Adding links to a 45-year Jacksonville connection, UF trains health professionals on two major campuses
Building on 45-year-old institutional ties, Jacksonville’s oldest community hospital is partnering with Florida’s largest academic health center to pave new ground in educating health professionals in ways that strengthen patient care throughout Duval County.
At the same time, the high volume of patient-care services provided in the community hospital now known as Shands Jacksonville (an integral part of Shands HealthCare) enhances the training programs of the University of Florida Health Science Center colleges in Gainesville.
“Chances to observe and participate in the care of a broad diversity of patients from a metropolitan region of more than 1.1 million residents are extraordinarily valuable parts of the curriculum for many of our students in medicine, dentistry, nursing and pharmacy,” said Douglas Barrett, M.D., UF vice president for health affairs.
“Our academic connection with the Shands Jacksonville hospital actually started in 1958 when our medical school was only two years old,” Barrett said. “Now, as Jacksonville grows and we expand our educational programs to address shortages of various health-care professionals, we are building on these ties. The affiliation clearly benefits UF educators, students, residents, Shands Jacksonville and patients throughout the region.”
The Health Science Center campus in Jacksonville is a training ground for several hundred future health professionals, including close to 300 physicians enrolled in 20 nationally accredited medical residency programs. The current enrollment of 71 graduate students in dentistry, nursing and pharmacy will increase this fall with the opening of new nurse specialty programs and expanded enrollment in the College of Pharmacy’s doctoral program. All UF medical students spend 25 percent of their third-year clinical training and part of their fourth year in Jacksonville.
Robert Watson, M.D., senior associate dean for educational affairs at the College of Medicine, recalls the medical clerkships in Jacksonville had a rocky beginning 11 years ago, as students weren’t prepared to drive the long, lusterless stretch of U.S. Highway 301 through the speed-trap town of Waldo to reach the hospital then known as University Medical Center. Watson was lampooned in the year-end skits in which the student actors exaggerated their encounters with Waldo traffic cops.
Watson laughed with the students while patiently advancing the clerkship program, and later realized the young travelers were beginning to appreciate their urban Jacksonville experience. Students began to tell Watson how much they learned while working with UF faculty and residents on the trauma team, as well as with the obstetricians and nurse practitioners in the labor and delivery suites, the newborn intensive care unit, cardiovascular center and other busy areas.
Robert Nuss, M.D., assistant vice president for health affairs at the Jacksonville campus and senior associate dean of the College of Medicine, said future planning on his campus is centered around “emphasizing complementary strengths on the Jacksonville and Gainesville campuses, while recognizing the impact that geographic distance makes in terms of where patients will go for medical care.
“Jacksonville is not only growing; it is changing from being primarily an industrial center to a broader business, cultural, social, educational and recreational environment,” said Nuss, a member of the Jacksonville-based UF faculty for more than 30 years. “Thanks to recent increases in local taxes, our city is taking an organized approach to further growth. And now, with the recent recapitalization of our medical center by the city and the state, Shands HealthCare and the University of Florida, our medical center will have a chance to compete in this changing environment. We expect to still meet our missions to care for the underprivileged and support the training of health professionals, while we also develop quality specialty programs that we hope will attract patients of all economic means.”
Cancer care is one area targeted for growth, said Nuss.
“The cardiovascular, neuroscience, trauma, pediatric and women’s health programs of Shands Jacksonville already reflect high-quality services, and we hope to do the same thing in developing comprehensive services for patients with cancer,” he said. “The university’s plans for building a proton beam cancer treatment facility here, and our current recruitments of additional experts in oncology, surgery and radiation oncology, give us awesome potential in this area.”
Nuss said the forthcoming appointment of a Jacksonville-based associate director of the University of Florida Shands Cancer Center will aid efforts by both the Health Science Center and Shands HealthCare to create a nationally recognized comprehensive cancer center.
With ongoing growth of educational programs on the Jacksonville campus, Nuss said he expects to see increased use of distance education and simulation technology. He added that growth does not occur without hurdles, including the needs for more student dormitories, parking areas and food services.
Ann Harwood-Nuss, M.D., the College of Medicine’s associate dean for educational affairs on the Jacksonville campus, noted, “The financial problems we’ve faced over the past several years, along with the federal government’s cap on the number of residency positions we can establish on our campus, have made recruitments very difficult. But throughout these stressful times, we’ve been fortunate to keep a strong core of very dedicated and outstanding health-care professionals.
“With our excellent faculty and staff, along with the recapitalization of Shands Jacksonville, we are trying to keep our residency programs aligned with the global goals of Shands HealthCare and the needs of the Jacksonville community,” she said. The Jacksonville campus has nearly 300 young physicians enrolled in 20 ACGME-approved residency and fellowship training programs. Harwood-Nuss said growth is now planned in neurology, cardiovascular medicine and surgical critical care. She noted that as knowledge expands, new subspecialties arise, and hence new residency training programs are needed in these areas.
Meeting Jacksonville’s needs for nurses
Almost a quarter century since the UF College of Nursing established graduate education programs on the Jacksonville campus, the venture is an enduring success with more than 200 graduates in the past decade and 29 students now enrolled.
Most of the graduates quickly find jobs or gain promotions in Duval County.
“We have expanded our enrollment to address widespread nurse shortages, and we adjust the course offerings year by year in keeping with changing market demands for various nurse specialists,” said Andrea Gregg, R.N., Ph.D., an associate professor and director of the College of Nursing’s graduate programs in Jacksonville.
Both master’s and doctoral degree programs are offered at the Jacksonville campus. Gregg said students in the adult, pediatric, psycho-mental health and nurse-midwifery nurse practitioner specialty tracks can finish all required courses in Jacksonville, while those in the other tracks, such as family nurse practitioners, take only their core courses in Jacksonville and commute to Gainesville two days a week for two semesters for specialty courses. She added that these students tend to travel in groups and review assignments along the way.
The Jacksonville campus also is UF’s primary site for master’s-degree training in nurse-midwifery, which full-time students can complete in four semesters. The program, with an average annual enrollment of 15 students, is one of only two accredited nurse-midwifery graduate education programs in Florida. The newly graduated certified nurse-midwives meet needs throughout North Florida.
In 1999, in anticipation of a statewide and national nursing faculty shortage that is now a reality, the College of Nursing expanded access to its Ph.D. program in Jacksonville, so that area nurses could finish all of their nursing major courses locally, traveling to Gainesville only for minor coursework.
“Right now 55 to 60 percent of our students are enrolled part time while still working, and most of them are in the program because they see a lot of very sick patients and feel the need for greater education,” she said.
While Jacksonville nurses enjoy higher-education opportunities in their hometown, local area hospitals and clinics also benefit from access to the graduates. Shands Jacksonville is about to benefit in a new way, as it turns to UF’s nursing college to train the nurse practitioners needed to implement a new staffing model. Ginger Campbell, R.N., Ph.D., Shands Jacksonville’s vice president of nursing, plans to staff every unit of the hospital with a nurse practitioner, a clinical nurse specialist and a nurse manager.
To meet this immediate need and address the shortage of nurse practitioners for other regional hospitals, Gregg said the Jacksonville-based program will be expanded this fall to include new master’s-level specialty tracks for training acute care adult nurse practitioners and adult clinical nurse specialists. She expects to enroll at least 10 students in each of the programs.
She said the college also plans to bring its R.N.-B.S.N. program to Jacksonville via the Web.
“The college’s strong use of telecommunications and Web technology has been part of the most amazing transition I’ve seen since I came into this position in 1986,” Gregg said. “The new technology allows us to offer our Jacksonville students the expertise of the college’s total faculty across campuses. The five faculty members, including me, who are located here in Jacksonville, also get to teach students from other campuses. It is very rewarding.”
Hand-in glove dental education and service
At a neatly appointed two-story building at 2028 Boulevard on the Health Science Center/Jacksonville campus, Clifford Starr, D.M.D., directs a clinic where 10,000 patient visits occur each year. The clinic is in its 17th year as a cooperative effort of the UF College of Dentistry, the city of Jacksonville and Shands Jacksonville.
Through high-volume patient care, rendered at two-thirds the average cost of dental services in the Jacksonville area, the clinic meets major needs in the metropolitan area—and for a surprising number of patients from other Florida cities. In May, a former Jacksonville resident who had previously undergone the placement of eight tooth implants at the clinic traveled back from her new residence in Tennessee for follow-up care.
Starr said emergencies account for 12 to 20 of the daily walk-in patients, and that access to the clinic helps to reduce the number of local residents seeking help in hospital emergency rooms. He added that because the state’s Medicaid program stopped paying for adult dental services two years ago, all patients have to pay for their care.
The steady influx of patients also supports the clinic’s mission in supporting advanced education for dentists who voluntarily spend an extra year in training prior to practice.
“Right now we have six dentists in residency training and two enrolled in the college’s Foreign Trained Dentist program,” said Starr, a clinical associate professor with UF’s dental college. “From the standpoint of learning opportunities, this is a great place to be. While most advanced dental education programs are hospital-based, we see the full gamut of healthy, sick and disabled patients, and we perform advanced procedures in every specialty of dentistry.”
In addition to state and federal support, Starr said that “incredible support from the Jacksonville Dental Society, the Northeast Florida Dental Association and the volunteer services of Jacksonville-area dentists keep this clinic thriving. We operate with two full-time and three part-time UF dental faculty and 18 volunteer dental practitioners from the community.
“We cooperate so closely with the two dental associations that our clinic provides them office space on our second floor, and some of the volunteer community dentists who are members of these societies pay travel expenses to enable UF dental residents to attend their continuing education programs,” Starr added.
Bold new approach to training pharmacists
The Health Science Center’s Jacksonville campus is one of three Florida sites serving as proving grounds for a new approach to educating doctors of pharmacy by delivering the bulk of the Pharm.D. curriculum on the Web. The other sites are St. Petersburg and Orlando. Two hours after a traditional class has ended at the UF College of Pharmacy’s main campus in Gainesville, 34 first-year Pharm.D. students on the Jacksonville campus view the same lectures and discussions on live video on the Web. The off-campus students access the Web “class” at home, in a coffee shop, a library or almost anywhere a laptop computer can be plugged into an Internet connection.
“The key information shared in the classroom also is made available on the Web through a program called Blackboard,” said Carol Motycka, Pharm.D., director of the Jacksonville campus program. “The neat thing is you can pause the tape, reverse it, and play it over and over.”
Pharmacy Dean William Riffee, Ph.D., the brains behind the new distance education program, said that although most of the course material is delivered on the Web and through telecommunications, students also get a hearty dose of real-life case studies, laboratory work and quizzes at evening classes, as well as clinical experiences in the community. He noted that all students, in their first year, are assigned to develop a wellness plan for a Jacksonville family and to meet with members of that family at least five times during the year. Each of the first-year students also shadows a fourth-year student one day each semester.
Motycka said second-year students work three hours a week in Jacksonville pharmacies.
“By their fourth year, they’ll spend all their educational time in clinical rotations across the state with pharmacists who hold adjunct faculty appointments with UF’s pharmacy college, and along the way, they have to go through a rotation in drug information,” she said. Riffee, who also is UF’s associate provost for distance education, champions the convenience of the Web-based curriculum for students and the cost-effectiveness of sharing existing meeting rooms (for example, in Shands Jacksonville).
“We’re taking a big leap in pharmacy education and all eyes are on us,” said Motycka, a 1998 graduate of UF’s conventional Pharm.D. program.
“During this first year that the entire curriculum has been implemented in Jacksonville, some of the students were worried about having to do almost all of their learning through Web courses. Now they’re saying they wouldn’t want it any other way. And we have some evidence it is working well, since the grade point averages of students in Gainesville and at our distant locations are almost identical,” Motycka said.
Riffee said some pharmacy educators “are looking at us skeptically, but a national accrediting team has visited our Jacksonville site three times, and we expect continued affirmation of our full accreditation when the American Council on Pharmaceutical Education meets in June.” He said the program is being further enhanced through the hiring of pharmacists from the community who serve as facilitators and mentors for afternoon and evening classes.
This fall, 50 new students will enter the Jacksonville-based Pharm.D. program, and 50 more will enter each fall until enrollment reaches 200. A total of 280 new doctors of pharmacy are expected to graduate in 2006 — twice the size of the college’s current spring graduating class.