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Kentucky’s Newest Medical School

By Mark Green

Students at Pikeville College School of Osteopathic Medicine work on their manipulation therapy technique with each other in class in November.

With estimates that a family physician generates $870,000 to $2 million in annual economic impact on his or her community, Pikeville College’s School of Osteopathic Medicine is quickly becoming a force in Appalachia.
Established in 1997, PCSOM has graduated 500-plus from its four-year program. Figures compiled in early 2008 found some 150 had completed internships, residencies, etc., and set up practices, more than 60 within two hours of its Eastern Kentucky campus, according to Dr. Boyd Buser, D.O., dean of the school.

U.S. News & World Report recently named Pikeville one of the top 20 U.S. schools in rural medicine. Many Kentuckians don’t know of its existence, but this special medical school in the mountains is aiming high as it helps alleviate the shortage of primary care physicians in rural reaches of the commonwealth.
With an annual class size of 75, roughly 300 students now attend PCSOM, paying $33,450 in tuition yearly. That’s $10,000 more than in-state med school tuition at the University of Kentucky and $8,000 more than at the University of Louisville. The state cannot provide direct support to private schools, but a special coal-severance-tax-funded osteopathic scholarship available to Kentucky residents essentially bridges the cost difference.

Buser and administrators at the private school last month announced plans to boost annual class sizes to 125 through an expansion program that will cost $4.5 million. That’s big money for a small school, but the long-term impact likely will be an astronomical return on investment for the region.

“The ultimate impact is our people being able to get their healthcare here as opposed to having to go to Lexington or elsewhere to get it,” said former Gov. Paul Patton, who had been on the Pikeville College board more than 30 years before becoming college president this year. “Keeping the healthcare dollars in the region is a huge economic impact.”

The Louisville-based James Graham Brown Foundation already has committed $500,000 to the capital campaign for the expansion.

“I think it will happen very quickly,” said Buser, noting Patton’s fund-raising ability. “People return his calls. He is very committed to this as a priority.”
Patton said he and other college officials are identifying potential supporters and will make personal appeals early next year.

To enable its growth to take place, the school will renovate a three-story apartment building just steps from its present home. Phase I, targeted to begin next summer or fall, will complete the first floor and prepare the infrastructure of the other two levels. Phase II’s buildout goal is 2014, which is when the class size will expand.

“We’re looking at a four-year timeframe before we can get all the necessary components in place to expand (class size),” Patton said. “There is not a great deal of rush on the second phase. The first phase is the part that there is an immediacy about. I feel certain that we can get that done by next fall.”

Phase II will include more lecture hall, classroom and faculty office space along with a new anatomy lab. But first, Phase I will lift medical instruction to the state of the art.

PCSOM students will be trained using human “standardized patients” and high-fidelity robots that have come to the educational fore in all medical schools in the past decade, Buser said. They can mimic in detail conditions and situations students will face as practicing physicians.

And these teaching tools allow educators to assess not only medical knowledge but students’ clinical skills, Buser said, which will go a long way toward addressing past criticism that clinical-skills assessment lacked objectivity.
The Phase I first floor of the planned new Clinical Skills Training and Evaluation Center (CSTEC) will have 10 standardized patient rooms, each with two cameras that can pan, tilt and zoom in on a session, the dean explained. This creates directly measurable evidence of whether a student is able to conduct a patient interview, take a medical history, conduct an exam appropriately, take a blood pressure, use an ophthalmoscope, and much more.

“It’s an ethical imperative,” Buser said. “It betters prepares the student.”
The ever-improving medical-instruction robots “are quite sophisticated: dialated pupils and tears … down to extreme detail,” he said. They are also quite expensive. “The more technical details you can reproduce, the more the cost.”

They can present life-threatening emergencies such as heart attack and anaphylactic shock, giving students the opportunity to interpret vital signs, make decisions, administer medications “in a situation where it is not someone’s actual life in danger,” Buser said. “As is said, you can kill these robots over and over again with no loss of life.”

Two robot rooms are slated for the CSTEC’s first floor. Its design includes a separate, interior hallway and lounge for the standardized patients, which will set up more effective interaction with students. And there will be space for PCSOM’s free community medical clinic, which offers care to the public – primarily osteopathic manipulation treatment.

Osteopathic manipulation’s goal is to put muscles, bones and tendons into proper alignment so that the body’s systems, especially its immune and repair functions, all work properly.

A military surgeon, Dr. Andrew Taylor Still, M.D., D.O., originated osteopathic medicine in 1874. In addition to drug and surgical treatment, osteopathic places an emphasis on musculoskeletal alignment and its impact on the proper function of all the body’s systems: Because bone and muscle are two-thirds of the body’s mass, correct alignment and free movement should boost the body’s natural inclination toward health and self-healing.
(One of Still’s students, Daniel David Palmer, founded the chiropractic discipline in the 1890s.)

Dr. Still reportedly became dissatisfied with traditional medicine’s offerings after his father and three children died from spinal meningitis. He began incorporating manual medicine into his existing medical practices with debatable success, according to Wikipedia. As a military surgeon, Still established credibility for manual manipulation in certain situations, sometimes achieving better outcomes than his peers.

Subsequent evidence backs up osteopathic’s effectiveness. The American Osteopathic Association cites a study of patient treatment in the deadly 1918 influenza epidemic that killed 3 million in the United States, which found a low 0.25 percent fatality rate among those receiving osteopathic treatment versus a 3 to 5 percent fatality rate among others.

A key manipulation to the torso known as the lymph pump facilitates circulation of the lymph fluid vital to the body’s immune system.

Growth of osteopathic
There are 25 schools – three have additional campuses in another state – in the United States that bestow Doctor of Osteopathic Medicine, D.O., degrees, compared to 131 schools that issue the more common Doctor of Medicine, M.D. Osteopathic has grown from only five schools in the 1960s.
PCSOM was founded by a group of Eastern Kentucky businessmen, led by attorney G. Chad Perry III, of Paintsville, Ky., who contributed $1 million. The Board of Trustees gave its imprimatur to the group’s goals when the established the school:

“The mission of Pikeville College School of Osteopathic Medicine is to provide men and women with an osteopathic medical education that emphasizes primary care, encourages research, promotes lifelong scholarly activity, and produces graduates who are committed to serving the health care needs of communities in Eastern Kentucky and other Appalachian regions.”

D.O.s are more likely than M.D.s to select family practice as a specialty (46 percent vs. 11 percent) and to practice in rural areas (18.1 percent vs. 11.5 percent), according to a 2007 Comprehensive Statewide Physician Workforce Study conducted for the Kentucky Institute of Medicine. The report cited a shortage of physicians and presented its negative impact on the state’s future economy and quality of life. Kentucky’s 8,981 active physicians in 2007 equated to 213.5 per 100,000 population compared to 267.9 nationally, ranking the commonwealth 32nd.

The first two years of PCSOM training take place mostly in the lab and lecture hall, covering typical medical school disciplines, plus special topics. Friday afternoons are spent in doctors’ offices, learning to take patient histories and do physical exams.

The second half of PCSOM’s program is clinical clerkships. Students rotate and work in various settings including: Family Practice, Appalachian Primary Care, Rural Clinic, ER, General Internal Medicine, General Surgery, Pediatrics, OB-GYN, Psychiatry and Osteopathic Practice. They spend from one to four months at each site, depending on PCSOM’s requirements and the student’s level of interest. About 90 percent of this clinical training takes place in the Appalachian region.

In May of their fourth year, the Doctor of Osteopathic Medicine degree is conferred to all successful students. The students begin post-graduate training, which traditionally consists of a one-year rotating internship followed by a two-year residency in the primary care area of the student’s choice. PCSOM is forming affiliations with hospitals in the Appalachian region to ensure adequate post-graduate training sites are available so graduates can and will stay in the area.

Including nearby Pikeville Medical Center, students currently do rotations in 27 Kentucky hospitals plus eight others in Appalachia and few more outside Appalachia, Buser said. Those numbers will expand in 2010.

Medical students historically tend to put down roots near where they study, said Patton, and Eastern Kentucky and Appalachia students who excel and attend medical school often have not returned home. That means PCSOM has compound benefits for the region. It not only provides doctors for an underserved population, it is keeping more of Eastern Kentucky’s best and brightest at home.

Its students and faculty who have moved in have a positive economic, social and cultural impact on the region as well, Patton pointed out.

The new dean
Buser arrived in Pikeville in September 2007 after spending 23 years at the University of New England College of Osteopathic Medicine in southern Maine, where he was vice president. Buser was invited to be interim dean in Pikeville upon the death of the highly regarded founding dean, Dr. John Strosnider, who was president of the American Osteopathic Assocation at the time.

After his diagnosis with cancer and before passing away, Strosnider recommended Buser to then-Pikeville College President Hal Smith. The school was due for an accreditation site survey and needed help preparing. UNECOM gave him a leave.

“I thought I’d be in Pikeville a few months,” said Buser, who’d grew up on a farm and received his education in Iowa. Plans changed after he arrived in Kentucky, though. “Every day I was here, it became more clear this was the right place for me to be. So I was named the permanent dean.”

Buser readily declares himself excited to be a part of what is happening at the college.

“From the time I arrived here, I have been telling the Pikeville College board that one of the necessities moving forward was we need to have an appropriate facility for clinical skills training and testing for our students,” he said.

With the expansion plans announced last month, that is set to happen. On Nov. 30, the college unveiled a new program offering Kentucky high school students the opportunity for automatic acceptance into medical school. As many as 10 applicants a year will be selected into the Osteopathic Medical Scholars Program, an eight-year 4+4 track carrying automatic entry into the medical school for students who meet required standards in earning their bachelor’s degree.

The application deadline is March 1.

Patton said Pikeville College is making plans to add master’s of education and MBA programs to its graduate degree offerings.

Training More Rural Doctors

Pikeville College’s two-phase $4.5 million capital campaign will create a Clinical Skills Training and Evaluation Center for its School of Osteopathic Medicine, allowing med school class size to increase from 75 to 125 annually. To get involved, contact

Dr. Boyd Buser, D.O.
Vice President and Dean
147 Sycamore St.
Pikeville KY 41501
(606) 218-5411
[email protected]