She was born with a congenital malformation that impacted her lower jaw and upper palate. Cullison was barely able to chew by the time she reached third grade.

“Sometimes I had really good doctors and sometimes I had really bad doctors,” said the second-year medical student from Caledonia. “I could tell how well the surgery went based on how well I was treated. That made me think the person who’s (administering) the medicine matters. That’s when I started to think about becoming a doctor.”

Cullison wants to be like one of the good doctors who took care of her. She is one of 376 students pursuing a medical degree at Central Michigan University’s College of Medicine.

Students are drawn to studying medicine for a variety of reasons. This is a time-consuming endeavor when combined with extracurricular activities most medical students are involved in, ranging from pursuing military service to volunteering in social justice activities.

Free time isn’t free

Dr. Robert Fleischmann, a CMED faculty member, said the college wants its students to have a well-rounded life outside of their studies.

“We try very hard to encourage them to make time for themselves (to) work out in the gym, go for a walk; maybe that’s the time when they want to watch TV — to save some time for themselves for their own mental health,” he said.

It isn’t always easy for a medical student to have a social life outside of school.

“Medicine is very focused, so during the week I work hard. I would probably say I spend 12 hours a day focusing on my work,” Cullison said. “But on the weekend, you can make time. It’s all about prioritizing and planning.”

Intramural sports are big among CMED students, said Cullison, who has played soccer, basketball, volleyball and is considering softball.

“Everyone here is active and a lot were collegiate athletes in undergrad,” she said. “We’re all very motivated and competitive young people and we’re fit — so it’s very fun.”

For Madeline Brockberg, activism is an interest she dedicates her free time to. The fourth-year student works with the Gold Humanism Honor Society, a group dedicated to medical students, residents and physician educators who provide for their community.

She’s worked with the Underground Railroad, a women’s shelter in Saginaw that helps victims of domestic violence, sexual assault, stalking and human slavery.

“Certainly we work hard, but we also tend to be high energy and passionate about a lot of things,” Brockberg said. “I’ve been very impressed by the amount of involvement that my classes and the classes below me have had in volunteer work and activism.”

In addition to managing how they spend their time, medical students must also be smart with how they spend their money.

Just scraping by

According to the American Association of Medical Colleges, the average amount of debt for a medical student in 2015 was $172,751.

“Going to medical school for the money is the worst decision you can make,” said second-year student Firas Shalabi.

Because of the cost, Shalabi mostly lives on loans and said he is lucky to have a wife who works during the year. He also supports himself by working during the summer.

“That’s how it works for me. My family is very supportive and wanted to try to help, but I showed them the numbers to show that they couldn’t really help,” Shalabi said.

As a member of the Army, Cullison receives a stipend that helps cover her cost of living expenses.

“I’ve seen people who got their loan money and went grocery shopping because they only had oatmeal left,” she said. “That’s a bummer. They’re here trying to do things that require energy.”

CMED works to help students find places to live when they travel to the partner facilities, said Dr. Steve Vance, associate dean of clinical education. Financial aid helps pay for their housing and the college provides scholarships to help reduce the burden.

Ghannam said getting by can be tough, but working with the college has made it easier.

“You’re definitely not living lavishly. You try your best to live reasonably,” he said. “CMED does a great job of helping with our budget and finding ways to make it work.”

Shalabi doesn’t mind living on a budget for now. After becoming a doctor, he knows his fortunes will improve.

“Nobody really feels pity for medical students because 15 years down the line (we’ll be) making a very comfortable salary,” he said. “That’s just the bumps that we’re going through now.”

Medicine on a mission

CMED’s mission is to train doctors who will serve in rural and under-served communities across Michigan, Vance said. CMED, which launched in 2009, has all four classes filled for the first time this semester.

First and second-year students spend most of their time in a classroom setting on campus while third-year students are embedded for six months at rural family practices across the state.

“This allows (students) to experience longitudinal care,” Vance said. “Seeing a patient and having the opportunity to follow them through the healthcare environment (gives students) a sense of how particularly in rural and underserved regions folks get their care.”

Third-year students will then join fourth-year students and spend the remainder of their time doing clinical rotations at CMED’s partner facilities: St. Mary’s and Covenant in Saginaw and St. John Hospital and Medical Center in Detroit.

Students showed their intellect to CMU through applying to the medical school, Fleischmann said. They were also recruited to be a part of the new school because of what drove them to pursue studying medicine.

“A distinguishing feature of our medical students is (they) are sensitive and caring individuals,” Fleischmann said.

In May, CMED will graduate 64 students — its first class. They will then go through four years of residency before receiving their medical license.

“We don’t expect all of our graduates will want to go into medical care in under-served communities,” Fleischmann said. “I hope we get a significant percentage of them. I’m hoping we don’t lose them all to the big city lights or the ultra-specialty.”

Treatment through teamwork

Shalabi believes CMED isn’t like most medical schools.

“We’re kind of on the cutting edge of the way medical school is changing — and that’s to include more teamwork,” Shalabi said.

Traditional medical schools educate through several hours of lecture, which can be difficult to retain, the Ann Arbor native said. From the beginning, students at CMED are presented cases on a daily basis. They work in groups to figure out how to approach an illness.

“It’s a long process of trying to think like a physician and learning the science through that process,” Shalabi said.

Fleischmann was the first faculty member hired by CMED and helped build the college’s curriculum. Starting a medical school from scratch has its advantages, he said.

“More and more medical schools are including problem-based exercise as part of their curriculum,” Fleischmann said. “Instead of going up against an established practice, we started with a concept we wanted as our feature — problem based learning with groups of students interacting with each other in self-learning environments.”

The importance of case-based learning can’t be overstated, Cullison said. When talking with medical students from other colleges, she was surprised by the differences between curriculum.

“It was interesting to hear what everyone was talking about because they had never been presented a case,” Cullison said. “We were presented a case on our third day.”

Brockberg is working clinical rotations at St. John Hospital and Medical Center in Detroit. She said the teamwork skills she learned in her first two years helped her in the hospital setting.

“When I think about CMED, I think about the community we have,” Brockberg said. “I feel lucky to be a part of a school that provides that.”

About the Patients

Alex Ghannam is a third-year student from Novi. He’s working in Owosso at a family health clinic and conducts rotations at Memorial Healthcare.

From the very beginning, CMED encouraged students to work on patient rapport, Ghannam said. He feels comfortable meeting and talking to patients because he’s had the experience to work past it.

“Most of the anxiety of walking into a patient’s room and examining them got worked out in the first couple of years,” Ghannam said. “By the time I got into a clinic with actual patients, in the real deal, it was much more natural.”

Fleischmann said the school wants students to understand the knowledge they gain in lecture has real world applications, and to learn to treat patients to the best of their ability.

“We want students to treat all patients the same way. Maybe some patients you might be tempted to say ‘well that patient drinks too much so I don’t care about them,’” Fleischmann said. “We don’t want our physicians making those judgments. We want to make sure all patients are given the same, highest medical care possible.”

Both Shalabi and Cullison worked at clinics in Clare as a part of their Integrated Clinical Experience. The students were able to interact with patients and practice their basic medical skills.

She remembers an awkward moment that occurred when conducting a routine cardiac exam on a female patient. The examination checks the heart at different places on the chest.

“I literally had to ask this woman to move her breast — it’s really awkward the first time you do that,” Cullison said, laughing. “But it’s interesting to hit those walls you didn’t know about and then have to overcome them with your instructor.”

‘Always more to learn’

Cullison and Shalabi still have two more years to go, while Ghannam has one.

Cullison hopes to get through CMED and serve her residency in the Army. She said wherever she is deployed, it’s important for her to work in family medicine.

“It’s hard to say because it’s 10 years away from me, but I would not be opposed to moving back to Michigan,” Cullison said. “Especially with the climate we have about public healthcare and how it is being developed and talked about — that’s a climate I want to be a part of,” Cullison said.

Shalabi has a big family in Michigan and plans on staying in the state.

“One of the things that really attracted me to this medical school is the fact that they’re aiming to serve rural and underserved communities,” Shalabi said. “I have always been interested in serving underserved communities, especially in southeast Michigan, certain racial and ethnic populations and that’s my personal plan.”

Ghannam isn’t sure what he’s going to do after his residency. He’s just grateful for the education he’s received at CMED.

“It was tough in the first and second years, because you’re trying to figure out how what you’re learning applies to patients,” he said. “Now I’m in a clinic and seeing people with a lot of the conditions that we’ve learned about — it’s been reassuring that I actually know what’s happening. There’s always more to learn, but I’m surprised at how much I now know.”

Fleischmann is excited to see what the college’s first graduating class is going to accomplish in residency and beyond. He hopes the students look back fondly on their experience.

“I hope they feel rewarded and feel they’ve gotten the highest quality education,” he said. “I hope they don’t lose their idealism — that sense of other-centerdness — to show care and concern for the patient above all else.”

Brockberg is a part of that first class of students that will graduate in May. She came to the school because she wanted to be a part of something new.

She said she wouldn’t have wanted to go to a medical school without the friends and mentors she met at CMED.

She has started applying to residencies and is waiting to find out which hospital she’ll be matched with.

“I really liked the idea of being a part of the first class,” she said. “I thought it was an exciting opportunity to be a part of shaping something, creating a culture and being a leader in a new venture.”