Different viewpoints are critical for students to learn early in their education. The Community-Based Clinical Education (CBCE) program at UWS gives students experience working with a diverse set of patients in varying health care sites and systems. We spoke with Patrick Battaglia, DC, DACBR, assistant vice president of CBCE, about the ways CBCE enhances student training, patient outcomes, and community well-being.
What is community-based clinical education?
DR. BATTAGLIA: It’s a distributed model of clinical teaching and learning. Traditionally, health science students attend preclinical coursework then go through on-campus clinical education. Sometimes that includes a small number of community-based placements. Community-based clinical education makes that model more distributed. Students have opportunities to be in different health systems, private systems, hospital systems, and so on. With a distributed system, you can take advantage of a bigger network and diverse clinical experiences.
How is CBCE important for students?
DR. BATTAGLIA: It offers a lot of geographic flexibility. For example, students could return earlier to their hometown to engage in real-world clinical education. The opportunity to be back home or in whatever geography they choose gives many students a good career on-ramp. Imagine being an intern in a site where you’re going to be employed later. You’d get a chance to learn the culture, be immersed in the site, learn the patients and the people. You’re going to be more successful earlier.
Community-based education inherently offers students diverse clinical experiences. If you spent all your clinical education in one site, you would see an insulated patient base that might not be representative of the population. Breadth of clinical education makes a better physician, someone who’s going to have more cultural competency, someone who’s going to be able to provide better care.
How does CBCE support local communities?
DR. BATTAGLIA: Students interface with the community early and often. This increases access to services that otherwise couldn’t be provided. Students develop a sense for that community and will be more inclined to give back and participate in other community initiatives.
How does CBCE address inequities in health care and serve historically disenfranchised groups?
DR. BATTAGLIA: Health inequities are often characterized by an access issue. If you have clinical education opportunities in underserved areas, you’ve offered health care services that otherwise wouldn’t be available, whether it’s chiropractic medicine, naturopathic medicine, or other whole-health disciplines.
How does CBCE improve patient outcomes?
DR. BATTAGLIA: Community-based education gives students the opportunity to see significantly more people and diversity of conditions. Future patients are going to be better served by graduates of this program because they’re going to get someone with more experience, more context, and a better ability to provide care.
What other skills do students gain from the CBCE program?
DR. BATTAGLIA: Students develop soft skills that are important for success in practice, things like talking to patients and understanding patients’ perspectives. Students learn to cultivate more empathy, communicate better, and better problem-solve unique situations. It’s important that they get these exposures while they’re students, because it’s going to make them more successful when they get into practice.
How else will the CBCE program position graduates for success?
DR. BATTAGLIA: We’re proactive about cultivating rotation opportunities in private practice settings, in retail health systems, and in large integrated systems. Our students have that range of health system exposure. We know what health care looks like today, and it’s important to prepare our students for that. More importantly, we prepare our students to thrive in the health care marketplace of tomorrow, and that’s going to look very different.
Montserrat Andreys, DC, M.S., CCSP provides much-needed health care to Portland’s marginalized communities.
When one accounts for her personal and family history, UWS alumna Montserrat Andreys, DC, M.S., CCSP, seems almost destined to have become a sports chiropractor.
Dr. Andreys comes from a long line of wellness providers. Her great-grandmother was a midwife and healer in Honduras. Her grandmother provided massage therapy, a practice Dr. Andreys observed as a child while living with her in Chicago. “I would see people come to the house, and she would care for them,” she remembers. “I was always so curious about what she was doing.”
Dr. Andreys followed her grandmother’s path and entered massage school, but the path eventually sparked an interest in chiropractic medicine. At the same time, she was devoted to her calling as a dancer. Thus, she pursued a degree in dance while using her electives to fulfill premedical requirements, planning to merge both passions into a career in chiropractic.
“With my background, I already knew that I was going to be treating aesthetic artists,” she says. “Dancers, aerialists, contortionists, things like that.” With this plan in mind, Dr.
Andreys’ path eventually led her to UWS to earn her master’s degree in sports and exercise science while simultaneously pursuing her doctorate in chiropractic.
After graduating from UWS, Dr. Andreys started working right away in sports medicine, but she kept her eye on serving the fellow artists to whom she felt so connected as a performer. The fields of sports and the arts were never divided in her vision for providing care.
“My goal was to bring the principles of sports medicine but apply them to the arts communities,” Dr. Andreys says, “because the injuries are the same. I could have a
conversation with a photographer about slipping and twisting their knee from being in a precarious position while trying to get a shot, and I was going to understand that person as well as I could understand that same twisted-knee scenario for a soccer player.”
Building on a Foundation of Inclusion
In 2021, Dr. Andreys founded her own clinic in Portland. She describes Hey Doc Clinic as an integrative health care space, meaning it offers acupuncture, pelvic health care, physical therapy, massage, and mental health care as well as chiropractic. Hey Doc is open to the general population, but the clinic was conceived with marginalized communities in mind.
“We center queer, trans, and BIPOC folks,” says Dr. Andreys, who is queer and Latina, referring to LGBTQ+ communities and the acronym for Black, Indigenous, and people of color. “What that means is that everything we do … signals safety to people that have been most marginalized in health care, most mistreated in health care, most dismissed.”
Dr. Andreys underlines that, through internalized biases of which they may not be aware, health care providers can easily put unintentional obstacles in the way of patients from marginalized groups. Every caregiver inevitably encounters patients from communities with which the provider has little or no previous contact, so they’ll be less familiar with those patients’ unique experiences and needs. Unfortunately, says Dr. Andreys, such barriers can lead to providers not offering the quality of care their patients deserve and patients being less likely to speak up for their needs.
“It can shut them down,” Dr. Andreys says. “It can give them a sense of not wanting to give you all the information that would actually be the most helpful for them to receive care, or that they’ll be judged if they do tell you the truth. Sometimes that is what happens, and people are really mistreated as a result.”
Maintaining Communication and Safety for All
Given the hazards that come with potentially mismanaging marginalized patients, and with the Hippocratic oath in mind, it’s every health care provider’s duty to monitor their own biases. Hey Doc Clinic incorporates fail-safes to accomplish exactly that.
“Even before starting my business plan, I put together an advisory council,” Dr. Andreys says. “The advisory council is there to check me. You don’t want to give the responsibility of checking you to the person that’s harmed; you want them to have somebody they can talk to. The advisory council can catch something before it makes it to a point where it could harm somebody.”
Making the extra effort it takes to serve the needs of patients who otherwise go underserved is no burden for Dr. Andreys and her clinic; it’s a pleasure. “For me, it feels wonderful,” she says. “All of the things that we do on the front end … allow those signals that say you don’t have to be the one to tell us that we could be asking and doing things in a different way. We’re doing it.”
Still, Dr. Andreys is careful not to assume Hey Doc’s patients have no concerns or questions about the health care they get from the clinic, or that they’re comfortable when they walk in the door. “I always do a lot of talking, especially in my initial intakes,” she says. “Part of it is establishing rapport. Am I responding to their statements? Am I responding to the things that they’re saying instead of just bypassing or ignoring them?”
Rapport and questions are just two elements in a larger suite of communication and safety tools that Dr. Andreys employs to reinforce the quality of patient care. Displaying appropriate body language and other nonverbal communication, expressing sympathy, affirming patients’ experiences and emotions, and obtaining consent for physical contact during an examination: these are all critical to supporting a patient’s mental well-being during their care, she says.
Recognizing the Importance of Whole Health
Attending to a patient’s mental health during their appointments speaks to the importance of a whole-health approach to care. To Dr. Andreys, whole health extends even beyond the totality of a person’s body and mind to also include their household, their community. “We know that environmental factors play a huge role in our health outcomes,” she says.
To that end, Dr. Andreys realizes those external factors and that community include her, her clinic’s other providers, and its staff. And health care workers like them aren’t immune to suffering from the same biases and obstacles their patients endure. “There was a tremendous amount of xenophobia during COVID that created unsafe environments for providers in their clinics,” she says, pointing out that providers from marginalized groups often experience discrimination from patients who don’t want to be treated by them or believe they won’t be able to offer a high quality of care.
Those types of interactions can take a toll on providers’ mental and emotional health. That’s why Dr. Andreys is proud that Hey Doc Clinic serves as a haven not only for its patients but for her and her staff as well. As she puts it, “When I walk into the clinic that I’ve created, and the providers are laughing, the staff is happy, and patients feel like they’re being treated well, I feel like I’m dreaming.”
University of Western States has been at the forefront of chiropractic education for 120 years. On this milestone anniversary, we spoke with Dr. Martha Kaeser, dean of the College of Chiropractic, and Dr. Stanley Ewald, associate dean, about how the Doctor of Chiropractic program at UWS is more vital than ever.
What is the need for chiropractors in health care today?
DR. EWALD: There’s a great need. Chiropractic medicine is an underutilized discipline in health care. Many people are either unfamiliar with chiropractic medicine or have misunderstandings about chiropractors and what we do. I think that’s improving. People understand the chiropractic approach better. The more that understanding grows, the more people will seek chiropractic care.
UWS is at the forefront of whole-person health and wellness. How do you define whole-person health care?
DR. KAESER: Whole health is looking at a patient not as a collection of separate areas. If a patient comes in, and their chief complaint is a headache, I’m going to look at this person as a whole person, not just a head or not just a spine if they’re complaining of some kind of back pain.
DR. EWALD: Chiropractic is about addressing patients’ primary issues but it also prevention. We ask questions such as, “How can we implement exercise to strengthen this patient and prevent future injuries or health problems? What does this patient’s nutrition look like? How is this patient’s mental health? I believe the whole-health approach influenced other disciplines of health care largely because the public saw it already happening in chiropractic.
A lot has changed over 120 years. How has the College of Chiropractic changed to address modern needs?
DR. EWALD: The fact that we’ve been successful for 120 years is a testament to UWS’ ability to adapt. We’ve had visionary leadership over 120 years, leaders who have kept pace with the changing health care and educational landscapes. Education today is vastly different than it was 20 years ago.
DR. KAESER: We’re using learning management systems now. Students don’t have to get all the material at once, but they can come prepared to a lecture. For instance, they may watch a 60-minute video or a 20- or 30-minute video. When they come to class, the instructor will have them working through cases, and they’ll apply the information they attained through the video in preparation for class. We use that same way of learning in our lab classes.
DR. EWALD: We have software that breaks down anatomy. Students can go online and see these anatomical breakdowns active and in 3D. They can see the actions of muscles, the effects they have on joints and bones. It’s phenomenal.
What soft skills will define the next generation of chiropractors? In other words, who is the ideal student for the doctor of chiropractic program?
DR. KAESER: I like a student to ask a lot of questions, to be resilient, and to be a good communicator, someone who not only is able to communicate with peers but with team members when they get into a clinical setting. I like a student who understands that, after UWS, learning does not stop, because things are going to be changing all the time. I encourage students to be in this for the long haul as far as lifelong learning.
DR. EWALD: I believe the definition of a good doctor should include compassion. Thus, the students who are best equipped for success are those who come to UWS with a compassionate mindset, who approach their studies with that mindset, and who seek to serve others with compassion, empathy, and kindness.
The Sports Medicine program adds a three-day lab session featuring standardized patient training as part of a program redesign.
Brent Marshall, Ed.D., Sports Medicine program director, and Jesse Shaw, DO, professor of sports medicine, have rolled out their revised model for the Sports Medicine curriculum at University of Western States.
In this new model, lab content for several different classes was collapsed into one lab course that students take mid-program and complete on campus in a three-day intensive session. As part of this program, Dr. Shaw and Dr. Marshall also unveiled the inaugural use of the standardized patient program in which trained actors play the roles of typical patients whom a sports medicine professional will encounter in their work, such as an athlete, coach, or a non-athlete who is beginning an exercise regime.
Dr. Marshall has been at University of Western States since 2014 and has been the director of Sports Medicine for two years. Under his direction, faculty and students of the program recently completed the first year of their new curriculum, which is the culmination of the most comprehensive revision to the program since its inception 12 years ago. This ongoing redesign of the curriculum includes aligning course offerings to better prepare students to work in clinical environments. Dr. Marshall says, “Part of our redesign was to allow students who are already working out in the field as clinicians to come back and get their master’s in Sports Medicine.”
Until this year, students taking courses in the Sports Medicine program have been predominantly Doctor of Chiropractic candidates on campus. The university is taking advantage of online instruction to bring in students from across the country and from different disciplines such as physical therapists and physicians, including MDs and doctors of osteopathic medicine (DOs).
Standardized patients are trained actors who portray scenarios that sports medicine professionals may encounter, commonly an injury that happens during a game. The students take turns interacting with the standardized patient, trying to determine the nature and extent of the injury.
In some scenarios, students assume the role of a trainer on the sidelines of a playing field who must tell a coach their star player has been diagnosed with a concussion and is going to miss the rest of that game and likely additional games, depending on the severity of the injury. The student must relay the information to ensure the athlete is removed from play through the correct concussion protocols.
“Standardized patients have been a great new development for our students because they allow us to replicate real situations that are hard to simulate,” says Dr. Shaw, an associate professor in his second year in the program. “I think our first go-round with the standardized patients allowed us to see how our students can apply the knowledge we’ve taught them as well as to see how they internalize and conceptualize what that interaction will look like.”
Dr. Shaw explains it’s one thing to teach students how to test for a concussion and what the diagnosis of concussion means, but it’s another thing to have a standardized patient recreate what the students will experience dealing with a living, breathing person for whose health, safety, and wellness they’ll be responsible.
“We weren’t sure how this was going to go for our first round,” Dr. Marshall says, “but as we were watching the video and hearing the way that the standardized patients interacted with the students, I said something to Dr. Shaw like, ‘I’ve heard all this before.’ The ways the actors portrayed the situations they were tasked with were verbatim words I’ve heard from coaches and athletes.”
Dr. Marshall was able to say to the students, “This is very real. The SPs somehow reached into our heads and pulled out memories of dealing with coaches who have said, ‘What do you mean they’re concussed? What do you mean they can’t play?’”
Without a script or a checklist, the students had to interpret what their standardized patients were saying and to formulate the correct responses. Dr. Shaw says the standardized patients were convincing in their roles, and none of the students took the exercise lightly. Without knowing in advance exactly what to expect, each student had a different interaction with a standardized patient, so even when multiple students were given the same clinical scenario, they were able to learn from one another.
Dr. Shaw believes the updated Sports Medicine program ushers in exciting new opportunities for internal chiropractic students at University of Western States to get sideline experience in clinical practice. “The university is taking ownership and leadership in high-performance sports medicine,” he says.
According to Dr. Marshall, the standardized patient lab offers University of Western States students rare opportunities to reflect upon and internalize the kinds of difficult conversations they’ll have as sports medicine providers.
Says Dr. Shaw, “This continues to show University of Western States’ dedication to growing the sports medicine field. Our excitement and dedication to growing the program is reflected in the enjoyment that the students get and the experiences that the students get.”
Complementary programs at University of Western States are molded to address the medical needs of communities through a patient-centered approach.
University of Western States plays a crucial role in addressing the health care challenges faced by the Portland community. Through its commitment to whole person health practices focusing on complementary medicine and preventative care, UWS prepares health care leaders who go on to set the global standard for health.
Patrick Battaglia, DC, DACBR, assistant vice president for Community-Based Clinical Education, highlights how UWS prepares students to meet the evolving needs of Portland’s underserved individuals and communities. Explore how UWS shapes graduates to be skilled practitioners and compassionate leaders.
Centering Patients in Health Care Decision-Making
At UWS, our motto is “For the good of the patient.” Our curriculum provides students with an evidence-based, patient-centered model informed by best practices. This patient-centered approach is the foundation for our complementary medicine programs. Students participate in a cultural competency course in their first quarter, which emphasizes how factors such as race and religion play into health care outcomes.
“Our students learn early on how to incorporate patient preferences, values, and beliefs into decision-making,” Dr. Battaglia says. “Patient-centered care is the current standard, and UWS is leading the way.”
Classifying the Standard of Preventative Care
Preventative care is at the heart of UWS’ mission. Preventative care is key to promoting long-term, affordable health for communities. Preventive care often starts with a conservative approach, which emphasizes avoiding invasive procedures or medication as the first step in treatment. For example, studies show that patients receiving preventative care, such as chiropractic care, are 60% less likely to require hospital treatment for spinal conditions.
This method prioritizes less aggressive interventions to manage and prevent conditions, focusing on simpler and less disruptive strategies before considering more intensive options. It avoids invasive treatments and the costs surrounding them. In fact, studies conclude that integrated care can decrease costs and increase patient outcomes. By educating students on the importance of preventative and conservative care, UWS equips the next generation of practitioners to focus on proactivity when it comes to treatment.
To illustrate the importance of conservative preventative care, Dr. Battaglia uses the example of back pain. A patient experiencing back pain might visit a medical doctor and receive an image X-ray or MRI and be prescribed medication. However, if they work with a chiropractic provider first, they might be less likely to develop a chronic condition—and they’ll often save money in the long term, too.
Preventative care plays a crucial role in improving the overall health and well-being of the Portland community, and UWS’ complementary medicine programs are at the forefront of this effort. By integrating our core principles of patient-centered care into every aspect of our curriculum, UWS prepares students to meet the diverse whole person needs of individuals and communities. This approach is the cornerstone of our mission, driving us to serve “For the good of the patient.”
On-Campus Clinical Experience
Here, at UWS, community service is not just an add-on; it is a core component of the educational experience.
For example, the Doctorate of Chiropractic (DC) students’ curriculum includes working in the UWS clinic on campus, serving Portland patients under the supervision of licensed clinicians. The on-campus clinic allows students to gain hands-on experience serving Portland patients under the supervision of licensed clinicians.
The UWS clinic is committed to providing high-quality care at little or no cost for underserved Portland communities. Students also have the opportunity to participate in community service events, one of which is led by our on-campus clinical team.
“These events provide a powerful contrast to the typical campus clinical environment, as students not only witness the challenges faced by these folks but also engage with their stories firsthand,” says Ryan Ondick, DC, associate professor, Clinical Internship. “Addressing their injuries and ailments offers an eye-opening experience, deepening the interns’ understanding of health care disparities and the impact they can have on improving the lives of Portland’s less fortunate.”
This approach ensures that students graduate with the skills and confidence to make an immediate impact in the Portland community—and it’s just the beginning of the UWS impact.
Community Clinical Experience
UWS students participate in an on-campus clinical rotation followed by a nine-month Community-Based Clinical Education (CBCE) program. During their community clinical experience, students have the opportunity to work under the supervision of licensed clinicians in more than 160 regions across the United States and Canada.
This program allows students to gain experience in diverse clinical settings. According to Dr. Battaglia, this model prepares health care providers to deliver high-quality care to underserved communities. “We need to serve big systems such as hospitals and the VA, but we also need to work with small clinics in remote areas,” he says. In fall 2024, 95% of all clinically eligible UWS students are doing clinical rotations in the community across the U.S. and Canada. Student involvement in community-based care increases the readiness of students once they graduate while also serving the needs of these communities.
“We want students to leave with cultural humility and a deep understanding of how to serve patients from diverse backgrounds,” Dr. Battaglia says.
UWS employs a matching process during the CBCE program. Students weigh in on what regions and health care roles they would like to serve.
The support from UWS doesn’t stop at coursework either. “We provide support for students prior to their clinical experience, as well as during and after,” Dr. Battaglia says. This includes help with the relocation process, arranging access to emergency contacts, and onboarding. “We check in with them frequently, both formally and informally, via surveys, emails, and other forms of outreach.” Students also have access to WellConnect, a student wellness program that offers additional support.
Gaining diverse clinical experiences helps students understand the diverse conditions that can affect the entire health care system, such as health care costs, access, and practitioner shortages.
Martha Kaeser, DC, dean of the College of Chiropractic, says, “Our foundational course in the DC curriculum is focused on identifying and teaching the concepts of cultural competency and cultural humility with the goal of equipping students with the skills to advance their professional journey toward becoming a culturally responsive clinician.”
UWS complementary clinical programs prepare students to make an impact, providing a well-rounded education on cultural competency, preventative care, and tangible experience. The UWS commitment to “For the good of the patient” ensures that residents in Portland and beyond benefit from personalized, preventative care that enhances their quality of life and promotes long-term wellness.
How University of Western States Programs Are Designed for Whole Person Health
UWS offers a range of complementary medicine programs that serve the dynamic needs of both regional and international communities. Our evidence-based programs equip students with the skills and knowledge to promote whole person health in Portland communities and around the globe.
UWS is dedicated to empowering its students to become leaders and change-makers in the community. Through a curriculum that emphasizes leadership, ethical practice, and community service, UWS instills values that go beyond technical expertise.
Students graduate with a commitment to lifelong learning, patient advocacy, and social responsibility, ready to make a meaningful impact wherever their careers take them.
University of Western States (UWS), a national leader in chiropractic education and whole-person integrated health care, announces the appointment of Nathan Long, Ed.D., as president, effective October 1, 2024. Dr. Long, who has served as interim president since June, will continue to guide University of Western States, positioning the institution for continued growth and success.
Nathan Long, Ed.D. President of University of Western States; Photo Credit: Kim Long
“We are thrilled to welcome Dr. Nathan Long as the next president of University of Western States,” said Marlene Moore, Ph.D. Chair of the Board of Trustees for University of Western States. “Dr Long is a highly effective and strategic leader who has already made a significant impact on the university. We look forward to UWS’ next era of success under his leadership.”
Dr. Long brings more than 25 years of experience in higher education and a track record of excellence in strategic planning, enrollment growth, and academic program development for institutions such as Saybrook University and The Christ College of Nursing and Health Sciences. His experience at Saybrook University is particularly relevant, as he led the institution in enhancing operational processes, advancement of new academic programs, and amplifying the university’s brand reach to achieve significant enrollment growth.
The University of Western States Board of Trustees’ decision to appoint Dr. Long as president comes after his impactful leadership as interim president, where he has played a key role in advancing the institution’s ability to adapt and problem-solve effectively for the future success of the university.
“I am honored to accept the position of president of University of Western States and am deeply committed to a highly collaborative approach to support the work of our dedicated faculty and enhance student learning,” Dr. Long said. “Building on a strong 120-year foundation and with the strategic support of The Community Solution, UWS is poised for growth. We are committed to advancing whole-person health education, expanding the reach of the UWS brand, and growing our programs and presence in the community.”
Founded in 1904, University of Western States hosts the longest-established Doctor of Chiropractic program in the Western United States, as well as programs in Clinical Mental Health Counseling, Human Nutrition and Functional Medicine, Sports and Performance Psychology, Naturopathic Medicine, Sports Medicine and more. The university has deep ties to Portland, Oregon, and continues to cultivate these connections by partnering with local organizations, schools, and institutions. In 2023, UWS joined The Community Solution Education System, a nonprofit education system made up of six colleges and universities that uses shared infrastructure and collaboration to drive innovation and advance student outcomes.
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