Community Engaged Residency Education in Rural Places (CERE-R) HRSA Webinar, April 11, 2016 Randall Longenecker MD Executive Director, The RTT Collaborative Senior Project Advisor, RTT Technical Assistant Program Dave Schmitz MD Associate Director for Research and Development, The RTT Collaborative Project Advisor, RTT Technical Assistant Program Thanks for the opportunity for me to friefly present, on behalf of the RTT Collaborative, a process and capacity tool that we have developed with the support of the RTT TA, for whom we are both project advisors, and a Title VII grant subcontract with Family Medicine Residency of Western Montana

RTT Technical Assistance Program “A consortium of organizations and individuals committed to sustaining RTTs as a strategy in rural medical education” Office of Rural Health Policy The RTT TA program has over the past 6 years enabled Dave and me to visit and provide technical assistance to several developing or existing RTTs each year. Last summer I had the opportunity to visit Ronan, MT. http://www.raconline.org/rtt/

At about the same time, FMRWM, a medical education consortium anchored at Montana State University in Missoula, MT, also asked us last summer, in addition to the Ronan consult regarding a 1-2 RTT, to develop a tool for determining the capacity of a variety of rural communities for residency education in western Montana, and we were very happy for the opportunity this provided to put what we had learned in the preceding years into what we hope will become a useful tool for other rural communities around the country.

RTTC 2016 http://www.rttcollaborative.net The community of practice that has emerged from the RTT TA program is a Board directed coop of rural programs – RTTs and full-scale rural residencies, and rural tracks in medical schools, both allopathic and osteopathic, existing and developing programs from Oregon to Maine, ND to Alabama. RTTC 2016 http://www.rttcollaborative.net

Community Engaged Residency Education A Global Context A Distributed Peer Network of Rural Medical Educators A Regional Academic Partner, Health System, and Participating Hospitals A FM Practice A Rural Community And the approach we are fostering, for both existing and developing programs, is a community engaged approach. Whether initiated by a member of the rural community or someone from the city with a bright idea for a residency program, it begins with engaging the community in a rural place. Then: Indentifying a primary care practice willing to be a teaching practice, most often a family medicine practice or CHC Partnering with a regional academic partner, health system and participating hospitals Consulting with a distributed peer network of rural medical educators All in the context of rural medical education efforts world-wide Community Engaged Residency Education RTTC 2016

Community Engaged Medical Education (CEME)1 Community-oriented – a body of knowledge to be taught about practicing in communities (about) Community-based – a place for residency education (in) Community-engaged – a way to address a specific community’s needs, for the mutual benefit of community and academia (with) This is the approach taken by Strasser and others in UME in Canada and Australia, and published in Academic Medicine this past November... RTTC 2016 1Strasser et al, 2015

Place-based health professions education Starts with a rural place and it’s assets It’s “all about the place” Uses various models, options for program design, modified rather than imposed upon the local context (organic medical education) Follows a developmental process that is community engaged, i.e. Community Engaged Residency Education (CERE) And it is consistent with the place-based approach taken in K-12 education programs and others in the US over the past 2 decades It starts with a rural place and it’s assets And brings a thorough understanding of the rules of accreditation and finance to bear in designing training programs organically developed for that particular community “Community Engaged Residency Education” RTTC 2016

At the turn of last century Frank Lloyd Wright brought a similar approach to achitecture, calling it “organic architecture,” since the houses and buildings he designed arose from the character of a particular location, and rather than imposing a model from somewhere else, the design emerged from and was uniquely fitted to that place. RTTC 2016

Rural Residency Capacity and Sustainability Assessment Engage the community Determine capacity Design for accreditation Build for sustainability All at the same time! We use a process that involves 4 steps: And if at any step one is not successful, we recommend you find some way of participating in physician training within the capacity and with the assets you have. Do not stop, and give up. Rather “pause” and wait for a more opportune time to grow into the larger vision you may have! And rather than a single sequence of steps, this is an iterative process, where you’re continuing to engage, continuing to rethink capacity, continuing to design and build. RTTC 2016 CERE-R http://tinyurl.com/engagedresidency

Community Engaged Residency Education (CERE) Engage the Community – Coalition building, following “rules of engagement” (like motivational interviewing in patient care: Pre- contemplation, Contemplation, Preparation, Action) Like motivational interviewing you have to first figure out what stage your community may be in, with regard to introducing a new program RTTC 2016 CERE-R http://tinyurl.com/engagedresidency

Community Engaged Residency Education (CERE) Determine Community Capacity – Helpful tools, Consultations Template for Exploring Community Assets/Challenges Capacity Inventory of Existing and Potential Resources Crosswalk: Concept Mapping If you are able to engage the community, the tool we’ve put together includes a portfolio of guides, templates, and links to additional resources that will further that engagement RTTC 2016 CERE-R http://tinyurl.com/engagedresidency

Options for Residency Rurally located residency program Rural training track of a larger urban program Rurally focused urban program with a rural mission, with community rotations, and broad scope of skills training Design your own And with regard to residency training, here are the options we offer. RTTC 2016 CERE-R http://tinyurl.com/engagedresidency

Community Engaged Residency Education (CERE) Design the program and curriculum for the purpose of accreditation and education Accreditation Guide Sample timeline Requirements Crosswalk It’s at this point, with the community hopefully at least in the contemplative stage, that you begin to flesh out the design. And these are additional tools for this purpose. It’s at this point that The RTT Collaborative and our rural program peers from around the country can help. RTTC 2016 CERE-R http://tinyurl.com/engagedresidency

Community Engaged Residency Education (CERE) Design the program and curriculum for the purpose of accreditation and education Faculty roster Challenges and solutions Sample curriculum And, by engaging a distributed community of rural medical educators, you can access all kinds of creative ideas that have been tried in other rural places! RTTC 2016 CERE-R http://tinyurl.com/engagedresidency

Community Engaged Residency Education (CERE) Develop a business plan – pro formas, affiliations, letters of commitment, contracts, and other agreements Only after you’ve begun the process of design, and have some idea of what you want to do, should you look at the money! If you start here, you’re going to get bad advice because you don’t have a substantive plan, and the process will only focus on cash in the short term, not the longer term investment view that is required for a successful program. RTTC 2016 CERE-R http://tinyurl.com/engagedresidency

Next Steps? CERE-R http://tinyurl.com/engagedresidency You can download the tool – it’s a free resource online. It’s meant to be revised from time to time, in light of feedback and additional resources. I revised it just this past week, and have some more revisions to make in the coming month, including the new eligibility tool from HRSA! The RTT Collaborative stands ready to help, and until the RTT TA program expires the end of August, there are resources available there as well. CERE-R http://tinyurl.com/engagedresidency

Resources for further exploration The RTT Collaborative http://www.rttcollaborative.net RTT Technical Assistance Program http://www.raconline.org/rtt/ Train Rural https://www.traindocsrural.org CERE-R http://tinyurl.com/engagedresidency