Although Dr. Alma Littles had served as interim dean of the Florida State University (FSU) College of Medicine since February 2023, having the word interim removed on July 1, 2024, was satisfying. The duties of the dean are familiar, but the respect accorded is different, and she appreciates the opportunity to motivate others to pursue careers in medicine.
“It was exciting, but even more than that, it is recognition that it means so much more to many other people,” says Littles. “I will never know the reach but based on messages I’ve gotten—the kids who are in high school and college—even junior faculty look at this and have a whole different thought about their lives, their careers and the possibilities.”
Dean
Littles says the title of dean makes it clear that the College of Medicine fully supports her work, particularly in terms of developing physicians prepared to work with underserved populations. FSU has ambitious plans for advancing healthcare research and education.
“We’re at the point of getting ready to have this explosive growth with FSU Health (an initiative to transform healthcare delivery in North Florida),” says Littles. “We’ll also be able to continue the … really excellent educational program. It’s a different kind of medical education where the clinical education for our students happens out in the community.”
Since the creation of the FSU College of Medicine in 2000, the curriculum has included addressing health inequities and community needs. “When the College of Medicine here at Florida State was created, that was a clear focal point of what we were looking at—those patients who were not receiving services at the level of others,” Littles says. “That included patients in rural areas, the geriatric population, which continues to grow significantly, especially in Florida, and other underserved minorities and communities.”
The education ensures that the medical students are seeing people from minoritized populations as a part of their training. After the first two years of coursework, each medical school class is divided into six groups of 20 each. Those students move to one of the regional campuses—Tallahassee (across town from the main campus), Pensacola, Orlando, Sarasota, Daytona Beach and Fort Pierce—for years three and four of medical school. At those campuses, they are assigned one-on-one to practicing physicians and go through the different rotations. This varies from the traditional model of medical education where third and fourth year medical students are assigned to one large academic health center.
“We assign them to practicing physicians and they go into whatever hospitals those physicians practice at for the in-patient part of their training,” says Littles.
Moving forward, FSU Health is partnering with Tallahassee Memorial HealthCare (TMH) to build an academic health center that will offer advanced medical training and translational research (a field of research that aims to improve human health) for FSU faculty and TMH clinicians. There will also be a healthcare campus in Panama City Beach for clinicians, researchers and students addressing the need for medical care in the Florida Panhandle. Part of Littles’ goals for the year ahead is to recruit faculty for these projects and for the College of Medicine.
As the research and practice are conducted, Littles wants to see its community impact measured. “The question I want to have answered is how did it impact the care and the health of the community?” she says. “We need to look at the outcomes.”
History
The youngest of 12 children growing up in rural Florida, Littles saw the extremely limited access to healthcare. After graduating from the University of Florida College of Medicine and completing her residency at TMH, she returned home to Quincy, Florida to practice.
Within a few years, she turned to medical education and began precepting medical students and residents, joining the faculty of the Family Medicine Residency Program at TMH, eventually becoming director of the program. Upon FSU’s College of Medicine creation in 2000, she became the founding chair of the Department of Family Medicine and Rural Health.
“I always loved teaching. Had I not pursued medical school, I might have actually been a school teacher,” Littles says. “In residency, I was chief resident, which means there is teaching. When I finished my residency and started practicing in Quincy, I would have students coming to my practice. I’d go to Tallahassee and teach … When the College of Medicine was being created and I was part of the initial group … I knew it was something I would love doing.”
Littles has been active in organized medicine, serving on committees and councils that deal with medical education in Florida and nationally, including speaking with state legislators on policy issues. It is a way to have a broader impact.
Preparing today’s doctors
Health and healthcare issues today are vast, and these no doubt impact current medical students. Littles notes that today’s students need to focus on not only learning clinical medicine but learning it in the context of the new delivery systems and new technology. For example, how to incorporate appropriate use of artificial intelligence into practice.
“It can’t replace the patient/physician relationship, so figuring out how to maintain that contact with the patient and utilize the new technology to enhance the care of patients,” Littles says. “The other [pressing issue] is there is a lot of stress out in the world, and physicians are not immune to that, so the students are going to really have to focus and learn how to care for themselves while meeting the needs of patient care and caring for their patients.”
Unquestionably, the pandemic brought an unprecedented level of stress to physicians. Littles says, understanding mental health issues and having an awareness that they exist in the healthcare workforce is crucial, which includes putting structures in place to deal with it.
“We literally hire full-time psychologists who are dedicated to our students,” Littles says. During new student orientation, the College of Medicine requires all students to have a 15-minute appointment with one of the clinical psychologists on staff. The psychologists provide information about the availability of services. “It takes away the stigma. We also encourage them to look out for each other,” she explains.
Florida legislation passed in 2023 restricts diversity, equity and inclusion programming and impacts work towards bringing greater diversity to medical education, but the College of Medicine was built on a foundation of diversity and inclusiveness.
“We have pipeline programs from middle school through undergraduate,” Littles says. “Our challenge will be to continue to monitor and make sure that there is not slippage of that overall mission.”
Going forward, Littles hopes that the physician population at large will want to provide care to underserved communities. The College of Medicine also offers a physician assistant program.
“We recognize now that healthcare is a team,” says Littles. “Having the other members of the team—physician assistants, nurse practitioners and other professionals—ready to contribute is part of improving outcomes.”