Biography
During medical school at UNM I became interested in how physicians make decisions in caring for their patients. As a resident in Family Medicine at Duke University and a fellow in Evidence-Based Medicine (EBM) as a Robert Wood Johnson Clinical Scholar at the University of North Carolina, I studied epidemiology, biostatistics and public health. In 1981, I entered the private practice of Family Medicine in a rural community in North Carolina and served as the physician member on the Orange County Board of Public Health, a county that also contains Chapel Hill and the University of North Carolina. Simultaneously being a student of public health and serving on a county health board, I realized that my colleagues in the School of Public Health had no idea what the community health needs were in their own community and the people in the community had no idea what was being taught in the School of Public Health. This realization stimulated me to become involved in the idea of Community-Oriented Primary Care (COPC), a concept introduced by the Institute of Medicine in the early 1980’s as a model for health care that links public health concepts with primary care practice in communities. .
In 1984 I decided to enter academic medicine and joined the faculty at UNM School of Medicine. My entire professional and academic career has focused on improving the health and health care of medically underserved, multiethnic populations and communities. My career in research, teaching and service has been consistent with this overall theme; and has concentrated on the specific areas of practice-based research, health disparities, community engagement, evidence-based medicine, preventive medicine and medical education.
Courses Taught
I believe strongly that 1) if medical students appreciate the scholarly process and learn to practice evidence-based medicine (EBM), they will be better physicians; and 2) if health professionals are trained in rural areas they will be more likely to practice there.
At UNM I led the development of the EBM curricula, first as block head of the Biometry Block, then in the new problem-based curriculum starting in 1993. I served as co-block head, with Andrea Allen, PhD, of the Evidence-Based Medicine and Therapeutics Block in the Phase I curriculum. I helped develop the research requirement for the undergraduate medical school curriculum and served as a member and chair (for 10 years) of the Medical Student Research Committee. As a tutor and chair of the evaluation committee for the Rural Health Interdisciplinary Program (RHIP), I designed a longitudinal study that showed student participants in RHIP were more likely to practice in rural areas than their non-RHIP classmates. Recently I concentrate on mentoring junior faculty, Family Medicine residents and medical students in their scholarly and research projects.
I am currently exploring best practices in translating evidence-based information to rural providers using a series of CME workshops that adapts the curriculum by addressing the perceived learning needs of the providers. My hope is that this program can help recruit and maintain preceptors for the SOM. We have piloted this technique in two rural community health centers over the last 2 years.
Research and Scholarship
In 2001, I co-founded Research Involving Outpatient Settings Network (RIOS Net), a primary care practice based research network, involving as many as 275 practicing providers in 60 practices across New Mexico. Examples of my research interests are reflected in the following three funded research projects, all of which involve intervention trials, translation of EBM, and practice-based research in vulnerable populations: 1) Colorectal Cancer Screening in Hispanics: testing a video decision aid and medical assistants as patient navigators in low English proficient Hispanic patients, 2) Chronic Non-Cancer Pain and Opiate Prescribing: testing a community engagement technique of health extension agent academic detailing (like drug reps for EBM) in an attempt to change dangerous narcotic prescribing behaviors in rural providers, and 3) Cardiovascular Prevention: a randomized controlled trial of 52 practices in NM to test patent involvement and community engagement techniques, focusing on social determinants of health. All these studies are intervention studies, which is another area of methodology I have developed as an emphasis in my research in the last 10 years. In addition, most of my research involves community engagement