The Thomas F. Frist, Jr. College of Medicine: Navigating the Launch and Staffing Landscape of a New Medical Institution
The establishment of a new medical school is a monumental undertaking, fraught with unique challenges and opportunities. The Thomas F. Frist, Jr. College of Medicine (FCOM) at Belmont University in Nashville, Tennessee, as the newest medical institution in the United States, embodies this reality. From its inception, FCOM has been focused on building a program from the ground up, encompassing its physical infrastructure, curriculum, and culture. However, like any nascent organization, it has encountered staffing hurdles that are critical to understand for its long-term success and for the broader implications for medical education.
Building from the Ground Up: A Distinctive Approach
One of the most distinctive aspects of the Frist College of Medicine is its status as the newest medical school in the country. This "newness" is not merely a chronological marker but a foundational element influencing every facet of its operation. Dr. Caleb Marsh, Director of Recruitment and Pathway Programs at FCOM, emphasizes that this allows for building "things from the ground up physically in the space of this brand new, beautiful building that we’re putting up here in Nashville, as well as building a brand new curriculum and building a brand new culture here." This "from scratch" approach means that FCOM is not bound by historical precedent; the refrain "That’s the way we’ve always done it because we haven’t ever done it a way before" is absent.
This philosophy extends to its educational approach, encapsulated by the "whole person approach to medicine." This concept manifests in two key areas: how students are trained to treat patients and how the institution treats its students. For patient care, the aim is to move beyond treating solely the disease or symptom, recognizing that sickness can impact family life, community well-being, and personal circumstances. Future physicians are being trained to be leaders in this holistic understanding. Crucially, this "whole person approach" is also applied to the students themselves. Recognizing that students are not just "robots that take tests and spit out grades," but individuals with personal lives, families, and external commitments, FCOM aims to provide a supportive environment. This is particularly relevant for non-traditional students who may be juggling multiple responsibilities, a demographic Dr. Marsh has extensive experience advising through post-baccalaureate pre-health programs.
Addressing the Physician Shortage and Fostering Diversity
Beyond the general need for more physicians, FCOM aims to meet specific needs by contributing to a diverse healthcare workforce and cultivating physician leaders. The Association of American Medical Colleges (AAMC) has highlighted the physician shortage, and FCOM's mission, vision, and values explicitly include creating diverse physician leaders. Diversity is understood in its broadest sense, encompassing not only race and ethnicity but also geographic origin, age, educational backgrounds, and the types of majors and experiences students bring.
The namesake, Thomas F. Frist, Jr., a former flight surgeon, entrepreneur, and involved figure in politics, embodies this leadership ideal. His multifaceted background serves as an inspiration for the kind of leaders FCOM aims to instill in its graduates-individuals who can not only practice medicine but also drive the field forward. The COVID-19 pandemic underscored the critical role of public health leaders and physicians in making significant policy decisions, a capacity FCOM seeks to cultivate.
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Practical Implications of the Whole Person Approach
The "whole person approach" translates into practical applications in patient care and medical education. The experience of having an elderly relative with multiple specialists, where no single primary care physician acts as a true "traffic director" for the whole person, illustrates the problem FCOM aims to address. Future FCOM physicians are being trained to understand this interconnectedness with colleagues, families, and the patient's broader life context.
While "personalized medicine" might suggest a customizable curriculum for students, Dr. Marsh clarifies that it refers to an approach where medicine itself is not "one-size-fits-all." Recognizing that individuals, while sharing similarities, are not identical, FCOM trains its doctors to view patients as individuals. This means tailoring treatment plans not just to a disease, age, or gender, but considering how each person will react to a treatment, how their family might be involved, and the unique delivery of care.
This philosophy is woven into the curriculum through "threads" that run throughout, touching upon medical ethics, health systems, health literacy, health advocacy, health equity, anti-racism, and spirituality. These elements focus on the community as a whole, moving beyond just the symptoms or the disease.
Navigating Affiliation and Inclusivity
Belmont University, as FCOM's parent organization, is the largest ecumenical Christian university in the country. This affiliation raises questions about inclusivity for individuals of different faiths or no faith. Dr. Marsh assures that applicants are not required to be Christian and that the college aims to be open to people of all faith backgrounds, and even those with no faith. The emphasis is on creating a place where students feel safe, comfortable, and a sense of belonging, which is a significant aspect of the FCOM culture. Applications will not inquire about religious affiliation, nor will it influence admissions decisions.
While acknowledging the influence of a Christian affiliation, similar to how Jesuit universities integrate tenets like "cura personalis" (care for the whole person), FCOM highlights "servanthood" as a core value. Medicine is viewed as a service profession, a reality inherent to the field regardless of institutional affiliation. Physicians encounter individuals at their most vulnerable, making service a fundamental aspect of practice. FCOM embraces this directly by embedding servanthood within its mission, vision, and values.
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Accreditation and Application Timeline
Frist College of Medicine has received preliminary accreditation, allowing it to recruit students and accept applications for its inaugural class, which matriculated in the summer. The AMCAS primary application deadline was February 29th, 2024, with a secondary application deadline of March 15th. For applicants to FCOM, applying within this timeframe does not place them at a disadvantage because the entire applicant pool is in a similar situation. This contrasts with applying to other medical schools with earlier deadlines.
Interviews for FCOM began in January and were expected to continue into late March or early April. The institution plans to matriculate 50 students in its first cohort, with subsequent cohorts also starting at 50 students. The goal is to gradually increase class size, aiming for approximately 75 students in the third cohort and reaching 100 students by the fourth cohort, a size deemed optimal for providing robust student support and fostering close student-faculty relationships.
Preliminary accreditation, received on October 11th, signifies the ability to recruit and accept students. The next stage is provisional accreditation, which the first two cohorts will undergo around their second year. Full accreditation is anticipated upon the graduation of the first class. FCOM does not anticipate any issues with graduates securing residency placements, citing examples of other new medical schools like TCU and the University of Texas at Tyler that have successfully navigated this process. The accreditation process is ongoing, requiring continuous effort even after full accreditation is achieved.
The institution acknowledges that this process may create some anxiety for applicants, and therefore seeks students who are "adventurous" and "trailblazers," comfortable with a degree of uncertainty. Successful residency placement relies on the institution's efforts, as well as the students' hard work, strong exam performance, and success in clinical rotations.
Student Support and First-Generation Challenges
FCOM's commitment to its students is further elaborated through its comprehensive student support programs. Learning Specialists provide academic coaching, guiding students to meet their academic and personal goals through personalized, student-centered support. Academic coaching focuses on guidance, skill-building, and accountability. Student Success Programs collaborate with various campus departments to offer holistic support and appropriate referrals.
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Specialized support includes readiness preparation for Step 1 and Step 2 exams, tailored to individual needs. The Peer-Academic Leader Program (PALs) offers peer-to-peer learning, connecting students with upperclassmen for academic mentorship and emotional guidance, fostering a stronger connection to the medical school community. Individualized Learning Plans (ILPs) help students identify their learning needs, set goals, and map out steps for success. Learning style assessments, including tools like the Myers-Briggs Type Indicator (MBTI) and the Learning and Study Strategies Inventory (LASSI), are available to help students understand their unique learning preferences. Self-Directed Learner Resources, including webinars, handouts, and guides, are accessible for students to enhance their learning strategies.
However, the broader landscape of medical education reveals that even with robust support systems, first-generation (FG) medical students face significant challenges. A qualitative study involving 37 FG students across 27 US medical schools highlighted immense financial stress as a pervasive issue. Coming from lower-income families, these students often struggle with mandatory expenses like board exams, study resources, away-rotation fees, and residency application costs, in addition to basic living expenses. Unexpected "hidden costs," such as the assumption of personal transportation for clerkships, can exacerbate these difficulties.
This persistent lack of resources impacts FG students' ability to learn, often requiring them to dedicate more time and effort to catch up with peers who have access to tutors and expensive extracurricular resources. The financial strain forces many to seek part-time employment, diverting energy from their studies. While institutions may praise FG students' engagement, this often reflects unmet needs for institutional support.
FG students reported a general lack of institutional support, including career advice, educational and psychological support, and disability accommodations. In some instances, this lack of support manifested as active discouragement from mentors regarding competitive specialties. Students from racially marginalized communities or with intersecting identities, such as learning disabilities, found the lack of support even more pronounced. The cumulative effect can lead to leaves of absence due to school-related anxiety and depression.
Feelings of exclusion and isolation are common, stemming from a difficulty in connecting with peers and faculty who may not share similar life experiences. The "hidden curriculum"-the unstated pedagogies, language, and rules of conduct-can be entirely new and overwhelming for FG students, leading to self-doubt about their belonging and worthiness in medicine. This insecurity can influence career aspirations, with some feeling "dumb" for considering certain specialties.
Despite these significant hurdles, FG students often possess unique sociocultural assets derived from their backgrounds, which inform their self-concept and benefit their future patients. They demonstrate resilience in the face of barriers, a strong work ethic, and the ability to persist and "make a way out of no way." However, this reliance on internal resources can also create a difficulty in asking for academic help, reinforcing the idea that they must manage everything independently.
The study suggests that while grit and resilience are desirable traits, FG students are often forced to rely on them as survival strategies rather than educational ones. They are using these qualities to navigate financial stress, opaque educational systems, and unwelcoming professional norms, leading to an overreliance that keeps them in "survival mode" with inadequate institutional support.
To foster a diverse physician workforce, learning environments must be created where all students can thrive. FG students bring vital insights and experiences that are essential for addressing the needs of our healthcare system, particularly in understanding and connecting with diverse patient populations. Educators must acknowledge the full context of students' backgrounds and the educational environment, which they have significant power to influence.
While holistic admission policies have made strides, admission does not equate to access. Adversity for FG students continues beyond matriculation, often due to learning environments that, though well-intentioned, fail to empower and foster achievement among diverse learners. Expanding a holistic lens to build student-centered frameworks, such as the Integrated Holistic Student Affairs (IHSA) model, is crucial for creating equitable and supportive medical education environments.
Faculty Turnover: An Emerging Challenge
A significant staffing challenge that has emerged at the Frist College of Medicine, as reported by The Nashville Banner, is faculty turnover. Since hires were made in the spring of 2021, the college initially reported approximately 90 individuals hired with 20 departures over four years, a turnover rate of about 22%. After the interview, FCOM revised its numbers to 96 hires and 27 departures, indicating a turnover rate of 28%.
The university attributes this turnover to the competitive nature of the field and the high-ranking titles of its recruited faculty, making them desirable to other employers. Building a medical school from scratch is inherently challenging, and this complexity could also contribute to faculty departures. A statement from University Communications acknowledged, "We understand this undertaking is not for everyone, and, at the same time, recognize that our employees are highly sought after for other roles given the level of expertise we have recruited over the past five years." Despite these staffing challenges, FCOM remains "fully confident in our ability to build a college that meets the highest standards of medical education."
This faculty turnover, while not unique to new institutions, presents a hurdle in establishing the consistent culture and educational delivery that a new medical school aims to cultivate. It underscores the difficulty in attracting and retaining highly specialized talent in a competitive academic healthcare market, especially for a brand-new entity striving to establish its identity and operational stability.
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