A conversation with Sarah Smithson: Course Director, Advanced Practice Selective

Sarah Smithson, MD, MPH, has had a busy summer. In addition to recently transitioning into full-time practice with the Department of Medicine’s Division of General Medicine and Clinical Epidemiology, Smithson was named course director for the UNC School of Medicine’s Advance Practice Selective, beginning the new roles July 1. We spoke with Smithson about her background and what she hopes to achieve in her new role.

A conversation with Sarah Smithson: Course Director, Advanced Practice Selective click to enlarge Sarah Smithson, MD, MPH

Q: What is the Advanced Practice Selective?

Smithson: Advanced Practice Selective is a one month course that’s required for all fourth year medical students. But, the students and teachers are together in the classroom for only one day and then the students go out to their different clinical sites to spend a month practicing and learning. Anne Mounsey designed and built this course, and I am so thankful for all the work she has done to get this great program going.

Q: How are the clinical sites chosen?

Smithson: Students can choose virtually any clinical rotation they’d like. So, if a student wants to match into a certain specialty and doesn’t feel like he or she has had enough exposure to that field, then they are welcome to enroll in a rotation related to that. If there is a specific faculty member they’d like to build a stronger relationship with, they can do that. We have students who do international rotations. It’s pretty open to whatever is going to be the best experience for the individual students.

In my role as course director, I’m charged with vetting the rotations. If it’s something that’s already well established then we have a pretty high level of confidence that it will be a great experience for the student. If it’s something new, we have a few quality control measures to make certain it’s a great learning opportunity.

Q: What do students gain from the experience?

Smithson: I hope it's a lot of practical education. Think about the differences in how we function in health care and what we learn in medical school. We’re very good at teaching clinical skills and disease management, but sometimes there is no structured place for students to learn about the bigger systems that govern health care. This is a chance to guarantee that students are exposed to information like the difference between Medicare and Medicaid, the impact of legislation like the Affordable Care Act, the options for charity care, care delivery, quality improvement, etc. There is no expectation that they’ll become experts – very few people are – but we want them to leave UNC with a common language and a foundational understanding of what system-based practice means and how those system impact how we provide care as providers all the way to how it affects the lives of our individual patients.

Q: Did you have specific experiences that led you to be so passionate about these issues?

Smithson: When I was in medical school, I decided that I didn’t just want to do one-on-one exams with patients in the exam room, but wanted to have a larger impact on their complete health. So, I got my Masters in Public Health specializing in Health Policy and Management while I was completing my MD. And that influenced where I chose to do my residency. I focused on a primary care residency track that was population health based. I then had the opportunity to join an innovative practice here in the Triangle – Carolina Advanced Health – that was designed from the ground up by UNC and Blue Cross Blue Shield North Carolina as a patient-centered medical home. But, I missed working with students and residents so I wanted to practice in Internal Medicine here on campus. I’m so excited about this chance to combine my practical and academic background while constantly learning more and honing my skills.

Q: Will this course be affected by the new TEC curriculum?

Smithson: As far as I know, the new curriculum will not change this course substantially. If anything, students will be exposed to this type of work a little bit earlier in their medical school career. That’s obviously a very good thing.

Q: Do you have any changes planned for the course content?

Smithson: None of the things that we’re learning about are static, so I’m constantly thinking about how we can evolve. We know the more they can be actively engaged, the better this information will stay with them. Every time you hear a new talk or participate in a new activity, you’re learning something. No matter how basic it is, there’s always some new information to learn.

Q: How would you define the long-term benefit of a course like this?

Smithson: I want to help the students understand how powerful their voices are as physicians, both for their patients and for the profession. Sometimes I think they underestimate themselves, saying ‘Oh, I’m just a student,’ but they are so passionate and skilled and I’m excited about finding creative ways to engage them with what’s happening in health care.