At the start of the new school year, a dream is finally coming true for Hanadys Ale.
She has wanted a career in medicine since girlhood, when she saw how compassionately a doctor treated her grandmother at their home in Cuba. But she interrupted her medical studies to move to Miami with her family. Now, having mastered English, she's back on track as one of 43 students in the inaugural class of the new medical school at Florida International University (FIU).
But the curriculum here is no conventional training, representing one of the most thorough reinventions of medical education in a century.
Known as NeighborhoodHELP, it will pair each student with a low-income family facing barriers to healthcare. With teams of fellow students from nursing and social work, the aspiring doctors will observe and support the families throughout their years in medical school. Alongside more traditional medical lessons, they'll get steady doses related to ethics, cultural understanding, and public-health policy.
Ms. Ale says, in a phone interview, that she was drawn to this program at FIU because it emphasizes serving communities in need. "It's changing the way medicine is seen in the United States, so we are like double pioneers," she says of her class.
Medical education in the United States is in a period of expansion, with at least a dozen new schools under development and classes expanding at more than 100 existing schools.
"This opening of new medical schools ... [is] an opportunity for innovation and experimentation," says George Thibault of the Josiah Macy Jr. Foundation in New York. Many medical schools still reflect standards set after a 1910 report by Abraham Flexner, he says, and while those standards are essential, they have not kept pace with changing technology and demographics.
FIU's approach exemplifies many recommendations made in a Macy report last year, including a focus on the needs of society rather than of the profession, Dr. Thibault says.
For one, the Herbert Wertheim College of Medicine at FIU has built a diverse class: 35 percent Hispanic/Latino, 7 percent African-American, and the remainder white and Asian. Given the racial and socioeconomic disparities in treatment in the US, it's important that physicians better reflect the changing population, the Macy report notes.
"You don't have to be Hispanic to treat a Hispanic ... you just have to be compassionate,... a good doctor,... and aware of the culture that the person you are treating is coming from," says Ale, who hopes to become a pediatrician.
Cheryl Holder, a faculty member and longtime doctor at a neighborhood clinic where students will serve, offers an example of cultural beliefs among her patients: Haitian immigrants sometimes say illness stems from another's malicious intent, and that voodoo can take it away. "A patient will tell me they're cured of their HIV because somebody gave them some potion," says Dr. Holder. She doesn't judge, but rather looks for ways "to use some of those health beliefs to strengthen the care."
Other factors students will see in the neighborhoods, where the populace ranges from immigrant Jews to Latinos to African-Americans: the effects of poverty, low literacy, a lack of parks conducive to exercise, a dearth of fresh produce, and limited transportation options to get to health clinics.
It's the type of learning that might be the subject of one class at many medical schools, but at FIU it will be integrated into all four years.
Students are also expected to research and help solve local problems, with an eye toward prevention. "To get to that [health] goal, maybe they need to lobby the commissioners to put some trees in,... or help a family put up screens so [they] don't have so many mosquitoes," says Pedro José "Joe" Greer, assistant dean of academic affairs and a curriculum designer, in a phone interview.
Ale says she's excited to be mentored along the way by people like Dr. Greer, who was recognized in August with a Presidential Medal of Freedom, in part for his longtime work delivering medical care to the homeless. He recently accompanied the new students on a bus tour of the Miami neighborhoods.
They won't pair up with families for several months, but Ale is anticipating the day. "I want to get ready to answer all the questions my family could have," she says. Then it will be her turn to learn from them.