Rural, Longitudinal, Interdisciplinary, Curricula for year 03: what have we learned? Roger W. Schauer, MD, FAAFP roger.schauer@med.und.edu ROME Director Dept of Family & Community Medicine Until 1998 UND had the traditional Department-centered basic science curriculum for the 1st two years, with independent clinical clerkships during yr 03, and electives plus a required 2 mo Family Medicine clerkship in yr 04. 1995 - new Dean - challenge to revise curriculum We moved from basic science courses to Patient-Centered Learning for the 1st two years, & moved the 2 month Family Medicine clerkship to yr 03. The dean also challenged us to develop a continuity-based, rural experience for highly motivated students. We reviewed & visited a number of schools, but the success rate of the Rural Physician Associate Program (RPAP) at U of M caught our attention, and was the model that seemed to fit our needs best, with some modification.

Goals Provide the student with a comprehensive, broad-based primary care medical education; Provide the student an opportunity to experience the lifestyle of rural health care providers.

ROME- Rural Opportunities in Medical Education Dean & Administration Support Office of Medical Education Support Steering Committee ROME Program Director Clinical Chairs/Clerkship Directors Campus deans Clinical coordinators in each community ROME is a collaborative interdisciplinary, continuity experience involving five core clerkships, including Surgery, Internal Medicine, Pediatrics, Obstetrics/Gynecology, and Family Medicine. The ROME director is responsible for directives of the ROME Steering Committee, which consists of the sis core clinical clerkship director and/or. department chairs, the campus deans, the associate deans for medical education and student affairs. The ROME director reports to the Office of Medical Education. -Steering Committee from planning stages to develop the ROME curriculum and set curriculum-related policies -Includes ROME Program Director, which has been either the DFM Chair and/or the Predoc Director -Also includes the Chairs of the clinical department/ Clerkship Directors, Bismarck & Fargo campus deans, Associated Dean for Medical Education, as well as the on-site physician coordinators

Yr 03 Curriculum ROME Students Rural setting, 28 weeks Traditional campus, 20 wks Full credit for Family Medicine & Surgery; Four weeks credit IM, Peds, OB/Gyn IM Peds OB/ Gyn Neuro science* Traditional Students 6 rotations, each 8 weeks Traditional students meet all core clinical clerkship requirements on one of three 3rd year campuses, including Fargo, Bismarck, and Grand Forks Internal Medicine Pediatrics Surgery Obstetrics Gynecology Family Medicine Neuro science

ROME Sites Hettinger - 1,307 Devils Lake -7,222 Jamestown – 15,527 Williston - 12,512 Dickinson – 15,632 ROME Sites Canada Devils Lake · Minot Williston · Grand Forks Minnesota Fargo Dickinson · ROME sites - Hettinger - 1,307 - Devils Lake -7,222 - Jamestown – 15,527 - Williston - 12,512 - Dickinson – 15,632 Other ND population information - 640,000, four cities over 35,000 - 36 of 53 ND counties are designated as Frontier (<6 persons/square mile) - 43 of 53 ND counties are full or partial Primary Care HPSAs Med School located at Grand Forks, for all MS1 & MS2 MS3 campuses in Fargo, Bismarck, and Grand Forks. MS4 students are assigned to Fargo, Bismarck, Grand Forks, and Minot (about 15 to each campus) Jamestown · Bismarck Montana Hettinger · Yr 03-04 campuses South Dakota

Outcomes Exam scores* Subject exams USMLE Step 2 Career choices MCATs 26-28, vs 30-31 Subject exams USMLE Step 2 214– 219 vs 215-220 Career choices 49% primary care; with Sx -66% FM– 19 (29%); IM– 8 (12%); Peds– 4 (6%); Med/Peds– 1; Gen S – 11 (17%); Ob/Gyn– 7 (10.7%); EM-4 (6%) Other – 11 (17%) 1 @ in NeuroSx, Neuro, Derm, Psych, Path, Radiol, 5 transitional /subspec 9 of 27 completing residencies are in practice in ND

Support by Clerkship directors Initial support Current support ++++ Family Medicine ++++ ++++ Surgery ++++ +++ Pediatrics +++ ++ Internal Medicine +++ - Obstetrics/Gynecology +++ + Neuroscience* - * Not participating in ROME

LCME findings (2006) – 6 strengths *Rural Opportunities in Medical Education (ROME) Patient Centered Learning (PCL) Volunteer Faculty Indians into Medicine (INMED) Other two were the research program and the Clinical Education Building

Why community-based teaching & learning? “Real world” medicine see more patients wider variety of patient problems more acute care more procedures closer supervision one-to-one teaching

Why smaller, remote communities? Practice and population unmodified by tertiary care practice To increase awareness of needs and opportunities for future practice

Why Ambulatory Setting? That ‘s where the patients are Requires unique skills Teachers possess unique skills/knowledge Authentic role models Influences careers

Additional reported benefits Common office-based problems Chronic disease management (continuity) Health maintenance Prevention & screening Doctor-patient relationship

Situation Prevalence of psych problems Dept of Neuroscience will not engage in teaching during ROME Longer continuity experiences have better outcomes*

Conundrum How can we best engage the Dept of Neuroscience to participate in this longitudinal, continuity, clinical education experience? Conundrum may refer to: A riddle whose answer is or involves a pun or unexpected twist A logical postulation that evades resolution, an intricate and difficult problem