Established in 2004, the University of California, Irvine’s Program in Medical Education for the Latino Community (UCI PRIME-LC) was developed to create not just excellent physicians but strong leaders for California’s poor and disenfranchised Latino population. This five-year program accepts approximately 12 students per year and provides additional training beyond the regular medical school curriculum to advance our students’ ambitions of being physician leaders.
All students accepted into PRIME-LC have a strong background in the Latino community prior to matriculation into medical school, and they all have at least conversational skills in Spanish before entering PRIME-LC. Additional essays and an additional interview in Spanish ensure that our students meet PRIME-LC admissions criteria. Moreover, all PRIME-LC students must be admitted to the general School of Medicine class before being accepted into PRIME-LC.
The PRIME-LC curriculum features a strong pedagogy and emphasis on participatory learning. It begins with a pre-matriculation curriculum in the summer before the first year of medical school (MS1 year), which serves as an overview of PRIME-LC and establishes a baseline for the next five years of training. This one-month course introduces students to the concept of physician leadership, highlighting health disparities around the state. Students spend time at local community advocacy centers and visit nonprofit organizations focused on health issues that are prevalent along the U.S./Mexico border and in California’s Central Valley. Students also spend a day at the Capitol in Sacramento advocating for health equity with legislators and staff.
During the first three years of medical school, the UCI Department of Chicano/Latino Studies teaches PRIME-LC students about the history, politics, and socio-cultural experiences of U.S. and non-U.S. Latinos. Students learn the underpinnings of health disparities among Latinos and develop strategies to intervene in social determinants of health to reduce these disparities. Overall, the Chicano/Latino Studies courses form the backbone of the curriculum for PRIME-LC.
PRIME-LC students see a majority of low-income, Spanish-speaking patients during their clinical rotations between MS1 and MS5 years. Approximately 1.08 million residents, or 34% percent of the population in Orange County, identify as Latino. This percentage varies throughout the county, being as high as 75% in Santa Ana where PRIME-LC students complete most of their ambulatory clerkships.
The capstone of the PRIME-LC curriculum is a rotation in Latin America. The goal of this one-month clinical rotation is to compare the physician-patient relationship and healthcare systems in Latin America with that of the United States.
Students begin their master’s degree training during the MS4 year, shortly after completing their educational capstone in Latin America. A master’s degree is required of PRIME-LC students who have not previously completed a master’s degree pertinent to Latino health. The most popular choices for master’s programs include Public Health, Business Administration, and Public Policy, but students are free to choose a program based on their personal ambitions to become leaders in Latino health.
In 2009, PRIME-LC graduated its first pilot class of 5 students. Since then, 165 PRIME-LC graduates have entered the field of medicine, and these students’ practice and leadership activities comprise the most critical evaluation tool of PRIME-LC.
Over 95% of PRIME-LC graduates match into the residency of their choice through the National Residency Match Program, with the vast majority of students reporting getting one of their top three choices for residency training programs. PRIME-LC features a disproportionate number of graduates engaging in core specialties most likely to improve health disparities for Latinos. The most popular specialty choice is Family Medicine, which has more than double the number of graduates compared with the next most preferred specialties, Pediatrics and Internal Medicine.
Among attending PRIME-LC alumni who have completed all of their postgraduate training, 79% stay in California to practice. 95% work in community health clinics, county health facilities, or other safety net sites. This is a remarkable achievement which speaks to these students’ ambition as difference-makers. They are highly qualified and can practice anywhere they want, but they choose to practice in a setting where they can put their skills to use and stay true to why they desired to be doctors long before entering medical school.
Moreover, half of graduates perform leadership roles as part of their routine. Some are leaders in academic medicine and teaching the next generation of physician-leaders. Others are leaders in their practice setting, particularly in creating more broad-based equitable care beyond their own personal practice. And others have taken their advocacy to government. PRIME-LC alumni include an elected member of a county school board and, just recently, the Director of Primary Care Services at the Department of Health and Human Services in Washington, D.C.
PRIME-LC has changed the climate of UC Irvine and successfully exported our health training model. There are now 9 PRIME programs, each with its own unique focus on different issues promoting health disparities, across 7 University of California medical campuses. In total, these programs boast 811 graduates who are changing the way healthcare is practiced and promoting better health outcomes where they are needed most. The future of PRIME lies in building on this strong foundation of physician-leaders to promote healthier communities in California and beyond.
