When the University of California regents approved UCR’s plans to establish a School of Medicine in July, they paved the way for the state’s first new public medical school in more than four decades. As the work progresses, the education of future physicians in the Inland region will be shaped by qualities for which the university already is known — a commitment to the health of the community; world-class research that forms the foundation for future advances in medicine; and proactive approaches in health and wellness to offer early intervention and prevention for those patients most at risk for chronic diseases.

These elements will form a solid foundation for a medical school that will fill a critical need in the rapidly growing and increasingly underserved Inland Southern California region.

For future physician Rafael Huezo, the commitment to practice medicine in a disadvantaged community is not primarily motivated by the terms of his federally funded scholarship, but by a genuine calling to serve.

The UCR graduate, and now a UCLA medical student, is one of approximately 100 medical students nationally to receive annually a National Health Service Corps scholarship. It funds tuition, fees and other educational expenses, as well as a monthly stipend. In return, he must practice in a federally designated Health Professional Shortage Area for four years — one year for each year of scholarship support he receives.

That requirement, in fact, will help him achieve his career ambitions in medicine. “My ultimate goal is to work for an underserved community,” said Huezo, who completed his first two years of medical school in the UCR/UCLA Thomas Haider Program in Biomedical Sciences and recently began his third year at UCLA’s David Geffen School of Medicine. “I want to provide services to people regardless of their race — fair and competent care.”

Huezo is an example of the kind of medical student UCR wants to attract to its four-year School of Medicine — dedicated to providing the highest-quality medical care to patients most in need.

Moving Forward
UCR has moved into the start-up phase in preparation for enrolling the first students in fall 2012. The medical school is rooted in the dire need to expand and diversify the physician work force in Inland Southern California and to improve the health of those who lack access to health care or who face economic, cultural or linguistic barriers to health care.

“This medical school is part of our commitment to serve the needs expressed by our community,” said Chancellor Timothy P. White, noting the region’s rapidly growing and diverse population and poor outcomes in a number of health indicators.

White’s vision for the medical school focuses on three themes — expanding and diversifying the physician work force, developing health care innovations in preventive medicine and health promotion and stimulating a stronger knowledge-based economy through research.

“It’s really a very strong trifecta for this region. As a University of California campus, it is our obligation to attend to the health care needs here,” he said.

Critical Shortfall
Physician shortages are forecast nationally, with the American Association of Medical Colleges calling for a 30 percent expansion in medical school enrollments by 2015. The Inland Empire, composed of Riverside and San Bernardino counties, currently has one of the state’s lowest ratios of physicians to residents. It faces a physician shortfall as high as 53 percent by 2015. Further, the physician work force does not reflect the ethnicity of the region’s population.

To address these challenges, UCR will build on the foundation established with its 34-year-old joint medical education program with UCLA and existing research strength in biomedically relevant areas covering a variety of human diseases and health care delivery issues.

“For more than 30 years, our biomedical sciences faculty members have educated the brightest and most dedicated medical students in the state of California and the nation. During the same time, the faculty have directed important basic research designed to understand the mechanism of disease processes,” said Craig Byus, dean of the Haider program in biomedical sciences. “The development of the medical school will surely benefit by this strong foundation.”

Since 1974, more than 700 UCR graduates have become physicians, receiving their early training in the Haider program. In 2003, the program’s mission was reshaped to emphasize preparing physicians who will serve health care needs of underserved, Inland Southern California and rural populations. At the same time, it was restructured to eliminate the accelerated seven-years-to-M.D. format and opened the doors for admission to the medical program for 24 UCR graduates from any undergraduate major who had completed the prerequisite medical school requirements.

The impact so far has been dramatic, according to Neal Schiller, associate dean of the biomedical sciences program.

“Before, we lost a lot of really, really good kids … who wanted more time as undergraduates to play intercollegiate sports, do research, double-major or take a year abroad,” he said.

Other students had life circumstances that prevented them from meeting the strict accelerated academic requirements of the program, but they had experiences to make them first-rate, compassionate physicians. “Now we have a greater variety of students with more varied backgrounds and experiences who are all capable of being excellent physicians,” said Schiller.

Developed jointly by faculty in the UCR biomedical sciences program and the UCLA medical school, the first two years of the medical school curriculum provide students with an integrated approach to human biology and disease processes with introductory clinical skills beginning the very first week of instruction. The first two years also emphasize case-based and problem-based learning. Doctoring courses cover the doctor-patient relationship, followed by more complex interactions with patients and patients’ families with an emphasis on developing culturally competent physicians.

“This approach is somewhat new in medical education. It helps students better understand from the outset the breadth of the practice of medicine. It also promotes in students the importance of lifelong learning to stay current with new research findings applying to medicine and new thinking in wellness and preventive care,” said Dr. Phyllis A. Guze, executive director of medical school planning at UCR and a recognized national leader in medical education.

In preparation for the UCR medical school, years three and four of the curriculum — known as the “clinical years” — were again jointly developed by UCR and UCLA faculty. Students will embark on “clerkships” in both medical center and community-based health care settings in a variety of specialties, such as family medicine, pediatrics, internal medicine and surgery. The community-based clerkships respond to the reality that most health care delivery occurs outside of hospitals. As an example, clerkship students will be assigned to a primary care physician and follow selected patients over time to gain in-depth knowledge of the patients’ interaction with the entire health care spectrum — from office visits to laboratory tests to hospitalization to post-hospital care.

UCR has selected a distributed model for student clerkships, which will take place in regional hospitals and medical clinics. The approach provides students with high-quality experience in community settings in which most medical services are provided. Guze said the affiliations will be similar to that between Harvard Medical School and Massachusetts General Hospital or, within the University of California, the association between UCLA and Cedars-Sinai Medical Center.

“We anticipate having several hospital partners in the community. This will assure that our medical students and residents have exposure to a diverse range of patients who reflect the cultural and ethnic diversity of the region,” she said.

The medical school curriculum combines the first two years of instruction at UCR, already accredited by the Liaison Committee on Medical Education, with an innovative approach to clinical clerkships, according to Byus. He added that the Inland Southern California region has many highly qualified clinical practitioners for clinical training, including those currently teaching in the UCR biomedical sciences program.

“We could not have developed this program without UCLA,” said Byus. “Especially the last five or six years, UCLA has played a large role and has been a wonderful partner for us. Without that, a small program cannot flourish like ours has thrived.”

Enhancing Student Success
The UCR/UCLA program has also placed great emphasis on student support and enrichment opportunities. Its two signature pipeline programs, named FastStart and Medical Scholars, instill a sense of camaraderie among UCR undergraduates interested in health care careers, who support each other through peer mentoring and study groups. FastStart, a five-week summer residential experience for incoming freshmen, incorporates daily preparatory classes in math, biology and chemistry; individualized academic, career and personal counseling; and team building and recreational activities.

The Medical Scholars Program (MSP) offers opportunities to do research in UCR labs and internships with community clinics, as well as financial support for the Medical College Admission Test (MCAT), the standardized admissions test required by virtually all medical schools in the United States.

As a UCR senior and now first-year medical student, Evita Limon has been an intern with the Latino Health Collaborative at the Community Hospital of San Bernardino, working with high-risk sixth-through 12th-graders and helping with a survey of Latino patients in San Bernardino County.

“MSP is an amazing program, run by truly dedicated individuals. MSP helped change my perspective on health care and the health professional that I want to become,” said Limon, who is considering the teen population and preventive care as focus areas when she becomes a physician.

According to Schiller, alumni from FastStart and the Medical Scholars Program are enrolled in such medical schools as the David Geffen School of Medicine at UCLA, UC San Diego School of Medicine and Keck School of Medicine at USC.

Providing a sturdy platform for the medical school’s research enterprise is the presence of more than 100 current UCR faculty engaged in health-related research on such topics as Alzheimer’s disease, doctor-patient communications, insect-vectored diseases, cardiovascular disease, wound-healing, health inequalities in cancer prevention and survivorship, and rural health. Additionally, a number of specialized research facilities — including a stem cell laboratory facility to begin construction this fall — provide the tools and instrumentation necessary to support and expand the biomedical research activity of faculty within and outside of the medical school.

Collaboration Across Disciplines
Particularly important is UCR’s long-standing tradition of collaboration across disciplines, born out of the campus’ beginnings as an agricultural experiment station, which was multidisciplinary by necessity to address problems in Southern California’s agricultural industry, according to Richard Luben, associate to the vice chancellor for research.

“We have laid the groundwork that will allow the campus to continue growing a biomedically strong research program,” Luben said. “There is a great deal of interaction between faculty researchers who are not in the current medical program and those in the medical program.” Increasingly, the most difficult research questions in medicine are being tackled from the perspective of several scientific disciplines, Luben said, and the medical school will participate in and build on existing relationships between researchers.

In Inland Southern California, outcomes for several key health indicators are among the worst in California. For instance, out of 58 counties San Bernardino ranks third from the bottom in deaths due to coronary heart disease, with Riverside County seventh from the bottom. For deaths due to diabetes, San Bernardino County ranks 49th.

As a consequence of these and other health challenges particular to Inland Southern California, the medical school will focus its research enterprise on such issues as cardiovascular diseases, insulin-resistant diabetes and metabolic syndrome, neurodegenerative diseases, and emerging infectious diseases. Various aspects of health services, public health and health care access are already investigated by UCR researchers, and these areas could be expanded to address other issues of current regional concern, such as prenatal care and infant mortality among underserved populations.

With the development of the medical school, Luben said, a wide range of significant fundamental research advances at UCR can be further developed through clinical and translational research. Translational biomedical research is a major thrust of the National Institutes of Health, the nation’s principal medical research funding organization, because of its essential link between the laboratory bench and clinical trials. Some of the faculty recruited to the medical school will undertake clinical trials needed for approval of new pharmaceuticals and medical treatments by the federal Food and Drug Administration.

Building on Existing Research
UCR’s momentum in recent years developing research expertise in areas such as genomics, nanoscale science and stem cell research will provide an additional impetus to the medical school’s research enterprise. Researchers in the recently launched Stem Cell Center have been awarded more than $6 million from the California Institute for Regenerative Medicine (CIRM). That funding includes nearly $3 million to construct a 2,000-square-foot stem cell core facility to culture and study human embryonic stem cells, which hold great promise for developing therapies to treat such diseases as Alzheimer’s and Parkinson’s.

The grant funding enables UCR to develop a basic research launching pad for development of new therapies based on stem cell research, the ultimate goal of CIRM, said Prue Talbot, director of the Stem Cell Center and professor in the Department of Cell Biology and Neuroscience. “CIRM wants solutions. They want the results of fundamental research to go into clinical trials.”

The two-year-old Department of Bioengineering is also expected to have close connections with the School of Medicine, according to department Chair Jerome Schultz. “Typically, bioengineering programs are very closely aligned with clinical activities.” Schultz said that as the department continues to grow, current expertise in molecular, cellular and tissue-level research will expand into development of new medical devices and diagnostics.

“There is a special opportunity here for both the medical school and bioengineering to grow together synergistically,” Schultz said.

The expansion of biomedical research and its potential to stimulate new technology start-up companies will likely make the Inland region a “magnetic” attraction for additional faculty researchers and R&D companies with an interest in commercializing new biomedical technologies, Chancellor White said. While the magnitude of the medical school’s economic impact cannot yet be forecast, national data suggest the region’s economy would experience a measurable boost. According to a recent report by the American Association of Medical Colleges, every dollar spent by a medical school or teaching hospital indirectly generates an additional $1.30 when it is “re-spent” on other businesses or individuals.

Meeting the Region’s Needs
The unique geographic and demographic circumstances of Inland Southern California also present the opportunity for building a medical school tightly aligned with regional health care needs, but also developing innovations that will have broad application to the needs of the nation generally. The framework for addressing this aspect of the medical school mission could be a center for promotion of healthy communities, Guze said.

This focus is critically important, White said, because research data consistently show that health promotion and preventive medicine — including good nutrition and physical activity — can prevent many serious diseases and prolong lifespan, resulting in better quality of life and reduced health care costs.

It is envisioned that health services and community-based, population and epidemiological research will result in the implementation of pilot projects on disease prevention and treatment, as well as health care access and delivery systems, with the goal of institutionalizing best practices in the region’s health care system.

“A commitment to improving the health of the people of the region is a unique design feature of the medical school,” Guze said.


Healthy Research
Mihri and Cengiz Ozkan, Electrical and Mechanical Engineering

Their research pursues a more direct, less harmful treatment for cancer using nanotechnology to detect cancerous cells and target them directly with chemotherapy, leaving the surrounding healthy tissues untouched.

Victor Rodgers, Bioengineering

His research with the interdisciplinary Biotransport and Bioreaction Kinetics Group applies experimental work with mathematical analysis to investigate drug delivery systems, artificial organ operations, bioreaction kinetics, crowded proteins and bioseparations.

Frances Sladek, Cell Biology

Her research aims to interpret how a certain liver-enriched transcription factor affects the expression of genes related to several diseases, including diabetes, hemophilia and hepatitis B.

Robin DiMatteo, Psychology

DiMatteo analyzed audio- and videotaped medical visits in her study on medical care and communication between doctors and patients. Her research has helped inform people of proper doctor etiquette and when it’s appropriate to make the difficult switch to a new physician.