Creative Education
2013. Vol.4, No.7A2, 165-170
Published Online July 2013 in SciRes (http://www.scirp.org/journal/ce) http://dx.doi.org/10.4236/ce.2013.47A2021
Unique Premedical Education Experience in Public Health and
Equity: Combined BA/MD Summer Practicum
Amy Clithero1, Robert Sapien2, Judith Kitzes3, Summers Kalishman1, Sharon Wayne4,
Brian Solan1, Lana Wagner1, Valerie Romero-Leggott1
1Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, USA
2Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, USA
3Internal Medicine, University of New Mexico School of Medicine, Albuquerque, USA
4Office of Program Evaluation, Education and Research, University of New Mexico School of Medicine,
Albuquerque, USA
Received September 27th, 2012; revised November 1st, 2012; accepted November 18th, 2012
Copyright © 2013 Amy Clithero et al. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
Background: Physicians will need increased skills in the areas of public health, equity based interventions
and patient safety skills to address the medical needs of patients in the 21st century. Premedical education
and experiences is one strategy to address these areas. Methods: A one month rural summer practicum
was developed for all BA/MD students. Key components include: 1) physician shadowing; 2) tutorials; 3)
narrative writings; and 4) group community projects. Students attend a preparatory community service
course prior to the practicum. Pre/post practicum surveys assessed students’ attitudes and skills with re-
spect to community interventions. Post practicum surveys evaluate the elements of the practicum. Results:
Survey results demonstrated no significant change in opinions or skills and activities with respect to
community interventions. Highly rated items in the post practicum evaluations included physician shad-
owing, community activities, and opportunities to learn from others. Conclusions: A pre-medical practi-
cum experience can help students define their roles as future physicians and increase their interactions
within communities around public health issues. Whether this translates into improved involvement of
physicians using public health equity based interventions is an area of ongoing study.
Keywords: Public Health; Pre-Medical Education; Health Equity; Service Learning; Combined BA/MD
Program
Introduction
The changing needs and expectations of society in preparing
physicians for the 21st century have resulted in several pub-
lished medical education reform papers. The central theme
cited in the majority of the reports is based on the Institute of
Medicine’s 2003 report, “Who Will Keep the Public Healthy?
Educating Public Health Professionals for the 21st Century”.
(IOM) Contemporary society is encouraging more focus on
public health, equity-based care delivery, and partnerships be-
tween Academic Health Centers (AHC) and the communities
they serve. These reports make recommendations including: 1)
the need to retool required premedical college science curricu-
lum, 2) incorporate known educational learning research for
structured, self-directed educational activities, and 3) to include
more individual competency based assessment tools to guaran-
tee that physicians are competent, ethical and professional (Irby
2010; Miller, 2010; Alpern, 2009; Leape, 2010; Fletcher, 2008).
Additionally, “all undergraduates should have access to educa-
tion in public health (IOM 2003). As noted by Cashman and
Seifer (2008) “Service-learning, a type of experiential learning,
is an effective and appropriate vehicle for teaching public
health and developing public health literacy”.
The commitment to these recommendations by the Univer-
sity of New Mexico Health Sciences Center School of Medi-
cine (UNM HSC SOM) is evidenced in the HSC vision “work-
ing with community partners, the UNM HSC will make more
progress in health and health equity than any other state by
2020” (Strategic Plan, 2010). The context of this vision is set
within the contraints of the following challenges. New Mexico
is geographically the fifth largest state in the United States,
ranks 36th in population size with two million residents, and is
one of four minority-majority states. It is a rural state with only
nine cities having populations over 30,000 and ranks 43rd in
per capita income (NM Quick Links, 2010; US Census Bureau,
2010). With regards to healthcare access, half of New Mexico’s
population lives in rural areas, yet two-thirds of its physicians
practice in urban areas. Thirty-two of its 33 counties are desig-
nated as Health Professional Shortage Areas as determined by
the Health Resources and Services Administration (HRSA,
2010) and NM ranks 16th highest in frontier counties.
In 2006, to support its mission and reflect the call to reform
medical education, UNM SOM implemented the Combined
BA/MD Degree program. This eight-year program results in
both a Bachelor of Arts and a Medical Degree. Its primary goal
is to improve the health and well-being of New Mexicans. It is

A. CLITHERO ET AL.
designed to help address the physician shortage in New Mexico
by selecting a diverse group of high school seniors who are
committed to practice in New Mexico’s communities of great-
est need (Cosgrove, 2007; Rabinowitz, 1999). The BA curricu-
lum is designed to prepare the students for entrance into the
UNM SOM program by emphasizing public health and equity
based perspectives.
Overview elements of the Bachelor of Arts/Medical Degree
(BA/MD) program at the University of New Mexico include:
(Combined BA/MD, 2010).
 Partnership between the Colleges of Arts & Sciences and
the School of Medicine.
 Undergraduate portion fully funded by the New Mexico
State Legislature including tuition, housing.
 BA/MD students pursue one of three degree options for
their undergraduate degree, all of which emphasize science
and liberal arts coursework.
○ Option 1: Arts and Sciences concentration;
○ Option 2: Health Medicine and Human Values concen-
tration;
○ Option 3: Biomedical Science concentration.
The curriculum is designed to provide a strong foundation
for practicing medicine with sensitivity to New Mexicans and
their public health and medical needs. Included in the custom-
ized curriculum are five integrated health seminars and partici-
pation in a summer community health project (Summer Practi-
cum) in a New Mexico rural or medically-underserved commu-
nity
Table 1 describes the five BA/MD Health Medicine and
Values Seminars and Summer Practicum which make up the
unique backbone of the BA curriculum. These classes prepare
the students to enter the MD curriculum with an enhanced ex-
posure to public health, ethics, health economics, cultural di-
versity awareness, literature, fine arts and medicine, and New
Mexico population health variables. These topics continue in
the MD curriculum culminating in all students receiving a pro-
fessional development Certificate in Public Health along with
their MD degree.
The Summer Practicum is an innovation in undergraduate
premedical preparation. The educational learning models that
support its development were Vygotsky’s historical sociocul-
tural approach, service learning, small group problem based
tutorials, self-reflective metacognitive narrative writing and
professional identity development through shadowing (John-
Steiner, 1996; Choon-Eng, 2009; Levine, 2008; Shapiro, 2006;
Table 1.
Health Medicine Human Values (HVMV) Seminars.
Contours of H ealth in New Mexico: Ethnic, economic, demographic,
and geographic variables impacting public health in New Mexico and
the Southwest.
Literature, Fine Arts, & Medicine; Links among health, illness,
literature and the arts, encompassing a diverse range of forms and
genres.
Health Economics, Politi cs, and Policy: Political and economic forces
that impact health care policies and practices.
Health and Cu ltural Di v ersity: Cultural variables that affect the
experience and practice of health and health care.
Ethics, Medic i ne, and Health: Ethical and legal considerations that
influence medical practices and decision-making.
Summe r P r acti c um: Introduction to the Core Functions and 10
Essential Services of Public Health.
Kitsis, 2011; Sheu, 2011).
While there are numerous medical school and other health
professional examples of community service learning and
community project requirements as part of the medical curricu-
lum, a PubMed search yielded no information on guided un-
dergraduate premedical community service opportunities. Be-
cause most international medical schools take students directly
from high school, aspects of this model may be of interest to
medical training outside the USA such as pre-practicum semi-
nars, on-site faculty guidance and reflection via narrative writ-
ing.
Through community engagement, the ultimate goal of the
Summer Practicum is for students to experience the connection
between social determinants of health and the health of com-
munity members, and how public health and medicine are in-
tertwined. Whether they recognize this as part of public health
or not, physicians diagnose, monitor health, mobilize commu-
nity partnerships, provide and evaluate care, and conduct re-
search and, by doing so, solidify the public health and medicine
relationship.
Curriculum
The Summer Practicum is a one month service-learning ex-
perience designed to enhance students’ knowledge and under-
standing of health issues and healthcare practice in rural and
underserved communities.
Given that there are numerous definitions of service-learning,
we adapted our definition from a variety of sources found on
the Community-Campus Partnerships for Health (CCPH) web-
site. CCPH is a nonprofit organization that “promotes health
equity and social justice through partnerships between commu-
nities and academic institutions.
http://depts.washington.edu/ ccph/index.html
The definition we adopted is:
Service learning has been defined as a type of experiential
education that involves people in both community service and
education. Service learning provides developmental opportuni-
ties that promote personal, social, and intellectual growth, as
well as civic responsibility and career exploration.” Specific
components that are emphasized in our program include:
1) Active integrated learning drawing lessons from the ex-
perience of performing service work and enhancing the knowl-
edge, values and skills of the participants
2) Engaging students and communities in as many aspects of
the project planning as possible
3) Meeting a real need in the community with age appropri-
ate, well organized outcomes oriented service
4) Collaboration involves all stakeholders in the planning,
execution and evaluation of the service
5) Reciprocity provides benefit to the recipient (BA/MD
communities) and the provider of the service (BA/MD students)
6) Reflection allows time for contemplation before (to pre-
pare), during (to troubleshoot) and after (to process and assess)
Students participate in the practicum during the second
summer of the BA portion of the BA/MD program. Figure 1
gives an overview of the preparatory sessions and Summer
Practicum. Prior to the practicum, students attend an 8-week
pre-practicum course that provides foundational information on
public health concepts, community assessment tools and com-
munity service basics. Students complete on-line Health Insur-
ance Portability and Accountability Act (HIPAA) training,
166

A. CLITHERO ET AL.
Figure 1.
Legend: Pre-practicum preparatory sessions and summer practicum curriculum overview.
Infection Control and Institutional Research Board (IRB) train-
ing. Both the students and physicians sign a student code of
conduct (see attachment). In addition, students receive training
in professionalism including how to introduce themselves to
patients and ask permission to remain in the room during an
exam or procedure. At the completion of the preparatory course,
students are divided into groups and sent to live for one month
in a rural New Mexico community, the Practicum.
The practicum has four components: 1) shadowing a local
community physician; 2) tutorials and homework assignments;
3) narrative writing; and 4) community project. By the end of
the practicum experience, it is expected that students will be
able to define a community; identify a community concern; dis-
cuss this issue of concern from both a clinical and a public
health perspective; identify possible solutions to the issue and;
suggest ways of monitoring the impact of solutions. Students
have assistance from community liaisons, local physicians, UNM
SOM faculty circuit riders, and UNM SOM faculty mentors.
Tutorials demonstrate the intertwining areas of public health
and medicine. Week 1 examines environmental factors (neigh-
borhood impact on health). Students investigate their commu-
nity by answering 25 questions by conducting a windshield
survey of both a “wealthy” neighborhood and an economically
disadvantaged neighborhood as identified by their community
coordinator. The goal is for the students to learn about the
physical composition of the community as well as the people
who live there and the services and facilities that are available.
The students are also asked to take photos that represent their
community as a whole. For example, if they had to describe
their community to someone who didn’t speak a common lan-
guage, what photos would capture the spirit of their community?
Week 2 focuses on structural factors (impact of wealth on
health). Students are asked to first think about their personal
beliefs regarding poverty, health and roles/responsibilities of
physicians. They then read three articles, “Poverty in America:
How Public Health Practice Can Make a Difference” (Erwin,
2008), “Poverty and Ill Health: Physicians Can, and Should,
Make a Difference” (McCally, 1998) and “The Nexus of Pov-
erty, Hunger and Homelessness in New Mexico” (Page-Reeves,
2013). The students then choose one of the community clinics
or hospital where they are shadowing and examine payment
and fees for a particular condition. Finally, they are asked to
find a list of items new parents should have (a layette) for a
newborn baby. They are given a list of products and they have
to “best guess” as to what the item costs. The students then go
out as a group to a local store and record the actual prices.
Week 3 emphasizes inequities and power gradients (impact of
education on health). After reading “Giving everyone the health
of the educated: an examination of whether social change
would save more lives than medical advances” (Woolfe, 2007)
and “the Robert Wood Johnson Foundation: Commission to
Build a Healthier America: Education matters for health”

A. CLITHERO ET AL.
(2009), students are asked to list and discuss some of the rea-
sons minority groups might have increased mortality rates; how
education might improve the health of individuals and the im-
pact of education on a particular condition. Week 4 is a culmi-
nation of the first three weeks by talking about policy and ad-
vocacy. Students are assigned readings including “Emergency
Medicine and Public Health: Stopping Emergencies before the
911 Call” (Kellerman, 2009) and “Imposing Personal Respon-
sibility for Health” (Steinbrook, 2006). Students look at exist-
ing prevention initiatives, legal remedies, public health initia-
tives and medical awareness campaigns while reflecting on
personal responsibility for health conditions.
Shadowing a local physician is an element of the Summer
Practicum curriculum, through which the student experiences
the rewards and challenges of being a rural healthcare practi-
tioner, and the advantages/disadvantages of the preceptor’s
specialty, practice model and location. They watch practitioners
interact with their patients and see a variety of medical prob-
lems and learn to link the patients’ medical problems with pub-
lic health concepts. This hands-on experience is supplemented
with weekly visits by a UNM faculty circuit rider who relates
readings and homework assignments to what students are ex-
periencing in the community. Community coordinators who
live and work in the assigned community also help guide the
student experience and give local perspectives.
The narrative writing element “promotes self-reflection and
increases self-awareness” (Shapiro, 2006). These megacogni-
tive skills may carry over into the medical school professional-
ism curriculum. Most people reflect, but the skill medical pro-
fessionals need, critical reflection, is different: According to
UCSF LeaP Learning from your Experiences as a Professional:
Guidelines for Critical Reflection (Aronson, 2012), Critical
Reflection is “the process of analyzing, questioning and re-
framing a personal experience to enhance learning and inform
future behavior.” It is a skill developed over time with practice
and feedback and is used by health professionals to promote
lifelong learning and improve outcomes.
Initially, students were allowed to write about anything they
chose. Some students did well with this, while others struggled
to identify an issue or used this as a timekeeping log. Currently,
topics are structured in order to further guide students and cre-
ate awareness. Topics include:
1) Describe a situation which was complex, surprising, un-
comfortable or uncertain using all five senses. Address your
own biases and/or prejudices by reframing the encounter from a
different point of view AFTER you have described it
2) What interests you about this community/practice? What
seems important?
3) What do you feel you are learning about medicine and
about yourself?
4) Other-student choice. For example:
a) Encounters with patients, colleagues, mentors;
b) Questions about the patients you are seeing;
c) Feelings about being in this particular community at this
particular time in this particular way;
d) What is easy, difficult, puzzling, enjoyable, confusing,
profound, boring, or rewarding about your experiences?
Students are required to write once per week to an assigned
UNM SOM faculty mentor. At the end of the practicum, stu-
dents choose one piece of their writing to read aloud in a forum
that includes their classmates, faculty, other interested person-
nel at the UNM HSC and community.
The community service project is a group project. Each
group of students addresses an important health issue identified
by the local community health council (Engaging Communities,
2010). As an example, in one community, the students re-
searched the prevalence of teen pregnancy and gathered opin-
ions through surveys of local community members. Students
present their findings to local key decision makers during the
final week and submit a written summary report. Upon return to
the University, students give oral and poster presentations to
the upcoming practicum students, faculty and invited commu-
nity members.
Methods
The Summer Practicum is evaluated by students completing
a course evaluation and a service learning course survey. The
first survey is an online course evaluation administered to stu-
dents at the conclusion of the summer practicum course. Stu-
dents are asked to assess course organization and objectives,
adequacy of time to complete assignments, course syllabus/
catalog, readings, the community project and the shadowing
experience with community physicians. Students rate each of
35 items on a 1 - 5 scale with 1 = strongly disagree and 5 =
strongly agree.
Completion of surveys at UNM is voluntary and all students
sign an informed consent document prior to participating in
survey research. The research described in this study was ap-
proved by the IRB at UNM.
Results
All sixty students from the first three classes who have com-
pleted the summer practicum course were included in this study;
21 students in each of the first two years and 18 students in the
most recent year, see Table 2. Fifty-two percent of the students
were female and 53% were under-represented minorities; al-
most two-thirds were from rural hometowns. All 60 students
completed a course evaluation and 55 of 60 (92%) completed
the service learning survey.
Students generally rated the summer practicum highly; the
mean overall scores for the 35 questions on the course evalua-
tion were 3.9, 3.9, and 4.2 for cohorts 2008, 2009, and 2010
respectively. Highest rated statements were those regarding the
shadowing experience as helping to understand their future role
as physician; learning about community health issues; learning
through the community project; and observing and learning
from a physician preceptor.
Discussion
In 2010, the UNM SOM ranked as one of the top 20 US
medical schools with a social mission index based on three
categories: “percentage of graduates who practice primary care,
work in a health professional shortage area and are underrepre-
sented minorities (Mullan, 2010).” The Summer Practicum
through the Combined BA/MD Program is a pre-medical edu-
cational model to enhance this social mission and support
medical education reform.
The Summer Practicum in our Combined BA/MD Program
occurs in the student’s undergraduate premedical academic
career (after four semesters of undergraduate work). It is de-
signed to provide students with an exposure to the practice of
medicine in rural NM, give them tools to evaluate health from a
168

A. CLITHERO ET AL.
Table 2.
Description of the 60 students participating in BA/MD Summer Practi-
cum program, 2008-2010 Update through 2012.
N (%)
Total 60 (100%)
Year of Summer Practicum
2008 21 (35%)
2009 21 (35%)
2010 18 (30%)
Gender
Female 31 (52%)
Male 29 (48%)
Minority status
Under-represented (Hispanic, Black, Native American) 32 (53%)
Not under-represented (Anglo, Asian) 28 (47%)
Hometown
Rural 38 (63%)
Urban 22 (37%)
community-based approach, and involve them in a public
health-based service learning project. It is critical that we pre-
pare students to practice in rural areas by allowing them to
experience the community first hand.
Overall, the results of the evaluation by the students were
very positive regarding content, design and implementation.
Highlights of the program for the students are reported as the
shadowing experiences, community activities and learning from
fellow students.
A unique aspect of this Summer Practicum is students’ par-
ticipation in community service learning during their under-
graduate premedical education. This service learning compo-
nent addresses: 1) reciprocal knowledge transfer between insti-
tutions and communities, and 2) involving community mem-
bers in identifying local health priorities (Hunt, 2011). Recipro-
cal knowledge transfer occurs as the students are in the com-
munity. The students benefit from shadowing local community
health care providers. They also learn from the community
about public health issues around which they design their local
community projects. The community receives the benefit of the
community project which the students design and conduct.
Additionally, many of these projects continue through the years
with the following year’s students continuing or augmenting
the project. Results are reported back to the community through
student presentations to appropriate organizations including
local school boards, rotary clubs, members of the New Mexico
Legislature, community health councils and hospital foundation
boards.
Enlisting active community members is paramount. Com-
munity members are engaged early in the educational process,
during the preparatory seminar series and continue to interact
with the students while they are in the community. The com-
munity members who serve as local coordinators are recruited
based on their reputations and roles in the health system of the
communities in which they live and work. Active coordinators
and the preceptors engage the students and make this course
interesting. The community residents welcome the students into
their homes, show them the recreational activities available and
go that extra step in working with the students. They give their
personal cell numbers in case of emergency, provide snacks
during tutorial, and arrange for optional outings for student
learning in the communities. The students remember these ef-
forts positively. This may help students choose subsequent
medical student rotations in that community. Students, who
expressed hesitation in going to remote areas, came back en-
thusiastic about their experience and “could see themselves
living in that community and practicing there”.
As academic programs develop, so do the curricula, staff and
faculty. In this situation, there have been changes to the faculty
instructing the seminar series which may affect the students’
responses. The seminar series has also been updated and ad-
justed annually, in part based on student feedback. Although
the core content is the same, the fine tuning may have affected
results. Another limitation is that the ultimate outcome of the
Summer Practicum is for graduates to practice in underserved
areas of NM. This outcome measure will not be assessable until
at least 2017, when the first cohort could e completing their
residencies and starting their medical career.
Future research for the Summer Practicum will include
qualitative assessment of the community projects and the im-
pact of the project in the local community. Also, we will con-
duct longitudinal studies of the students on future career
choices: location (rural versus urban), setting (e.g. group, pri-
vate, academic), and focus (e.g. primary care, community-based,
public health, etc.). An additional area for potential research
relates to whether this early experience in community service
and public health will influence these individuals to be involved
to a greater extent in community engagement later in their
medical careers. Outcome measures regarding this will not be
available for more than a decade.
In conclusion, the UNM SOM Combined BA/MD Program
was designed and implemented to address medical education
reform recommendations for preparing physicians for the 21st
century. In particular, the students entering the BA Summer
Practicum curriculum experience are embedded in an authentic
service learning environment that prepares them to address
public health and equity based issues. The Summer Practicum
curriculum also initiates them into a deliberate educational
ladder that continues into medical school and towards a com-
pletion of a Public Health Certificate and professional medical
identity.
Acknowledgements
The authors thank Dan Gonzales and Kim Halsten-Mora of
the Preceptorship Office, Karen McGillvray BA/MD Program
Manager and Margaret Dornedon BA/MD Office for their out-
standing coordination of all practicum logistics and tireless
dedication to the program. Special acknowledgement is given
to Dr. Lily Velarde for her originating ideas.
REFERENCES
Alpern, R. J., & Long, S. (2009). AAMC-HHMI scientific foundations
for future physicians (pp. 1-43). Washington DC: American Associa-
tion of Medical Colleges.
Aronson, L., Kruidering, M., Niehaus, B., & O’Sullivan, P. (2012).

A. CLITHERO ET AL.
170
UCSF LEaP (Learning from your Experiences as a Professional):
guidelines for critical reflection. MedEdPORTAL
www.mededportal.org/publication/9073
Cashman. S., & Seifer, S. (2008). Service-learning: An integral part of
undergraduate public health.” American Journal of Preventive Medi-
cine, 35(3):273-278. doi:10.1016/j.amepre.2008.06.012
Choon-Eng-Gwee, M. (2009). Problem based learning: A strategic
learning system design for the education of healthcare professionals
in the 21st century. Kaohsiung Journal of Medical Science, 25, 231-
239. doi:10.1016/S1607-551X(09)70067-1
Combined BA/MD Program University of New Mexico (n.d.).
http://hsc.unm.edu/som/combinedbamd
Cosgrove, E., Harrison G., Kalishman, S., Kersting, K., Leggott-Ro-
mero, V., Timm, C., et al. (2007). Addressing physician shortages in
New Mexico through a combined BA/MD program. Academic Medi-
cine, 82, 1152-1157. doi:10.1097/ACM.0b013e318159cf06
Engaging in Communities to Serve the People of New Mexico: County
Health Report Cards: UNM Health Sciences Center Office for Com-
munity Health (n.d.). Office of the vice-president for community
health.
http://hsc.unm.edu/community/documents/CountyReports2010.pdf
Erwin, P. (2008). Poverty in America: How public health practice can
make a difference. American Journal of Public Health, 98, 1570-
1572. doi:10.2105/AJPH.2007.127787
Eyler, J., Giles Jr., D. E., & Asrin, A. (1999). Resource C: Survey and
interview instruments. In Where’s the learning in service learning
(pp. 225-274), Jossey-Bass.
Fletcher, S. W., Hager, M., Russell, S., & Fletcher, S. W. (2008). Con-
tinuing education in the health professions: Improving healthcare
through lifelong learning. Proceedings of a Conference, Bermuda:
Josiah Macy, Jr. Foundation, 28 November 2007-1 December 2008.
Gebbie, K., Rosenstock, L., Hernandez, L.M. (2003) Who will keep the
public healthy? Educating public health professionals for the 21st
century. Washington DC: The National Academies Press.
Health Resources and Services Administration, US Department of
Health and Human Services (HRSA) (2010). Find Shortage Areas:
HPSA by State and County. http://hpsafind.hrsa.gov/
Hunt, J. B., Bonham, C., & Jones, L. (2011). Understanding the goals
of service learning and community-based medical education: A sys-
tematic review. Academic Medicine, 86, 246-251.
doi:10.1097/ACM.0b013e3182046481
Irby, D. M., Cooke, M., & O’Brien, B. C. (2010). Calls for reform of
medical education by the Carnegie Foundation for the advancement
of teaching: 1910 and 2010. Academic Me dicine, 85, 220-227.
doi:10.1097/ACM.0b013e3181c88449
John-Steiner, V., & Mahn, H. (1996). Sociocultural approaches to
learning and development: A Vygotskian frame work. Educational
Psychology, 31, 91-206.
Kellerman, A. (2009). Emergency medicine and public health: Stopping
emergencies before the 9-1-1- call. Society for Academic Emergency
Medicine.
Kitsis, E. A. (2011). Shedding a light on shadowing. Journal of the
American Medical Association, 305, 1029-1030.
doi:10.1001/jama.2011.267
Levine, R. B., Kern, D. E., & Wright, S. M. (2008). The impact of
prompted narrative writing during internship on reflective practce: A
qualitative study. Advances in Health Sciences Education: Theory
and Practice, 13, 723-733. doi:10.1007/s10459-007-9079-x
Lucian Leape Institute at the National Patient Safety Foundation (2010).
Unmet needs: Teaching physicians to provide safe patient care.
Boston, MS: Report of the Lucian Leape Institute Roundtable on Re-
forming Medical Education.
McCally, M., Haines, A., Fein, O., Addington, W., Lawrence, R., &
Cassel, C. (1998). Poverty and ill health: Physicians can, and should,
make a difference. Annals o f Internal Medicine, 129, 726-733.
doi:10.7326/0003-4819-129-9-199811010-00009
Miller, B. M., Moore, D. E., Stead, W. W., & Blasar, J. R. (2010). Be-
yond flexner: A new model for continuous learning in the health
professions. Academic Medicine, 85, 266-270.
doi:10.1097/ACM.0b013e3181c859fb
Mullan, F. (2010). The social mission of medical education. Annals of
Internal Medicine, 52, 804-811.
doi:10.7326/0003-4819-152-12-201006150-00009
US Census Bureau (2010) New Mexico Quick Links from the US Cen-
sus Bureau. http://quickfacts.census.gov/qfd/states/35000lk.html
Page-Reeves, J. (2013). The nexus of poverty, hunger, and homeless-
ness in New Mexico. Social Justice, 38, 33-41.
Rabinowitz, H. K. (1999). Demographic, educational and economic
factors related to recruitment and retention of physicians in rural
Pennsylvania. Journal of Rural Health, 15, 212-218.
doi:10.1111/j.1748-0361.1999.tb00742.x
Robert Wood Johnson Foundation, Commission to Build a Healthier
America (2009). Education matters for health.
Robert Wood Johnson Foundation: Commission to Build a Healthier
America (2008). Where we live matters for our health: Neighbor-
hoods and health.
Shaprio, J., Kaseman, D., & Shafer, A. (2006). Words and wards: A
model of reflective writing and its uses in medical education. Journal
of Medical Humanities, 27, 231-244.
doi:10.1007/s10912-006-9020-y
Sheu, L. C., Zheng, P., Coelho, A. D., Lin, L. D., O’Sullivan, P. S.,
O’Brien, B. C., et al. (2011). Learning through service: Student per-
ceptions on volunteering at interprofessional Hepatitis B student-run
clinics. Journal of Cancer Education, 26, 228-233.
doi:10.1007/s13187-010-0142-6
Steinbrook, R. (2006). Imposing personal responsibility for health. New
England Journal of Med ic in e, 355, 8. doi:10.1056/NEJMicm050051
University of New Mexico. School of Medicine. (n.d.). Strategic Plan
2010-2015. http://hsc.unm.edu/som/administration.
Woolf, S. H., Johnson, R. E., Phillips, R. L., & Philipsen, M. (2007).
Giving everyone the health of the educated: An examination of
whether social change would save more lives than medical advances.
American Journal of Public Health, 97, 679-683.
doi:10.2105/AJPH.2005.084848
US Census Bureau (2007). Personal income per capita in current dollars.
http://www.census.gov/statab/ranks/rank29.html