New consortium links three medical schools to one community training pipeline

Northeastern Pennsylvania has become the proving ground for a collaborative program designed to keep medical students in the area they train to become new physicians.

The Northeast Pennsylvania Clinical Education Consortium (NEPA-CEC) also shows how medical schools and students can benefit from working together instead of competing for clinical training sites.

On Aug. 12, the American Association of Colleges of Osteopathic Medicine (AACOM), Lackawanna College and Commonwealth Health Regional Hospital of Scranton hosted “From Scranton to the Nation: A New Model for Clinical Education.” It was a public introduction to the early success of NEPA-CEC, a model that supporters hope will be replicated around the country.

That partnership developed as a response to a regional physician shortage paired with a training pipeline that too often sends local students elsewhere for the clinical rotations that shape where they eventually build their careers.

“Too often, talented students who can put down roots here train somewhere else, build relationships somewhere else, and end up practicing somewhere else,” said Lackawanna College President Jill Murray, Ph.D. “If we want a healthier northeast Pennsylvania, literally, we have to change where that pipeline runs.”

How it works

Lackawanna College, which offers health sciences programs but is not itself a medical school, serves as the convener of the consortium. Under the model, the college coordinates clinical rotations for third-year osteopathic medical students from three partner colleges of osteopathic medicine: Philadelphia College of Osteopathic Medicine, the University of New England College of Osteopathic Medicine and Touro University College of Osteopathic Medicine. Students spend a full year completing rotations across every required discipline at hospitals and clinics throughout the region, working with local physician preceptors.

“Our job is not to teach medicine. That’s what our incredible physician preceptors do,” Murray said. “Our job is everything around it: coordinating rotation logistics, scheduling, credentialing, communication across three different schools and a dozen-plus placement sites.”

Murray said the consortium also provides professional development and mentorship so students build relationships with physicians, health systems and the community during their rotation year, with the hope that they choose to return for residency training and, eventually, to practice in the region.

The program began several years ago as an informal conversation among regional health care leaders, Murray said, and it grew when AACOM became one of its earliest and strongest advocates. It started with nine students three years ago, grew to three dozen for its third cohort and is expected to reach 50 next year.

“This kind of growth doesn’t happen without extraordinary partners,” Murray said, citing Commonwealth Health, The Wright Center for Graduate Medical Education and Community Health, and Tenor Health among the regional institutions that have opened their doors, departments and physician schedules to host students. “This program does not exist without all of you.”

Murray called the consortium “a regional strategy” built on one goal: training tomorrow’s physicians and other health care professionals so more of them choose to build their careers in northeastern Pennsylvania. “It’s the power of a conversation, the power of dreaming, and the power of a community willing to ask, what if?” she said.

AACOM data show clinical training sites under growing strain

Osteopathic medicine is growing even amid “growing pressure” on the community-based clinical training network that teaches thousands of new physicians. The same day, AACOM published survey findings that nearly three-quarters of responding deans said developing rotation sites and recruiting physician preceptors has become more difficult in the last five years.

“We have a national clinical training system operating without national strategies or measures of success,” said Mark Speicher, Ph.D., M.H.A., AACOM’s senior vice president of research, learning and innovation.

“These data are a first step toward knowing what our clinical education network actually looks like, so that schools, communities and policymakers can act on evidence rather than anecdote,” Speicher said in the analysis. He framed the NEPA-CEC program against the new national findings. Obstetrics and gynecology, pediatrics and psychiatry were identified as the hardest rotations to secure; no responding school reported having no difficulty placing students in obstetrics and gynecology rotations.

Competition for sites was cited as the leading threat to retaining them:

• 57% of respondents pointed to competition from M.D.-granting medical schools
• 50% cited competition from other colleges of osteopathic medicine, with additional competition reported from physician assistant and nurse practitioner programs.

In response:

• 83% of responding deans said their schools are expanding their geographic reach
• 80% are increasing payments to sites and preceptors

Deans expect institutional fees to rise roughly 20% and preceptor fees roughly 30% over the next three years. Across reporting schools, the median clinical training site sits 24 miles from campus, though the average distance is 157 miles, and nearly 6% of sites are more than 500 miles away. Sixty percent of responding deans said they are very concerned about finding preceptors qualified to teach osteopathic medicine.

Speicher told attendees that projects like NEPA-CEC are “local and not local,” and that AACOM hopes the Scranton model can be replicated in other communities. He credited Scranton Mayor Paige Cognetti’s backing of the project as “meaningful, both practically and symbolically,” before introducing her.

Collaboration, not silos, is the path forward

The consortium reflects a broader lesson about how a city and its institutions succeed: not by operating in isolation, but by working together, said Cognetti, Scranton mayor since January 2020.

The college, the local hospital and other health care institutions cannot operate in silos “and we all just hope it works out,” Cognetti said.

“The way that we are successful, the way that we move forward in an increasingly difficult economic environment, is to work together,” she said.

Cognetti pointed to the collaboration among health care institutions, physicians, nurses and staff who worked through the COVID-19 pandemic and subsequent industry pressures as evidence the region can adapt. She argued that Scranton’s size of about 80,000 residents in a broader region of roughly 600,000, makes it well suited to test new models.

“We are big enough that we matter. We are also small enough that we can try things. We can fail fast, and we can start over again and try something new,” Cognetti said, adding that she sees the consortium as a model that can be a model across Pennsylvania and nationally.

She thanked the health systems, educators and government partners in the because the city is committed to continuing that partnership “to keep Scranton and this broader region healthy.”

State support targets rural health and workforce retention

Pennsylvania state Rep. Bridget M. Kosierowski, R.N., spoke about the importance of retaining medical professionals who train in the region.

“When we talk about retention, recruitment of medical professionals to come here and stay here and work with us here in the valley, this unique valley that I am so proud to be a part of, I couldn’t be more happy to be here this morning,” Kosierowski said.

Kosierowski, who said her father and grandfather were both physicians in the area, asked physicians and health care workers in the room who were born, trained or educated locally to raise their hands. Many of them had returned to the region to practice after attending medical school elsewhere, she said.

She also warned that rural health care in Pennsylvania is “under attack” and described it as a crisis requiring continued attention, pointing in particular to preventive care, primary care and gerontology as priorities given the state’s aging population. She said she was encouraged that NEPA-CEC students are training in those areas.

“It warms my heart to look out at this group,” Kosierowski said. “I know it is a group that’s laser-focused on making Scranton, Pennsylvania, northeastern Pennsylvania, a hub of health care-trained professionals that stay here and take care of all of us.”