculated what they call a “Brain Care Score,” an estimate of the general health and wellbeing of a person’s brain. Based on this score, they asked me what specific areas I would like to work on to improve my overall health. The team went through ideas like increasing exercise during the week, replacing sugary drinks with more water to control blood sugar levels and getting more sleep.

"Research suggests convincingly that risk factor reduction, such as reducing high blood pressure, and adopting healthy lifestyle behaviors, such as exercise, can decrease the likelihood of cognitive decline,” said Lazar. “This program provides an individualized approach to health promotion. After calculation of the Brain Care Score to determine which risk factors need to be addressed, we allow the participant to take charge of their own well-being by indicating which areas of their health is/are a priority to them.”

I chose to work on improving my anxiety levels by being more regular with journaling (3-5 times per week), getting more rest by beginning my nighttime routine by 10 p.m. each night (and avoiding screens after this time) and engaging with physical activity more regularly by adding 10 reps of weights to my walking routine. (The nurse was kind enough to show me several ways of getting my reps in.)

Follow-Up

The program team will call me in six months to check in and see how I am doing with my goals. There is another research group that will have more frequent calls. They want to measure whether personal choice and supportive accountability can elicit change more quickly or build habit more effectively in patients at all levels of health. Because primary care focuses on prevention and incorporating lifestyle changes to improve health, the program team is excited to work within a primary care setting to learn more about this program’s potential.

“The implications are that working toward better health is a lifelong endeavor, and primary care is the ideal setting to promote this goal,” said Lazar.

The program is open to 100 participants. Talk with your UAB family medicine physician if you are interested in joining the program and working toward a healthier brain and a healthier you.

March, celebrated as Women’s History Month, offers us another chance to reflect on women’s health needs and concerns.

UAB Department of Family and Community Medicine providers take pride in addressing these unique needs with personalized care for female patients, including everything from important preventative screenings to advice for conception, pregnancy or infertility. While this has always been a part of the care our providers offer, the department is currently expanding and formalizing its women’s health program, making it easier than ever for female patients to access care.

We spoke with two providers, Erin DeLaney, M.D., assistant professor, vice chair of clinical affairs and quality and medical director of UAB Family and Community Medicine – Highlands, and Sumayah Abed, M.D., assistant professor and clinician at the Hoover Family Medicine clinic, to learn more about women’s health offerings within family medicine.

Q. What are the most important screenings female patients should discuss with their provider?

DeLaney and Abed: Female patients should talk with their provider about the following critically important screenings:

• Cervical cancer screenings with pap smears starting at age 21 and then every three to five years based on age and risk factors
• Breast cancer screening with mammograms starting as early as age 40 for some women
• Sexually transmitted disease (STD) screening for those who are sexually active and higher risk
• Osteoporosis screening with bone density studies starting at age 65 or younger for some women depending on risk factors
• Skin cancer, hypertension and depression screenings for all women, regardless of age.

Q. What are some other questions women should be discussing with their primary care providers?

DeLaney: Important topics to raise include nutrition, exercise habits, sleep habits, questions about supplements or vitamins, cancer screenings, preventative immunizations (particularly Gardasil, the HPV vaccine) and preconception counseling for women preparing to have children.

Sumayah Abed, M.D.

Abed: Besides screening and contraception, family medicine physicians manage many other women’s health-related illnesses, such as PCOS (polycystic ovary syndrome), infertility, vaginitis, STIs (sexually transmitted infections), PID (pelvic inflammatory disease), menstrual and abnormal bleeding disorders, postmenopausal symptoms, preconception health, management of chronic medical diseases during pregnancy and screenings for domestic violence. Patients can bring up concerns about any of these conditions or topics to their family medicine provider.

Q. How has women’s health advanced in recent years to provide a better experience and better outcomes for patients?

DeLaney: Now that we better understand the role HPV plays in cervical cancer, we have been able to offer updated cervical cancer screening recommendations, drastically reducing the number of PAP smears a woman needs in her lifetime. Similarly, changes in breast cancer screening implementation have reduced the number of mammograms a woman may need. The HPV vaccine has also led to a huge reduction in the number of interventions needed for cervical changes.

Abed: In the last few decades there was significant improvement in breast and cervical cancer screening and then decrease in mortality from both cervical and breast cancers. These advances have expanded women’s lifespans. There has also been an increased focus on women’s mental health, as well as decreases in teen pregnancy and smoking rates and rising levels of education for women. Contraception methods have become safer and more easily accessible for women.

There is still room for progress in screening for cervical cancer. Seven percent of women between ages 21-65, which accounts for 8 million American women, have never had a cervical cancer screening with a PAP smear, and more than 11% have had irregular screenings. More than 12,000 American women are diagnosed with cervical cancer each year and more than 4,000 die of it annually. Our goal as family medicine physicians is to reduce deaths from cervical cancer to zero with universal screening that allows for early diagnosis, treatment and care.

Erin DeLaney, M.D.

Q. Are there any wellness practices you would suggest particularly for women, or for particular concerns?

DeLaney: Women of child-bearing age should make sure they are getting enough folic acid (from fortified foods or vitamins) and vitamin D (from dairy, green leafy vegetables or vitamins) to help support a healthy pregnancy. As women approach menopause, they should make sure they are getting plenty of calcium and vitamin D to support bone health. For all women, I recommend limiting red meat, eating plenty of vegetables, fruits and whole grains, avoiding sugar-sweetened beverages, choosing low-fat or skim dairy products and limiting eating out.

Abed: Women often take care of their whole family but sometimes forget themselves. I encourage my female patients to take some free time for themselves, often by doing exercise for 30 minutes per day, five times weekly. This helps you stay fit, relaxed and enjoy a good night’s sleep.

Q. How is the Department of Family and Community Medicine expanding and growing women’s health offerings in our clinics?

DeLaney: We have many providers who perform women’s health services and procedures, with a list of services that each provider offers. We are preparing to have a women’s health clinic session so that providers can refer patients to this clinic to be seen in a timelier manner or to have a procedure or counseling done if their regular provider is not able to perform something. We are also preparing to offer our patients pre-natal care in collaboration with UAB Obstetrics and Gynecology. Overall, women can expect to have their needs met with excellent care.

Abed: By establishing a women’s health program, we will deliver comprehensive care for women of all stages of their life, providing gender-specific care and very skilled health management. The female patient should expect to meet a provider who is ready to answer all of her questions and address her concerns.

We are also looking forward to starting hand-on training of medical students in women’s health issues, and to seeing family medicine residents spend more time in women’s health training.

A group of AHEC Scholars and other COVID-19 event workers (photos provided by the Southern Alabama AHEC)

When a hospital or health care center experiences worker shortages, the impact can be far reaching. Shortages impact patient care, put strain on current employees and affect a hospital’s ability to make positive changes as it scrambles to complete daily tasks. The COVID-19 pandemic, including the most recent surge, has put even more pressure on health care systems and exacerbated many situations where shortages were already an issue.

Alabama appears to be on the tail end of the omicron COVID-19 surge after case numbers and hospitalizations spiked in January as the contagious variant spread rapidly through the population.

The surge stretched hospital capacity, but it also stretched the capacity of primary care clinics, highlighting some important gaps that need to be addressed as health care leaders plan for the future of primary care in Alabama.

We asked Irfan Asif, M.D., chair of UAB’s Department of Family and Community Medicine, associate dean for primary care and rural health and head of UAB’s primary care service line, about what omicron can teach us about primary care in Alabama. Several programs in the Department of Family and Community Medicine, including the Comprehensive Urban Underserved and Rural Experience program, or CU²RE, aim to increase the number and quality of primary care providers in Alabama, providing more health care coverage in urban and rural underserved areas.

Q. What did the omicron surge tell us about the state of primary care in Alabama?

A. Initially, much of the thought around COVID focused on people who were being hospitalized, which was certainly a terrible problem. Everyone was intent on figuring out how we could help those who were hospitalized and at risk of death, and that remains a concern. However, as the disease mutated into the omicron variant, it became less lethal but infected more individuals. That is when it starts to become a problem for those outside of the hospital. This latest surge really taxed our primary care system, whether it was people visiting their primary care doctor for a milder case, people leaving the hospital or emergency room who need follow-up care, or staff members and providers getting sick. We don’t have enough access to primary care in Alabama, or enough primary care providers, and this surge made that clear.

Irfan Asif, M.D.

Q. Which trends worried you the most?

A. Lack of access, especially in rural and urban underserved areas, is a huge concern. On the staff side, burnout is also a big worry. The joy of primary care is being lost because people are working so hard. During this latest surge, so many people were infected that staff were out as well and the system was really taxed because people were working 150% all of the time, on top of this chronic two-year COVID battle.

Q. How can we combat burnout?

A. This is something I think about often. One thing we can do is make sure that burnout is an open part of our conversations. A lot of people do not actively think or talk about burnout. We have to do that. We have to make sure it is ok to use as part of our vocabulary, and that we are openly assessing burnout. UAB has some tools to do that with our faculty and staff, such as a well-being index that helps people self-assess their mental health and discuss it with colleagues and supervisors. We need to have those conversations and, especially as leaders, understand where our people are and what they are facing. We also need ways to build people up. In our department, that might look like the new Kudoboard we just launched (an online board for sharing congratulations, thanks, photos, kudos and other encouragement) or programs like our Wellness Walks, which encourage faculty and staff to take breaks for exercise and time outside. Communication is also critical, because in COVID we are all particularly stuck in our silos – or little Zoom boxes. We need to prioritize reaching out to each other and getting creative, even when circumstances make it more challenging.

Q. What good signs or encouraging trends have you seen even as omicron?

A. Providers and staff came up with some creative solutions using things like telemedicine in ways we had not done in the past, or trying to implement remote patient monitoring. We were able to lean on those techniques more effectively in this most recent surge, as opposed to the first COVID surge where we were still adapting to telemedicine.

However, it is important to remember that telemedicine brings its own concerns, particularly related to health disparities. Not everyone has reliable access to broadband internet, so some patients might have to have phone visits rather than video visits. That could impact the level of care we can provide.

Q. How can we address some of the gaps that omicron exposed?

A. On the workforce development side, we need to figure out how to bring back the joy of primary care so that health care workers are not as burnt out and we can accommodate patients that come in with appropriate access. In my view, that needs to be not just a patient and one provider, but a team of providers – nurses, doctors, advanced practice practitioners, pharmacists, social workers, nutritionists, psychologists, etc. – working together to provide that access. We need to put that team-based structure in place and create an education system that prepares a workforce that will want to go and take these jobs.

I think CU²RE is an important part of that mission, as is the Alabama Statewide Area Health Education Centers (AHEC), housed in our department. These initiatives are working to train students in team-based care and help them to recognize health disparities and identify creative solutions. We have to model those kinds of practice transformation efforts for our students. If they learn an older model of primary care and step into a world that needs a new model, they will not be prepared.

Q. As you consider the future of primary care in Alabama, and a strategic plan for that future at UAB and beyond, how has COVID factored in or shaped your thinking?

A. From a UAB side, this is a massive effort. We are working to focus attention on primary care, and that was true before COVID. However, COVID certainly exacerbated some of the issues we were seeing and added urgency to the situation. I am looking forward to working with health care leaders to build a primary care strategic plan for Alabama. The time is right and we need to get started right away, as bringing our vision to fruition will require considerable time and effort from a lot of people.

Click here for more information about Asif's vision as associate dean for primary care and rural health. 

Reading or learning about events in a classroom is important, but it’s hard to substitute physically being in a space, seeing where history has happened and new stories play out every day.

In the summer of 2021, eight UAB medical students in the Department of Family Medicine’s Comprehensive Urban Underserved and Rural Experience, or CU2RE, program joined Brandi Shah, M.D., MPH, and Shyla K. Fields, MBA, for tours of civil rights landmarks and museums in Birmingham and Montgomery. 

The CU2RE students took in the history of each space and used the setting as an opportunity to discuss health care disparities, racism in medicine and social determinants of health. Those concepts are foundational to CU2RE’s mission of building a stronger primary care workforce for urban underserved and rural areas of Alabama, and to UAB’s larger mission of practicing compassionate, culturally conscious health care that meets the needs of all Alabamians.

Students at the time called the program “extremely impactful,” according to Channing Bruce, and full of meaningful discussion. CU2RE student Kristina Redd said the program not only grew her understanding of what it means to be a physician, but also “create[d] memories that captured my soul and resonated with me in such a way that affirmed my work and calling as a healer.”

To commemorate Black History Month, three members of the Department of Family and Community Medicine communications team – Caroline Newman, Erin Slay-Wilson and Kenia Hernandez – recreated the Birmingham portion of the tour with Shah and Fields. Below, you can see the stops that they visited, along with reflections from the team.

Anyone wishing to recreate this tour can use publicly available resources created by Shah and Fields, including this map showing every stop. Photos, links and additional resources are available below.

Preparation

The tour began before the team even left the office, as each member did advance research on several of the sites they would be visiting. Shah and Fields also assigned each person an intersectional identity to think about during the tour, prompting discussions of how people of different backgrounds, with different advantages and disadvantages, might think about each site.

Slay-Wilson said she appreciated being able to do research in advance. “It made me feel more connected and engaged with the material and history of each location,” she said.

The intersectional identity exercise added another layer. Each person was given symbolic taxes (privilege) or rebates (resilience) that came with advantages or disadvantages in their identity including, for example, gender, race, access to transportation, health conditions, or socioeconomic status.

“I was a young Black man with a GED, car and criminal record,” said Hernandez. “Being a man and having a car was an advantage but my skin color and background were a disadvantage. The exercise showed us how many opportunities a person could miss because of the color of their skin or their criminal record.”

Landmarks

Follow the links below to learn more about each site visited on the tour.

• The A.G. Gaston Motel
• 16th Street Baptist Church
• Boutwell Auditorium
• Linn Park (confederate monument removal)
• Penny Savings Bank
• Carver Theatre
• Colored Masonic Temple
• Third Avenue Murals
• Negro Southern League Museum

Reflections

At the end of the tour, Hernandez, Slay-Wilson and Newman each took time to reflect. Here are some of their thoughts.

I have lived in Birmingham for more than three years and hadn’t ever visited most of the sites that we toured. The day was filled with plenty of emotions, and I felt like it was a great experience to go on the tour with coworkers I had built relationships with—it felt like we could all have genuine reactions and share our thoughts together authentically. […] The identity exercise was eye-opening and humbling as we each answered questions and reflected on where a person with those identities might be or how they might react to a similar tour or part of history. The entire process was thoughtful and encouraged us to play an active role in the tour and in the world based on what we learned. The tour concluded with us eating lunch together and sharing both reflections and casual conversation. I think that was a special time for me as it provided an opportunity to reflect on what we had just done as well as be grateful for the folks around me that are kindly walking alongside me as I learn and unlearn how to address racism and disparities as they exist in our world. --- Erin Slay-Wilson, communications specialist

I am so glad that I had the opportunity to do this tour alongside my coworkers, led by Shyla and Brandi. The tour combined information about some of Birmingham’s most prominent civil rights landmarks, and the racism and violence witnessed there, with intentional moments highlighting joy, empathy, art and celebration in the city’s African American community, such as reflecting on the arts scene at the Carver Theater, the culture of mutual aid at Boutwell auditorium, or music festivals in some of the parks. I found that combination to be really powerful and an important reminder to appreciate both how someone’s background or identity can complicate their life and how it can enrich it. The intersectional identity activity carried a similar message, asking us to both reckon with the disadvantages unfairly imposed on someone because of their identity and to celebrate their unique perspective and contributions. -- Caroline Newman, communications director

This tour was eye-opening, I learned so much about the history of Birmingham. I had no idea that many civil rights activists would meet in the AG Gaston Motel and that it still exists. I learned that many of these locations were a part of “Project C”, a desegregation campaign by Fred Shuttlesworth. […] As I compare my native intersectional identity with my imaginary intersectional identity, I realize that we both have privileges and disadvantages. Both my imaginary and native identity can live wherever, worship whoever, and can be with people like me. I realize that my imaginary identity can have trouble finding preferred hair products and my native identity can have trouble finding preferred foods and music. My imaginary identity and native identity are not portrayed positively on television, movies, songs or in the media especially in these past four years. Slavery is a big part of our history, as well as the Civil Rights Movement and war on drugs but these instances are not positive for Black people. As for the history of Mexican people in the United States, it is overlooked and not positive. This was a great exercise because I realize that even though my imaginary identity and native identity is not the same there are similar struggles. -- Kenia Hernandez, communications intern

Further Resources

Map: https://www.google.com/maps/d/u/0/edit?mid=1q0pVQzGSserVHcoLAZaWmsQcCHPtGgnn&usp=sharing

Foundational article (and reflection exercises) by Peggy McIntosh on the invisible backpack framework adapted for the Flipped Privilege/Resilience Intersectionality activity.

Post-activity reflection in which you compare your native intersectional identity (who you are in real life) with the imaginary intersectional identity that you inhabited during the activity.

February is American Heart Month, and it’s a good time to revisit an important question: How can you take care of your heart while exercising or playing sports?

UAB Sports & Exercise Medicine – a partnership between the Departments of Family and Community Medicine, Orthopaedics and Physical Medicine and Rehabilitation – operates a Sports Medicine Cardiology Clinic for Young Athletes at UAB Hospital-Highlands and helps athletes of all ages maximize their performance and stay safe and healthy while competing.

Irfan Asif, M.D., professor, chair of the Department of Family and Community Medicine, associate dean for primary care and rural health and director of UAB’s primary care service line, offered tips for maintaining cardiac health while exercising and playing sports. Asif specializes in sports and exercise medicine and particularly in sports cardiology.

Q. First, how can regular exercise help your heart?

A. Regular exercise has many benefits, including building muscle endurance and strength. Your heart is a muscle, so regular exercise strengthens that muscle. There is also an inverse relationship between regular exercise and heart disease. This includes a beneficial effect of lowering bad cholesterol (LDL) and raising good cholesterol (HDL). Regular exercise also lowers inflammation in your body and reduces blood pressure, both of which have protective benefits for the heart.

Q. What are some of the most common cardiac concerns that athletes of all levels can face?

A. If you are younger than 35, your chance of having heart problems is much lower than those over 35 or over 50. However, there are some conditions that can affect younger individuals. About one in 300 individuals might have an underlying condition and not realize it. Some of those conditions include hypertrophic cardiomyopathy, which is an enlarged heart, Wolff-Parkinson White Syndrome, which is an electrical problem, and arrhythmogenic right ventricular cardiomyopathy, where fat might infiltrate your heart. Those are all conditions that you can be born with and would typically show up before age 35. We don’t yet know the exact mechanism that triggers problems with those conditions – if exercising at high intensity causes a little problem to become a big problem, or if there is another factor, such as not getting enough oxygen. We are still learning about that.Irfan Asif, M.D.

Individuals over 35, and especially over age 50, are at higher risk of coronary artery disease. Blockages in your heart often occur due to buildup in the arteries that occurs over time. That buildup might get worse with diabetes, high blood pressure or smoking.

Q. What are some simple best practices to keep in mind for exercise?

A. Regular exercise is important. Getting 150 minutes per week is a good goal, balancing between endurance training, such as running, biking or walking, and strength training to build muscle.

One study, in the Journal of the American Medical Association, showed that increasing moderate-to-vigorous physical activity by 10, 20 or 30 minutes per day was associated with a 6.9%, 13.0% and 16.9% decrease in the number of deaths per year, respectively, in the adult U.S. population. Adding 10 minutes per day of physical activity resulted in an estimated 111, 174 fewer preventable deaths per year, with greater benefits associated with the addition of more physical activity.

Q. Are there any warning signs that people should look for before, during or after exercise?

A. If you are exercising and you feel light-headed, short of breath or you get chest pain more than what you might experience normally, that is a cause for concern. Shortness of breath can be tough to quantify, but if you are getting unexpectedly short of breath, are in more pain than usual or if you pass out, you should go straight to a medical provider to be checked out.

Q. If you already know that you have a heart condition, are there certain types of exercise you should pursue or avoid?

A. It depends on the condition, so you would want to work with your doctor to figure out which forms of exercise are best for you. Your health care provider might do certain tests to determine which exercises are safe for you or which heart rate zones you might need to stay within, but the specifics are dependent on the type of disease.

Q. We have heard a lot about heart conditions associated with COVID-19. What should athletes keep in mind if they have had COVID?

A. We are seeing that most people who had COVID but had no symptoms or mild symptoms tend to do OK afterwards and not face cardiac issues. Those with more moderate or severe symptoms should have their heart checked out by a doctor, particularly before athletic activity. I would consider an EKG (electrocardiography) test at minimum, and additional testing depending on the case, to make sure the heart is functioning well.

Most often with COVID, we have seen myocarditis, or inflammation of the heart, after infection. In addition to COVID, myocarditis can occur after other viral infections, such as influenza, and can lead to heart trouble. The risk is highest in the short-term aftermath of an infection and diminishes over time.

I was part of the team that developed cardiopulmonary guidelines for high school student-athletes during the pandemic, published by the National Federation of State High School Associations. Among other things, we recommended that athletes with moderate symptoms, including a fever greater than 100.4 degrees, chills, flu-like symptoms for two or more days, or initial cardiopulmonary symptoms such as chest pain of palpitations, should be evaluated by a clinician. Cardiac testing is recommended for any athletes with cardiopulmonary symptoms during the acute phase of infection. Carefully screening for those symptoms and conducting tests as needed can help get athletes back into competition safely.

Crystal and Alex Odom with daughter Everleigh (photos provided by the Odom family)

Written by: Kenia Hernandez

At 17 weeks pregnant, Crystal Odom and her family were packing to leave for Thanksgiving to Savannah, Georgia when she felt an intense amount of pressure and had to be rushed to UAB for an emergency cerclage due to an incompetent cervix, a condition that causes the cervix opens too soon during pregnancy.

(Top: Ksneia Blinnikova, M.D., MPH, Kala Dixon, Ph.D., Jill Marsh, M.D., Bottom: Adrienne Fowler Payne, Earl Salser, M.D., Kimberly Smith, Ph.D., MIchael Wiederman, Ph.D.)

Though the pandemic brought many challenges to educators, virtual learning, virtual collaborating and the strain of a world crisis also created opportunities for faculty and staff members in the Department of Family and Community Medicine to focus on ways they could impact their students despite the distance.

Hoover clinic team members

The UAB Hoover Family and Community Medicine Clinic, led by Sameera Davuluri, M.D., assistant professor and medical director, and Annie Shedlarski, R.N., nurse manager, consistently ranks among the best UAB outpatient clinics across the health system. Shedlarski knows why.

Project ECHO Depression, a partnership between the UAB Department of Family and Community Medicine, the Department of Psychiatry and the Depression and Suicide Prevention Center, is hosting a two-part virtual presentation on suicide prevention to kick off its Spring 2022 series.

Marissa Grayson, Ph.D., of the Alabama chapter of the American Foundation for Suicide Prevention, will speak at both events, the first on Thursday, Jan. 20 at noon and the second on Thursday, Feb. 17 at noon. The talks are open to any interested health care provider or worker. You can register here to attend.

Each talk will also include the case-based discussion that is part of every Project ECHO session. The Project ECHO model is designed to connect family medicine and primary care practitioners across Alabama with teams of experts to help them better care for patients suffering from depression.

The project uses virtual tools to “move knowledge instead of people” and encourages open discussion about difficult cases to help health care teams provide even better care.

Participating physicians receive access to virtual monthly clinics, staffed by UAB psychiatrists, a family medicine physician, psychologists and patient advocates.

Find out more about Project ECHO Depression and see the full schedule of spring semester talks here.

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.

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.”

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.

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.”

Jeremy Pritchett, his wife Sarah and their two sons.

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.

The downtown Birmingham YMCA location.

“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.

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.Irfan Asif, M.D.

“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.

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.

Happy Holidays from the Department of Family and Community Medicine!

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.

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.

Kim Fagan, M.D., left, and Erin DeLaney, M.D.

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