ROADMAP TO RURAL: CREATION OF A NEW RURAL MEDICAL EDUCATION PROGRAM Jonathan Cartsonis, MD; Katie Brite, MD; Kathleen Brooks, MD, MBA, MPA; Sara Hillman, MBA STFM 2016

ROADMAP FOR TODAY Entrance Ramp: 20 minutes Introduction Defining Rural Needs Assessment Highway:45 minutes Strategic Planning Small group discussion – our experiences and yours Exit Ramp: 25 minutes Constructing and evaluating your programs Sustainability STFM 2016

TODAY’S OBJECTIVES 1.List obstacles confronted by faculty building a new Rural Medical Education Certificate of Distinction within a mostly urban medical school curriculum. 2.Devise a road map for developing a rural medical education program. 3.Identify strategies that promote and enhance general faculty support of a family medicine- based Longitudinal Integrated Clerkship and appreciation for the educational value of rural preceptorships STFM 2016

Introduction to UAEntering Class of 2015 STFM 2016 Location: Downtown Phoenix First Class: August 2007 Separate Accreditation: Class of 2017 Current Medical Students: 301 New Medical Students each year: 80 Dimensions of Diversity Socioeconomically disadvantaged, educationally under-resourced, underrepresented groups, rural regions: 57%

BACKGROUND TO UA COM-PHOENIX  Arizona in 1990’s faced acute shortage of rural primary care doctors  1997 Arizona Legislature required 15 UA medical students 4 weeks clinical experience in a rural area of the state  Essentially anywhere other than Phoenix and Tucson qualified as “rural”  UA College of Medicine—Phoenix budded from UA COM--Tucson  2013 Rural Health Professions Program started at UA COM-Phoenix STFM 2016

PRIMARY CARE SHORTAGE STFM 2016

UA COM-P RURAL CURRICULUM  Year 1 and 2  Rural COD application due October 1 of Year 1  Scholarly Project on rural-relevant subject (across 4 years)  16 noon seminars  One month Rural PAL block with clinical emphasis, also assignments to understand community medical needs-- same site as future Year 3 clerkship placement  Year 3  19 weeks rural clerkship: 6 wks Internal Medicine, 6 wks Family Medicine, 3 wks Pediatrics, 4 wks Surgery (in development)  Housing and transportation costs + small stipend  Reflective writing assignment  Year 4  Rural electives  Deans letter and transcript noting completion Rural COD STFM 2016

TOTAL RURAL ROTATIONS (ALL STUDENTS)

RURAL PHYSICIAN ASSOCIATE PROGRAM (RPAP) UNIVERSITY OF MINNESOTA STFM

RPAP: How it began in late 1960s – the Stakeholders RPAP: HOW IT BEGAN IN LATE 1960S – THE STAKEHOLDERS  Rural family physicians  Minnesota Academy of Family Physicians  Minnesota Legislature  University of Minnesota Medical School and visionary family medicine faculty STFM 2016

UMN RURAL PIPELINE  Duluth regional campus Years 1 and 2 curriculum  Rural Summer Internship in Medicine elective  RPAP STFM 2016

RPAP 9-month longitudinal integrated clerkship for third year medical students Students complete core clinical clerkship requirements Distributed model across Minnesota Approximately 40 students/year STFM 2016

RPAP OUTCOMES  1164 RPAP alums in active medical practice. Of these:  76% practice primary care  64% practice family medicine  44% practice in rural setting STFM 2016

POLL EVERYWHERE STFM 2016 Join the session: Text Phone #: Message: RHPP Join the session: Internet Web address:

WHAT IS YOUR INVOLVEMENT WITH RURAL? A. Thinking about it B. Just getting started C. 10+ years STFM 2016

HOW DO YOU DEFINE RURAL?  Numerous Definitions, Most Widely used  The U.S. Census Bureau: Anything other than Urbanized Area (UA) or Urbanized Cluster (UC)  The Office of Management and Budget: Not a Metro Area  U.S. Department of Agriculture (USDA) Rural-Urban Commuting Area system (RUCAs)  definitions STFM 2016

ARIZONA STATUTE  Rural means either:  1. A county with a population of less than four hundred thousand persons  2. A census county division with less than fifty thousand persons in a county with a population of four hundred thousand STFM 2016

NEEDS ASSESSMENT STFM 2016

STRATEGIC PLANNING: CREATING A PRESENCE/BUILDING CAPACITY  Faculty and staff Recruitment  Subspecialty Culture – “call it out” STFM 2016

FAMILY COMMUNITY MEDICINE CLERKSHIP (FCM)  Underserved Populations – 97%  Urban Underserved  Rural

FCM CLERKSHIP  Distributed Model  30 sites across the state  Community and Student match

RURAL HEALTH EXPANSION IN FCM CLERKSHIP Growing class size Primary care provider shortage/crisis  Creating excitement in the rural communities  Campus and Clerkship Director: service learning passion  Numbers:  average rural FCM clerkship students:  academic year rural FCM clerkship students:

FCM CLERKSHIP IS A NATURAL RURAL HEALTH PROGRAM ”HUB”  Primary care is the mission  Established in the community  Rewarding relationships  A jumping off point

COLLABORATION IS KEY  Identify natural partners  Involvement is crucial  Identify “nay sayers”  Involvement is crucial

GROWING A RURAL NETWORK STRATEGY  Guidance from mentoring institutions  Classic Questions – Break out STFM 2016

WHAT ARE CHALLENGES IN YOUR ORGANIZATION TO PLANNING A COMMUNITY-BASED RURAL CURRICULUM?

STFM 2016 WHO NEEDS TO BE ON YOUR TEAM?

STFM 2016 HOW DO YOU GARNER RESOURCES FOR PLANNING AND IMPLEMENTATION FOR YOUR RURAL PROGRAM?

DEVELOPMENT OF CURRICULUM: THE UNIVERSITY OF ARIZONA COLLEGE OF MEDICINE – PHOENIX RURAL HEALTH PROFESSIONS PROGRAM Curriculum for Certificate of Distinction  Goals and objectives  Barriers / Obstacles  LCME - identical vs equivalent experiences  Naysayers opposed to non-tertiary experiences, others uncomfortable with LIC  Bringing the consultant/expert with the data (K Brooks) to counter naysayers  Helps if first class of students knocks it out of the park (we were lucky) STFM 2016

FOR THE FUTURE- WHAT ARE YOUR GOALS?  Longitudinal Integrated Curriculum  Possible Rural Track  Ultrasound diagnostic training for COD students  Native Communities  Adding Surgery, Psychiatry and Emergency Medicine  Community Engagement Requirement  Working with Admissions and Recruitment, Pathway program, rural residencies and rural communities to develop pipeline of rural students (continuum of contact)  Cooperation with NAU PA program in site development and interprofessional education  Collaboration with Geriatrics

SUSTAINABILITY STFM 2016

THANK YOU! Thank You!