In commemoration of UC PRIME’s 20th anniversary, we look back at the successful model of medical education through the experiences of PRIME alums and highlight some of the aspects of the program that make UC PRIME so unique.
“There’s the culture of the person who comes in to see you. There’s the culture of the physician, and there’s the culture of medicine around them - that context, that healing space – that has its own culture. If you don’t recognize those things, you lose what’s really going on.” - UC Irvine PRIME-LC alum Anna Fellmann, M.D., MPH, associate director, Central Washington Family Medicine Residency Program
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
“If you can’t be seen, and you can’t be heard, how do people know what’s wrong? It’s more than just the fact that I can speak Spanish. It’s that I can understand the non-verbal cues, the cultural inferences, the context, and understand what somebody’s path has been just to get to see me and all the barriers that they had to face to sit here in my office and look at me and talk to me.” - Anna Fellmann, M.D., MPH
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 complexities of both human culture and medical science are immense, making it difficult to ever say, 'Okay, I fully understand what's happening.' The more you learn about medicine or someone’s life, the more you realize how much there is yet to know.”
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.
From guitarist to internist
Marco Angulo, M.D., M.A., followed a circuitous and somewhat untraditional path to the UC Irvine School of Medicine. A former lead guitarist for Romantic Torture, an East L.A. alternative rock band from the early 1990s, Angulo was one of the early graduates of UC Irvine PRIME-LC (in 2011) after completing his undergraduate work at East Los Angeles College.
Currently the medical director for the AltaMed Institute for Health Equity, Angulo reflects on his medical school experience. “PRIME-LC gave me the confidence and ability to carry the voices of our communities into every room I walk into as a physician. It’s through PRIME-LC that I learned my training wasn’t just about clinical skills. It was about shaping a future where the medically underserved, particularly the Latino community, are seen, heard and cared for…. PRIME-LC doesn’t just train physicians; it creates leaders who are committed to changing the landscape of health care for the better.”
More than just a medical school program
“UC PRIME was developed to increase the size of our physician workforce, comprised of physician leaders committed to providing care to under-resourced populations. So that could mean going to shortage areas or it could be providing care to medically underserved populations. We are trying to graduate and create a generation of physicians who are not only trained in clinical care, but also strong advocacy and leadership.”
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.
PRIME's multifaceted and multidisciplinary curriculum of specialized coursework, structured clinical experiences, advanced independent study, and mentoring helps create physician leaders. UCSF School of Dentistry students and Dean Reddy, as well as current UCSF School of Medicine PRIME students, visited Sacramento in 2024 to talk with legislators and staff about the program's impact.
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 unique curriculum providing knowledge and training beyond the clinical walls
The specialized courses across the various UC PRIME programs and curriculum focus on history, culture, language, social sciences, community research and advocacy as well as training in public speaking, policy development, and legislative activism skills.
- Coursework on the history of Indigenous people, regional sovereignty, politics, Indian Health Service, health policy, and traditional Indian medicine/Indigenous healing practices. (Tribal Health PRIME at UC Davis)
- Cultural immersion, with courses offered by the UC Irvine Department of Chicano/Latino Studies, exposing students to the history, politics, and socio-cultural experiences of U.S. and non-U.S. Latinos. PRIME-LC students begin with a summer course on Latin American culture and health disparities, conducted in Spanish, to complement clinical experiences across the state. (PRIME-LC [Latino Community] at UC Irvine)
- Early clinical experience serving underserved communities in settings such as student-run homeless clinics, AltaMed clinics (Federally Qualified Health Center), LA County health centers, Saban Free Clinic, and Veterans Affairs facilities. These hands-on experiences help first-year students build skills working with underserved communities in roles like health coach, patient navigator, and intake coordinator. (PRIME-LA [Leadership and Advocacy] at UCLA)
- Leadership development and mentorship through courses such as Community Health and Health Leadership Designated Emphasis Programs, which train students in the legislative process, advocacy, amplification of community voices, and effective communication with policymakers/legislators to address health disparities. (PRIME LEAD -ABC [African, Black, and Caribbean] at UC Riverside)
- Community engagement opportunities through the Healthy Minds, Healthy Bodies course, designed to address the need for a health education program at a local high school. PRIME students are trained to give lessons on health topics to students, such as nutrition, substance abuse and healthy relationships. (PRIME-HEq [Health Equity] at UC San Diego)
- Training on health issues impacting geographical regions, like the San Joaquin Valley. The San Joaquin Valley PRIME program curricula focuses on health issues impacting the area, such as immigrant health, diabetes and obesity, valley fever, human trafficking, pre-term birth, and methamphetamine use disorder. A pathway program, SJV PRIME+, was also recently established to expand the health care workforce in the region. (SJV [San Joaquin Valley] PRIME at UCSF, UCSF Fresno and UC Merced).
Read more about what makes the UC PRIME curriculum unique in the 2023-2024 UC PRIME Legislative Report.
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
“Walking in speaking Spanish and then using some of the language that is just maybe not in the textbooks or at school but using the language that you use in your community – it’s an instant connection.” - UC Irvine PRIME-LC alum Dinora B. Chinchilla, M.D., UCI Health pulmonologist; assistant professor, Division of Pulmonary Diseases & Critical Care Medicine, Department of Medicine, UC Irvine School of Medicine
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.”
Since its beginnings at UC Irvine School of Medicine, UC PRIME has maintained a steadfast commitment to training the next generation of physician leaders and advocates who will effectively address the needs of the state’s under-resourced communities.
UC PRIME students convene annually to attend seminars on providing culturally congruent care and meet PRIME students from across the state, as seen during last year's UC PRIME conference at UC San Diego.
During UC PRIME conferences, PRIME students can share the real-world research they've conducted with their peers from across California.
From California for Californians
The vast majority of UC PRIME graduates remain in California to provide high-quality, culturally congruent care in their communities.
Nearly three-quarters (74 percent) of UC PRIME graduates go on to residency programs in California or continue practicing in the state, with more than half of all UC PRIME graduates having completed residency training in primary care (51 percent) and other designated workforce shortage specialties such as psychiatry, general surgery and emergency medicine. Finally, 39 percent of UC PRIME graduates are matched at a UC academic health center for their residencies.
Looking ahead to the next 20 years
The integrated, holistic approach that the UC PRIME curriculum has provided – and will continue to provide future health care leaders in California – will remain critical for the next generation of physicians who are working to solve some of the most pressing and complex issues facing various medically underserved groups and communities across the state.
UC Health is exploring how to apply the UC PRIME model to other health professions, especially in the areas of dentistry, pharmacy and veterinary medicine, which are experiencing a shortage or maldistribution of providers in California.
At its core, UC PRIME is about making connections that focus on patient-centered care, attending to those patients’ unique needs and circumstances, and helping them realize the best path for a healthy and prosperous life.
As Anna Fellmann, M.D., MPH, says, “I think in medicine one of the things that is many times lacking is we look at diseases, the drug for the disease and the body systems but sometimes forget about the patient. That’s something that UC PRIME has reincorporated back into our medical education and our learning, and it is so incredibly valuable. That’s what makes it such a unique program.”
About University of California Health
University of California Health comprises six academic health centers, 21 health professional schools, a Global Health Institute and systemwide services that improve the health of patients and the University’s students, faculty and employees. All of UC’s hospitals are ranked among the best in California and its medical schools and health professional schools are nationally ranked in their respective areas.