Encouraging Altruism in Future Doctors

The UIC College of Medicine, in Rockford, Ill., is taking the next step in patient welfare by encouraging its students to learn the realities not always found in a textbook.

Since opening its doors in 1972, the University of Illinois College of Medicine in Rockford, Ill., has focused mainly on two things: teaching, and providing community-based medicine. As part of the largest public medical school in the United States, the staff at the campus on Parkview Avenue strives to foster wellness and health care, and instill compassionate dedication in its doctors and staff.
The direct involvement of the college in the overall welfare of the greater Rockford community has been wide-reaching as well. Recently, the college took the next logical step, by encouraging its medical students to get involved, from the very beginning of their professional careers, in two community programs that teach realities not always found in textbooks.

Dr. Vivek S. Kantayya, FAAFP, assistant professor and interim head of the Department of Family and Community Medicine, created Under-Served Pathways for the College of Medicine. He says his inspiration sprang from 13 years spent with Crusader Clinic, the final two as the clinic’s medical director.
“Doctors with visa obligations, who were mandated to comply with immigration waivers, volunteered [at Crusader Clinic],” Kantayya says. “But I didn’t understand why it was so difficult to recruit American citizen doctors. When I would read applications submitted by the college’s medical students, it often was clear that they felt a passion for serving, but by the time they left medical school, that fire was squelched.”
While he knows there may be many reasons this happens, Kantayya also knows that the average debt carried by medical students after graduation is about $180,000. That factor alone weighs heavily on students as they make decisions about how and where to begin their practices. Primary and general practice physicians typically earn less than specialists. The fact that more students today are going into specialized medicine rather than general medicine negatively impacts populations under-served with health care. It’s also detrimental to the overall community, since doctors treat vulnerable patients after they have become ill, rather than preventing disease through consistent wellness care.
So, in 2007, Kantayya began talking with Dr. Steve Nitz, Mt. Morris, about openings in the community and family medical fields.

“I had no idea at the time what we were starting,” Kantayya says. “The idea of Under-served Pathways is roughly based on other, similar programs. The concept focuses on helping students to feed the flames of altruism through medical school. Many of them grew up knowing the underside of society and have a personal appreciation for the work these agencies do.”
Under-Served Pathways uses five components to engage the enthusiasm and spirit of volunteerism, Kantayya explains.
“The first is mentorship,” Kantayya says. “We go to the Urbana campus in spring of the students’ first year. An average of 16 to 20 students attend our presentation, with about half of those joining the program.”
Physicians and mid-level health care providers are assigned to mentor students. Most work at Rockford’s Crusader Clinic, but some are based in Elgin and South Beloit. The students shadow their mentors once or twice per quarter, learning how to care for the very vulnerable.
“We hope the students, who come to Rockford from Urbana for their second, third and fourth years of study, will maintain the mentor relationship throughout, and look to these mentors not only for experience, but also for advice,” Kantayya says.
The second component of Under-Served Pathways involves a regular series of meetings featuring inspirational speakers. For example, a plastic surgeon recently shared his work with the poor in India who could not afford corrective surgeries to improve functionality. Other speakers share vital information on how nonprofit organizations comply as federally-qualified health care centers.

“Through the University of Washington, our students can access eight or nine Web-based teaching modules that focus on all aspects of health care for under-served populations,” Kantayya explains. “They can ask and answer questions, post their ideas and thoughts, receive valuable insight and discover the most recent innovations from a reliable source.”
The fourth part of program involves an annual field trip to Chicago to tour not Cook County Hospital and several clinics operating in all types of conditions throughout the inner city.
“The students meet the doctors and staff, and see first-hand the intense dedication with which they provide the best possible care to those who cannot pay,” Kantayya says. “It’s truly heart-warming.”
The fifth element of Under-Served Pathways concerns service-based learning. Students are expected to volunteer three to four hours each quarter in clinical settings.
“On one Wednesday each month, we go to Woodstock, Ill., to help at the migrant farm workers’ clinic,” Kantayya says. “We average about four students each time, some of whom speak Spanish. This is helpful, because the majority of patients at the clinic are Hispanic. The students interpret and see the examination and the final treatment plan, as well as learn about low-cost prescription programs and other important resources.”
The students come away encouraged and feeling blessed, he says. Closer to home, Kantayya’s students help with the all-volunteer Bridge Clinic at the First Presbyterian Church in downtown Rockford, which offers free medical care on Saturdays from 10 a.m. to 2 p.m. They also work with Dr. John Koehler of Physicians Immediate Care at the Rockford Rescue Mission.

“Along with medical practices, the students learn how to access resources for patients in need,” Kantayya says. “They learn about vouchers and negotiating services for out-patient care. They get a sense of how frugal and prudent these organizations must be to juggle medical need with available resources. That’s one lesson that’s hard to pick up in a classroom environment. Treating under-served populations is about so much more than pure medicine. It involves communicating and working with people with diverse issues and needs.”
How well this program works for individuals depends, in part, on where students are posted for clinic clerkships in area hospitals. But by the end of their third year at University of Illinois College of Medicine, the dynamic balance of classes and volunteer work should accomplish Under-served Pathways’ goal – to feed the fire and sustain the passion a future doctor has for lending a hand to those who need him or her most.
“Some students tend to say that they will get involved in volunteer work when they’re finished with their education. The truth is, that will never happen,” Kantayya says. “They need to do this from the very beginning, from high school forward, despite the pressures and obligations of everyday life. It’s simply not realistic to believe they will start later. This is why Under-served Pathway is such an important extra-curricular program within the Department of Family and Community Medicine at the medical college in Rockford. We’re helping to prepare tomorrow’s physicians, not only in an academic way, but also in the area of service to the poor and needy.”
To broaden medical students’ experience in community service, the college also developed the Community Experience program, now in its second year. It enables students to develop an appreciation for the roles nonprofit organizations play and understand how these agencies interact with medical professionals. Dr. Margaret T. Maynard, PhD, assistant dean of the Medical Education and Evaluation department, says the program not only helps the community, but also makes students more aware of resources their patients might need.
“The Community Experience is a 30-hour volunteer program that matches our students with one of about 20 local social service agencies,” Maynard says. “They list their top five choices among the agencies, and I match them up.”
During August and September, agencies make short presentations to the college’s second-year medical students. The representatives explain the agencies’ missions, community areas served, fees and what doctors need to know about the services each agency provides. From October through March, students spend a minimum of 30 hours working with assigned agencies.
“We would expect that multiple students might work with one agency, but on independent experiences,” Maynard says. “We’re also open to an agency using teams of two students.”

During this volunteer effort, medical students are expected to become knowledgeable on how the agency operates, its funding stream, client base composite, outreach programs, required staffing levels and challenges faced, both immediate and long-term. How agencies interact and collaborate with each other is equally as important as how agencies interface with the medical community. Students are monitored throughout this program on a pass/fail standard.
“In early April, we expect students to complete papers about their experiences, including a discussion of characteristics of the agency and how the student was involved,” Maynard says. “Students also meet in small groups to share what they’ve learned.”
At this point in their medical careers, most students have not yet chosen a specific field.
“Most don’t know what medical field they will pick, and probably won’t know until they’ve had a chance to actually experience the specialties during their third year,” Maynard explains. “What they bring to the Community Experience is not only the desire to heal, but also a sense of altruism. They want to help, but at this point they lack understanding of community dynamics and the need to support patients beyond actual medical care.”
Working with nonprofit organizations allows medical students to learn how subsidiary issues like transportation, child care, elder care and the role of care givers can impact a patient’s ability to give full attention to his/her own health care issues. Agencies such as Rosecrance, the Alzheimer’s Association, the Center for Sight and Hearing and the Youth Services Network benefit from students’ volunteer work while helping the medical students broaden their experiences.
“They certainly learn what communities like Rockford need,” Maynard says. “When they go into practice, they will have a practical appreciation of what problems their patients may be facing and possible community-based solutions, based on what they’ve learned here.”
Maynard adds that medical school applicants consistently demonstrate long histories of active volunteerism.
“It almost is a must, this sense that they should be doing something, whether it’s working with the physically or mentally disabled, the under-served, seniors, children or other areas of health care,” she says. “The Community Experience builds on this base. Our students take this newly-acquired knowledge of the role of nonprofits within the community, as well as a team approach to patient care, to the next educational level. They also more fully appreciate that doctors’ offices simply cannot provide everything a patient needs.”
With these two philanthropic programs firmly in place and actively changing the way medical students view their futures, the University of Illinois College of Medicine in Rockford is impacting the quality and longevity of life, not only in this community, but in those places where students eventually practice. Feeding the fire of altruism now increases the odds that people in need will find not only sound clinical treatment, but also a warm, caring touch, when they most need it. ❚