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A mission of service

Osteopathic medical school targets the needs of underserved areas

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When Toria Knox graduates, she wants to practice in a rural area, probably
somewhere in Appalachia. Photo by Don Petersen

The Edward Via College of Osteopathic Medicine, known as VCOM, says its mission “is to prepare globally minded, community-focused physicians to meet the needs of rural and medically underserved populations and promote research to improve human health.”

The school, which has collaborative ties to Virginia Tech and Auburn University, focuses on recruiting students from Appalachia with the hope that many of them will return to that region — or other rural areas — to practice.

A good example is Toria Knox, the college’s 2019 student doctor of the year. Scheduled to graduate in 2021, she was recognized for “leadership, professionalism, community service and dedication,” according to the school’s announcement of the honor.

From Boones Mill (pop. 239 in the 2010 census) in Franklin County, Knox has participated in international service missions, but she also has worked on health-care projects in Grundy, Fincastle and her home county. When she graduates from medical school, she wants to practice in a rural area, probably somewhere in Appalachia.

“I think I would really miss the mountains if I got too far away,” she says.

With nearly 1,900 students studying at three campuses in Virginia, South Carolina and Alabama, VCOM is the second-largest medical school in the United States, according to U.S. News & World Report.

The Blacksburg campus, which graduated VCOM’s first class in 2007, has 696 students, with 178 set to graduate in May.

Those graduates are trained in osteopathic medicine — which focuses on patients rather than disease — and the importance of human touch in diagnosis and treatment. Students at VCOM and other osteopathic medical schools get much of the same training and are required to pass the same state board exams as students pursuing doctor of medicine degrees (M.D.). In fact, students earning doctoral degrees in osteopathic medicine (D.O.) take about 200 more hours of coursework.

The American Association of Colleges of Osteopathic Medicine says osteopathy’s philosophy holds that all body systems are interrelated and interdependent. That idea was developed by Andrew Taylor Still, a native of Virginia’s Lee County who served as a Union surgeon during the Civil War. He opened the first school of osteopathic medicine in Kirksville, Mo., in 1892.

Plans for fourth campus
In the beginning, half of VCOM’s 150 spots were reserved for students from rural Virginia, North Carolina and the Appalachian regions of West Virginia, Tennessee, Ohio, Georgia and Kentucky.

Those students are more likely to go – and stay – in underserved rural areas. D.O.s are more likely than M.D.s to become primary-care physicians, the kind of doctors most needed in those underserved areas. Nearly 60% of D.O.s go into primary care.

VCOM, based in Virginia Tech’s Corporate Research Center, has a collaborative agreement with Virginia Tech that provides for joint research and faculty sharing. The agreement also allows VCOM students to use Tech’s libraries, recreational facilities and student center; participate in arts and theatre and intramural programs; and have access to football and other athletic event tickets.

Because so many VCOM students came from the Carolinas, VCOM decided to establish a campus in Spartanburg, S.C., in 2011. That year, Auburn University officials began looking into establishing a medical school. Like the Appalachian areas the VCOM Virginia and VCOM Carolina campuses were meant to serve, Alabama’s rural areas needed more doctors, especially primary-care physicians.

Some Auburn officials visited the VCOM campuses and decided the school was a good fit. The Alabama campus opened in the Auburn University Research Park in 2015.

VCOM has an agreement with Auburn similar to the one with Virginia Tech. VCOM students can participate in Auburn student activities, events, research and the arts. They can use Auburn libraries, transportation and recreational facilities and attend some athletic events.

VCOM is developing a plan for a fourth campus, on the campus of the University of Louisiana – Monroe, in Monroe La. VCOM plans to partner with UL-M as it has with Virginia Tech and Auburn.

Lifelong volunteer
Knox’s path to medical school developed through her interest in chemistry and biology. Her curiosity about how the human body works began earlier, sparked by her lifelong experience as a dancer. She started with ballet at 2, danced competitively in a number of styles through high school and joined a student-run dance company, the Contemporary Dance Ensemble, at Virginia Tech.

“Now,” she says, “I just try to take ballet classes when I can.”

Her sense of service to others also began long before she considered medical school. As a youngster, she volunteered with her parents at the Rescue Mission of Roanoke, graduating from passing out napkins to washing dishes.

Knox grew up in the Church of the Brethren where “the emphasis is on the works of Jesus and how you show the light through acts of service,” she says. “So, I grew up doing service projects. That sort of was a big passion of mine since I was really little.”

Knox was a counselor and later a health coordinator at Camp Bethel in Fincastle. While attending Virginia Tech, she was an EMT with the Blacksburg Volunteer Rescue Squad and volunteered with local churches.

At Tech, Knox was a biochemistry major, with minors in Spanish and medicine in society. “It was sort of looking at the humanistic aspects of medicine,” she says.

During her freshman year in college, Knox talked to a doctor of osteopathic medicine at her church, and that seemed to set her on her career path. “It just felt like something I would love to do for the rest of my life,” she says.

Knox learned of a lecture series about osteopathic medicine VCOM was offering to members of Tech’s honors college. She attended and found out she could — if she met certain criteria — be accepted into VCOM early. That meant Knox would know where she was headed after college long before earning her undergraduate degree. She was accepted early.

“I was really falling in love with what osteopathic medicine was and really learning all about it,” she says. “I just felt like I really came alive when I felt like that could be my purpose.”

VCOM’s interest in serving rural areas, particularly in Appalachia, especially appeals to Knox. “I love their mission and their vision,” she says. “I felt like it really aligned with my own goals about serving this area.”

Physician shortage
A report published last year by the Association of American Medical Colleges predicts a shortage of up to 120,000 physicians in the United States by 2030. That shortage already has arrived in rural areas, particularly in the South, according to the report. It says that, if people without insurance and people living in rural areas used medical care the same way as insured urban dwellers do, the country would have needed 31,600 more physicians in 2016. Nearly half of those would be needed in the South.

“I feel like, being born in Appalachia, I have a unique skill set of how to talk to people who are from this area, how to relate to them,” Knox says. “I feel like a lot of doctors don’t have that skill who come to Appalachia. That’s one of the reasons that it’s so underserved — people don’t want to stay. People come and they don’t understand why people act the way they are, how to be friends with them. It turns them off, and then they leave and go into the cities … I feel like that’s something that, if I didn’t utilize that, it would be such a waste for everyone who has invested in my upbringing.”

Knox also wants to put her foreign language skills to work, serving Spanish speakers in her medical practice. One of her service projects since coming to VCOM has been working with the Franklin County Health Fair. She helped out one year and organized the fair the next year. Knox translated fliers promoting the event into Spanish and posted them on social media. The Hispanic turnout was surprisingly large, she says. “That’s a population that’s really overlooked here — and it’s growing, a lot,” Knox says.

Another Appalachian project Knox worked on through VCOM supported Mountain Mission School, a faith-based orphanage and school in Grundy founded in 1921. The school serves about 200 resident students, and some day students, from pre-kindergarten through the 12th grade.

VCOM students helped with sports physicals and checked to see Mountain Mission students had all the necessary immunizations. Since it was such a long drive from Blacksburg to Grundy, Knox asked, couldn’t they do something else while they were on campus, maybe a health fair?

Deciding that suggestion was a good idea, doctors and school administrators assigned VCOM student groups health topics to cover with the Mountain Mission students. Knox was startled to learn her group, the family medicine students, had been assigned to lead a discussion on male puberty.

“I was like: ‘I’m so glad I’m the one that gets to lead this,’” Knox says, with tongue in cheek. The program, however, turned out fine. “The whole experience was really cool,” she says. “I learned a lot.”

While Knox’s volunteer experience at VCOM has focused on Appalachia, she went farther afield while studying at Virginia Tech. Through VT Engage, Tech’s center aimed at involving students in service-learning, Knox spent a spring break in the Dominican Republic and a month in Peru. In the Dominican Republic, students installed water filters and taught residents how to use and maintain them.

With two years until her graduation, Knox hasn’t worked out her plans.

“For now, I’m just trying to learn everything I can,” she says. “Every day, I try to meditate and think about: ‘What’s God asking me to do? How can I serve people the best? How to live a purposeful life, I guess.’”

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