Through their eyes and in their voices: UC PRIME alums reflect on 20 years

In 2004, the late Dr. Alberto Manetta, then senior associate dean for Educational Affairs at UC Irvine’s School of Medicine, had a vision: create a training curriculum and model that would address California’s statewide need to increase health care delivery in under-resourced areas, serve the medical needs of underserved communities, expand the number of physician leaders committed to addressing these health care disparities, and address California’s workforce shortages. 

Twenty years and more than 800 physicians later, UC Programs in Medical Education (UC PRIME) continue to educate and produce medical professionals committed to addressing and solving the state’s most daunting and complex health care challenges around health equity.

This innovative and unique program recruits, trains and retains highly motivated, socially conscious students from across the state who are committed to advocating for health equity and training to provide high-quality and culturally congruent care to California’s medically under-resourced and underserved communities. 

In commemoration of UC PRIME’s 20th anniversary, we look back at the programs through the experiences our alums have shared, plus highlight some of the aspects of the UC PRIME programs that make them so unique.  

Guiding care through culture

While language skills are vital for physicians working in multicultural communities to ensure communications and connections can be made, it’s also critical to understand the broader cultural context in which a patient is seeking care. Understanding the cultural cues, sensitivities, and nuances of a patient’s environment and context remains crucial for making connections and for success in treatment and healing — often summarized in the phrase "culturally congruent care."

The Association of American Medical Colleges (AAMC) found that “having a diverse physician workforce increases access to care for areas and populations that are historically medically underserved, including for military veterans, people with low socioeconomic statuses, recipients of Medicaid or Medicare, and those who live in rural and medically underserved areas.” 

According to Javier Rodriguez, a recent Rural PRIME alum from UC Davis School of Medicine, “Having a background in medically underserved areas has taught me the importance of recognizing a patient's cultural and personal history. However, understanding one community doesn't mean you understand another," he explains.

The various UC PRIME programs continue to deliver training and support to address the spectrum of health care inequities across the state.  

For example, to address the needs of rural populations, Rural PRIME at UC Davis provides students with coursework on topics relevant to rural communities, including rural public health issues, pesticide exposure, addiction medicine, rural law, as well as effective advocacy, change management, and crucial conversations. 

To address the needs and health issues affecting African, Black, and Caribbean (ABC) communities, UC Irvine’s PRIME LEAD-ABC students engage in interdisciplinary coursework that addresses topics such as social determinants of health, community engagement and capacity building, health disparities, anti-Black racism, and social justice.  

More than just a medical school program 

From its inception and by design, UC PRIME has continued to be so much more than a medical school program, as Angulo noted. Its multi-faceted and multi-disciplinary curriculum of specialized coursework, structured clinical experiences, advanced independent study and mentoring trains future physicians to become leaders not only in their respective medical fields, but also in the communities they serve.

Students in UC PRIME programs complete the same core and standard coursework as all UC medical students. In addition, UC PRIME students also take additional courses, participate in seminars and workshops, and engage in other learning opportunities that expand the student’s understanding of the unique health needs and cultures of the populations each program serves while also training them as future community leaders and advocates.

While each UC PRIME program is different, some of the common elements across the specialized curricula generally include a summer orientation or immersion experience, a seminar series with site visits, clinical immersion in settings with underserved groups of people, community engagement, options for a master’s degree or research year, and sponsored events that are open to the broader campus community.

Some UC PRIME programs require an additional year to complete beyond the typical four years of medical school to accommodate this additional study.

In particular, students in four UC PRIME programs (PRIME-LA, PRIME-LC, PRIME-Heq, and PRIME-US) are also required to complete a master’s degree as part of their medical degree training. The most popular choices include public health, business administration, advanced clinical sciences, leadership of health care organizations and education.

A testament to UC PRIME’s interdisciplinary training 

One 2009 UC PRIME alum who also was a member of the first cohort at UC Irvine, Sarah Lopez, M.D., MBA, is a testament to the interdisciplinary inspiration that the program engenders. She is the Chief Medical Officer for Zocalo Health and an assistant clinical professor of emergency medicine at Harbor-UCLA Medical Center. 

In reflecting on her time in the UC PRIME program, Lopez said, “Programs like PRIME-LC aim to train physicians who understand the unique social, cultural and economic factors affecting Latino communities…[t]here is data showing that patients do better when they receive care that is linguistically and culturally sensitive, leading to better trust, adherence to treatment and overall outcomes.” 

The importance of connections and trust

For many physicians working across California’s communities, knowing Spanish remains an important component of their ability to connect with their patients and deliver effective care. For example, while Latinos/as make up 39 percent of the state’s population, they comprise only six percent of physicians, and almost seven million Californians report speaking English “less than very well.” 

Studies have shown that communication skills are critical for care adherence, and by extension, speaking the same language as the patients can dramatically and positively affect care delivery. For example, according to the study Physician Communication and Patient Adherence to Treatment: A Meta-Analysis, “Training physicians in communication skills results in substantial and significant improvements in patient adherence such that with physician communication training, the odds of patient adherence are 1.62 times higher than when a physician receives no training.” 

For many physicians working across California’s communities, knowing Spanish remains an important component of their ability to connect with their patients and deliver effective care. For example, while Latinos/as make up 39 percent of the state’s population, they comprise only six percent of physicians, and almost seven million Californians report speaking English “less than very well.” 

Studies have shown that communication skills are critical for care adherence, and by extension, speaking the same language as the patients can dramatically and positively affect care delivery. For example, according to the study Physician Communication and Patient Adherence to Treatment: A Meta-Analysis, “Training physicians in communication skills results in substantial and significant improvements in patient adherence such that with physician communication training, the odds of patient adherence are 1.62 times higher than when a physician receives no training.” 

Furthermore, the AAMC recently reported, “There is evidence that improving communication and trust between clinicians and patients improves patient willingness to engage in prevention practices, adhere to medical advice, and follow prescribed treatment regimen.”  

According to UC PRIME alum Dinora Chinchilla, M.D., language and cultural understanding also help dissipate distrust and skepticism about medicine. As she notes, “I feel like there is a trust that is laid out when you walk in, and they understand that you understand and speak their language and their culture, and it just opens up a gate that I think is sometimes closed when there’s some distrust of the medical community.”