Student Projects Explore Science of Primary Care

University of Washington medical student Hong Zhou aims to serve the Asian immigrant population as a physician. By the end of her first year of medical school, her service had already begun. Her project on lead exposure among Seattle’s Asian communities uncovered risks that included lead contamination in traditional Asian folk remedies.

“I found something ignored or overlooked,” said Zhou. “Children are rarely screened for lead poisoning in Washington state, under the assumption that the risk of exposure is low. I was able to educate patients and providers about the higher risks specific to Asian communities.”

The hazards of lead poisoning; the usefulness of state-mandated physical exams in school athletic programs; the level of trust rural patients have in their doctors; misconceptions about breast cancer in a rural community. These were among the subjects first-year UW medical students investigated in 2002 during their summer placements in medically underserved areas.

While the students learned the skills of scientific inquiry, they also contributed a valuable community service.

During the summer following their first year of medical school, students in the Rural/Underserved Opportunities Program (R/UOP) get a four-week experience of primary care in either a rural or urban underserved area of the WWAMI region. Some choose to combine R/UOP with an investigative project, a graduation requirement designed to teach scientific methodology.

As part of the new curriculum launched in 2002, a R/UOP project or Independent Investigative Inquiry takes one of two forms. It may be experience-based, completed during the standard R/UOP placement, with the student critically exploring some locally relevant primary health-care topic and then presenting the information to the community and writing a paper. Alternatively, R/UOP students accepted into the Medical Student Research Training Program (MSRTP) can do extended 12-week projects: hypothesis-driven, analytical investigations based on data collected at the R/UOP site. MSTRP investigations need clearance from the Institutional Review Board for human subject research.

Angie Hunter did her MSTRP project in Tonasket, Wash. Every schoolchild who plays school sports in the state must first have a physical exam. In Tonasket, where the local clinic organizes regular fall “Sports Physical Nights,” doctors were skeptical that these limited exams were worth the considerable time and resources expended. Hunter examined the medical records of every child who’d had a sports physical in Tonasket the previous year and noted their pre- and post-physical health. Her analysis showed surprising benefits. Among other findings, fully 22 percent of the physicals revealed abnormalities that needed follow-up. These included a number of conditions, from poor vision to an inguinal hernia that later required surgery. Hunter’s study validated the practice of pre-sports physicals.

Alethea Hanley gathered her MSTRP project data while on a R/UOP placement in Port Townsend, Wash. She followed up a 1996 study in urban Massachusetts, the Primary Care Assessment Survey (PCAS), which had investigated levels of trust in the doctor/patient relationship and the effect on medical interactions. Would the results differ in a rural setting? Hanley spent two weeks interviewing every patient who visited her clinic. They answered a set of questions based on the PCAS study. Her survey showed a level of patient trust in their physicians that was markedly higher than in the urban study. It also revealed complicating details, including high dissatisfaction with the area’s lack of specialists and health-care choice, that warrant further study.

Sumitra Chandrasekaran did her R/UOP project in Wheatland, Wyo. Interested in women’s health, she learned that many local women lacked information about breast cancer. Misconceptions were common, such as a notion that women without a family history weren’t at risk. A free state-screening program for breast cancer was under-used. To effect change, Chandrasekaran researched the literature on breast cancer and summarized her findings in a practical, easy-to-read brochure. Brochures were distributed at a local health fair and at an educational forum during National Breast Cancer Awareness Month.

Hong Zhou’s R/UOP project stemmed from her training at Seattle’s International District Community Clinic. When a doctor suggested she investigate lead exposure from old buildings in the neighborhood, her review of the literature turned up a study that showed harmful levels of lead in traditional Chinese medicines. Several remedies identified as contaminated in the study were on sale in local stores. Another paper showed elevated blood lead levels in immigrant children from China, a result of environmental pollution. Yet the clinic performed few blood lead screenings. Zhou alerted district physicians and her own patients to the risks of lead exposure. She produced a simple Chinese/English education pamphlet and also distributed a Vietnamese-language leaflet on the topic. To further disseminate the message, she wrote an article for the Seattle Chinese Post.

By combining scientific inquiry with primary health care in underserved communities, these first-year student projects encompass the missions of the UW School of Medicine in research, primary care and public service.