Cheers erupted during a brief pause at the start of the Training in Urban Medicine and Public Health (TRIUMPH) graduation in May 2018, when some students noticed a familiar face flash across the screen in Aurora Sinai Medical Center’s Rapkin Auditorium in Milwaukee.

The fleeting video clip revealed the image of Cynthia Haq, MD (PG ’87), TRIUMPH’s founding director who led the program through 2017. And much to everyone’s surprise — via an online video system — Haq later congratulated the graduates, who had started their training under her leadership. Her joy in seeing these students graduate was evident in her voice and on her face, even from a great distance.

Training in Urban Medicine and Public Health leaders
Michelle Buelow (from left), Kjersti Knox and Theresa Umhoefer-Wittry are the leaders of the Training in Urban Medicine and Public Health (TRIUMPH) program.

Members of the TRIUMPH Class of 2018 — like all students in the program — chose to train in a medically underserved, urban environment with the goal of helping to ease the doctor shortage in large cities like Milwaukee.

The program:

  • Prepares motivated medical students to become community-engaged physician leaders
  • Promotes health equity
  • Engages students in addressing complex public health concerns, such as obesity and infant mortality

Perhaps the students’ accidental preview of the video symbolized TRIUMPH’s recent year of transitions, including its top leadership, curriculum and program size.

When Haq — formerly a professor in the University of Wisconsin School of Medicine and Public Health’s Department of Family Medicine and Community Health and Department of Population Health Sciences — left to become the chair of the Department of Family Medicine at the University of California, Irvine, School of Medicine and Public Health administrators looked to the program itself to find new TRIUMPH leaders.

They chose Kjersti Knox, MD ’11, as its director and Theresa Umhoefer-Wittry, MD ’12, as a new co-associate director, to join forces with Michelle Buelow, MD ’11, MPH, co-associate director.

The three physicians are TRIUMPH alumni who practice medicine and community health in Milwaukee.

“Dr. Knox is one of our first TRIUMPH graduates, and we’re thrilled to come full circle with this great accomplishment of having three of our alumni leading this program,” notes Christine Seibert, MD, associate dean for medical student education and services and a professor of medicine. “They are following in the footsteps of their beloved mentor, Dr. Haq.”

At TRIUMPH’s graduation celebration, Robert N. Golden, MD, dean of the School of Medicine and Public Health, told the Class of 2018, “A true measure of the strength and success of a program is when the torch is passed in leadership, and it doesn’t miss a beat.”

Moving forward

Indeed, Knox, Umhoefer-Wittry and Buelow haven’t missed a beat, even though they are carrying the torch during a time of several transitions.

For instance, the 2018 graduating class trained under the school’s old curriculum; members of the next class are training in the legacy curriculum; and all other classes started their training with the new ForWard Curriculum, a three-phase model that the School of Medicine and Public Health has been gradually rolling out to fully integrate basic science, public health and clinical science throughout all medical students’ education.

A student showing a project
Fourth-year TRIUMPH student Kerrianne Fullin (center) describes the “Blood Pressure Land” game she designed during her community project to (left to right) third-year TRIUMPH student Nicholas Thompson, School of Medicine and Public Health Dean Robert N. Golden, MD, and community partner Kay Maas. Photo by Todd Brown/Media Solutions

Further, TRIUMPH has grown substantially since its first six students entered a sixmonth pilot program in 2009. Responding to student demand and community interest, the program has expanded in cohort size and program duration several times since then, growing to include 16 students per cohort in 2014. Most recently TRIUMPH expanded to include M2 students in Milwaukee during Phase 2 of the ForWard Curriculum, resulting in the program’s expansion to approximately 50 students in M2, M3 and M4 classes.

Now, 16 students are competitively selected each year from the cohort of 176 first-year medical students. All begin their training in Madison. Because the Forward Curriculum’s Phase 2 has second-year medical students enter their clinical years sooner than they did in the legacy curriculum, TRIUMPH students now relocate to spend the last half of their second year and their entire third and fourth years in Milwaukee.

Reflecting the school’s focus on combining medicine and public health, each TRIUMPH student is matched with a Milwaukee-area partner to pursue a population-based health improvement project, in addition to clinical training.

Through these projects, students gain a robust understanding of the types of patients and communities they will serve in their future practices; build skills in community health assessment, project design and interprofessional collaboration; and learn to work upstream to address the social determinants of health and health equity.

Another growth boom helped the program leaders and students keep pace: TRIUMPH’s partnerships — including those with Aurora Health Care, the City of Milwaukee Health Department, schools and an abundance of community and public health organizations — have expanded to accommodate more students, who come from Wisconsin and across the nation.

“With the arrival of the 16 members of the M2 TRIUMPH class in January (2018), we are excited to expand our TRIUMPH cohort to more than 50 students who are in Milwaukee at any given time,” says Knox. “They work in collaboration with their clinician teachers and more than 40 community partners that are leading our students and our community toward better health. It’s exciting!”

Fulfilling its mission, embracing challenges

James Dahm is a 2018 TRIUMPH graduate whose successful TRIUMPH journey spanned several of these changes. He did his community project at the Sixteenth Street Community Health Center, a federally qualified community health center, where he worked to improve screening rates for colorectal cancer among Latino patients.

Through data analysis, collaborative engagement and creative community-based interventions, Dahm played a key role in increasing the screening rates among some of Milwaukee’s most underserved patients.

“I believe TRIUMPH will be successful for years to come,” he shares, adding that the program’s family atmosphere and its new leaders’ vast experience levels add to its strength.

While Dahm’s class had a dozen graduates, that number varies each spring because some trainees take time out to pursue global health opportunities or a dual degree with a master of public health (MPH). After these activities, all TRIUMPH students return to finish their training in Milwaukee. With the addition of the newest accepted first-year students, TRIUMPH has enrolled 166 students throughout its 10-year history.

A person looking at a research poster
Natalie Dosch, a third-year TRIUMPH student (center), describes her community project to Azure’De Williams at the student showcase event in May 2018. Photo by Todd Brown/Media Solutions

To date, of the 110 students who have graduated from TRIUMPH, all have gone on to residencies that emphasize service to people in urban, low-income communities. Forty-four graduates have completed residency training, and 100 percent of these physicians now practice in urban areas. Twenty-one of them (about 47 percent) have returned to practice in Wisconsin.

A Milwaukee-area native, Buelow — who splits her time between working for the program and serving as a family physician at the Sixteenth Street Community Health Center — notes that she and other TRIUMPH faculty and staff have worked hard to keep up with the program’s growth. For instance, they coordinate community projects, rotation assignments and many other education-related tasks for twice the number of students they used to accommodate.

She notes, “It’s been challenging for the past few years to have students at different curriculum stages, but they have been really resilient as we’ve gone through several transitions in curricula as well as leadership.”

Perhaps the most difficult part of the curriculum change has been keeping the students connected with each other and with program leaders, says Knox, who practices at Aurora Health Care.

In the previous curriculum, students worked on their community projects for 16 months, and they met with TRIUMPH leaders every one to two weeks, depending on the stage of their education. In the new curriculum, students’ community-based time is closer to 28 months, and they meet with leaders every other week.

“We are thrilled that the students have more time to gain experience with their community project sites,” Knox says. “And to make this happen, we have been redesigning the way students connect with us.”

She adds that the future holds more changes related to the new curriculum, including an increased focus on incorporating health advocacy.

Umhoefer-Wittry predicts that each new class of TRIUMPH students will embrace the changes and will continue to embody the program’s goals of serving the underserved and making a difference in the city.

These goals shine brightly at an annual project showcase, at which all TRIUMPH students present their knowledge and demonstrate their results to an audience of parents, SMPH leaders and community partners.

For this annual spring tradition — held with the TRIUMPH graduation celebration — each fourth-year student shared a brief presentation that described his or her community project, while second- and third-year students displayed abstracts and posters that detailed their projects. TRIUMPH leaders also presented community partners with awards to thank them for their service to the program.

“As a graduate myself and with the ability to see this program from a new perspective, I recognize what a wonderful program TRIUMPH is, and why these community projects are so important,” observes Knox, adding that Haq left a lasting impression on those who trained under her.

“It is a testament to her legacy and the power of TRIUMPH that three alumni provide its physician leadership. We are thrilled that Drs. Theresa Umhoefer-Wittry and Michelle Buelow are on board with me to provide outstanding leadership and support for our students,” Knox concludes. “And we are incredibly grateful to all of our community partners for their help in making this important work possible for the benefit of our students and the community members they serve.”

By Andrew Hellpap
This article appears in Quarterly magazine.