From conflict to the classroom

Rosellen Roche, M.D., Ph.D., is no stranger to daunting environments. From studying disaffected youth in the crosshairs of violence to training military medical students using cutting edge technology, Roche’s career, in the many forms it has taken, has followed a common thread –– increasing resiliency in the face of challenge.

Now, Roche has brought this passion to VCU’s Department of Family Medicine and Population Health, as an academic physician and the new vice chair of medical education. She is dedicating her expansive research and medical experience to the equally challenging pursuit of addressing the nationwide shortage of primary care physicians and training the next generation of family medicine practitioners.

“How we teach our physicians is important because for a large portion of the public, family medicine and primary care doctors are their first and sometimes only experience with medicine,” Roche said. “We’re there for a lot of life’s big moments, from births to deaths.” 

Answering the call

Roche found her way to medicine through an unconventional route. Having always been fascinated by people, she began her career as a social anthropologist – in an active conflict zone.

When she was fresh out of college and on the Trustman Traveling Fellowship from Harvard University, Roche regularly passed through Aughnacloy, a small village at the border between Northern Ireland and the Republic of Ireland. It was 1994, the latter region was the epicenter of an ethno-nationalist conflict known as the Troubles, and the site of largest military checkpoint in Europe at the time was in Aughnacloy. This meant that most days, she was met with armed military personnel and vehicle searches during her research work. 

It was a stark reminder of the decades-long conflict, the impact of which was at the heart of her work — she was studying how young people caught in the middle of sectarian conflict were affected by the “everyday violence.” Her graduate research work at the University of Cambridge then focused on the rates of alcoholism, drug abuse, paramilitary violence, state and military policing violence, terrorism and other negative outcomes among young men and women in the region.  

Roche noted that as an American, she had the rare opportunity to work with both Catholic and Protestant young adults, groups that were generally on opposite sides of both the geographical and ideological border during the Troubles. 

“It was somewhat unusual to be able to work across that divide – most researchers would choose one population or the other because they were hard to access,” Roche said. “But what I found was that there are commonalities in how stress, threat and violence weave together for these communities in exactly the same ways.” 

This led Roche to study the public health consequences of heightened rates of anxiety, depression and post-traumatic stress disorder, and the endemic coping mechanisms, like substance abuse. The next step, she said, was to apply those observations to a new career path – in her early thirties, she began an accelerated medical degree program in the United Kingdom.

Since earning an M.D. at the University of Southampton School of Medicine and returning to the U.S. in 2016, she has continued researching the challenges of specific populations. Currently, she is working with military medical students and military personnel, using virtual and augmented reality to simulate emergency, conflict or disaster environments. Helping students prepare for those potential scenarios, Roche explained, can decrease the likelihood of negative outcomes and trauma responses.

As she settles into her new role at the School of Medicine, Roche said she relies heavily on the skills and experiences she acquired as an anthropologist to direct her population health and medical education research.

“Both experiences lead me to think of medical and research questions for patients, and medical learners in a holistic and cultural way,” she said. “Being an anthropologist is part of me being a doctor, and vice versa. Those lenses, while not interchangeable, inform each other in a way that is only possible with training in each field.” 

Translating experience to outcomes

In her role as vice chair of medical education in the Department of Family Medicine and Population Health, Roche is taking the lessons learned from her research and applying them to another demographic under severe stress –– primary care physicians.   

According to the American Medical Association, 83 million Americans live in areas without sufficient access to primary care, an issue exacerbated by the COVID-19 pandemic’s strain on health care networks. By 2036, the American Association of Medical Colleges projects that the U.S. will be 86,000 physicians short of adequate coverage.

The shortage has created a vicious cycle, as fewer practitioners in the field can overburden active physicians, leading to increased rates of stress, burnout and other negative mental health effects among primary care doctors.

The shortage, Roche said, is a systemic issue the whole country is facing, not just Virginia alone. To address it, investigators, clinicians, educators and politicians need to continue to examine the training they receive and the intersections between physicians, government and patients, and use those findings to influence curriculum and inform policy. It will require continued interdisciplinary investigations into how family medicine trainees are taught, how different entities interact and how educators can build resiliency among a group experiencing a stressful environment, something Roche knows all too well.

One strategy Roche plans to explore is incorporating more simulation and virtual reality technology into medical training at VCU. Roche aims to take lessons learned from her burgeoning work in simulation, virtual reality and artificial intelligence in health care training, and aims to use this knowledge to work with other faculty at the School of Medicine to increase resilience in medical students and residents in primary care specialties in the future.

“I see the world of medical training as something that is long, demanding and necessary,” Roche said. “How do we build an environment to better teach our people and better inform our outcomes? How do we make better, happier, healthier physicians? How do we build systems that will help them to practice their craft at their best? These are the questions at the heart of my research in medical training.”

Scott M. Strayer, M.D., M.P.H., chair of the Department of Family Medicine, echoed the importance of promoting and advancing primary care training and research. He noted that family medicine is still a relatively new field – VCU’s department was founded in 1970, one year after the American Boards approved family practice as a specialty. In 1972, then-faculty member Maurice Wood, M.D., founded the North American Primary Care Research Group (NAPCRG) to support research and researchers within the growing field.

Today, NAPCRG is the preeminent organization for advancing primary care research. Its members include students, clinicians and researchers from across North America and around the world, including Roche, who was introduced to VCU through NAPCRG connections and currently serves as co-chair of the medical education subgroup.

“It’s a really cool, full-circle moment to have a member of NAPCRG join the place it was founded,” Strayer said. “It’s a testament to our institution’s reputation in the world of primary care and medical education research.”

VCU continues its leadership in family medicine, Strayer said, and, in collaboration with residency programs at partnering hospitals across the commonwealth, trains the highest number of family medicine physicians in Virginia. Researchers like Roche, Strayer said, will help advance the department’s overarching goal –– maintaining, and ultimately increasing, the number of family medicine doctors in the state.

“If you’re trying to change outcomes within health more broadly, primary care is one of the best places to look, because we’re the first stop for most patients,” Strayer said. “Dr. Roche's experience will help us grow and innovate our medical education and continue to be a leader in our state.”

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