Educating the Rural Physician Workforce: The Roles and Successes of Regional Campuses Jim Boulger, PhD; Emily Onello, MD University of Minnesota Medical School Duluth Campus James Leeper, PhD; John Wheat, MD, MPH University of Alabama, Tuscaloosa Campus Matt Hunsaker, MD*; Craig Davenport, MD University of Illinois, Rockford Campus Taihung Duong, PhD; Kelly Hall; Robin Danek, MPH Indiana University School of Medicine – Terre Haute * Now Campus Dean at MCW – Green Bay

Session Objectives: Attendees will be able to compare and contrast “best practices” from the programs that lead to specific desired outcomes for students’ specialty choices and practice site selections; attendees will be able to identify relevant questions, policies and procedures which may be reviewed at their institution to alter existing program outcomes, and attendees will be able to create a concept map of key decision points in the selection and training of physicians who will meet the national needs for better distribution of physician providers.

Some Basic Cross Campus Data "Main" Campus Regional Campus Population 1,041,467 97,551 Class Size 174 32 NBME Step 1 227.2 213.7 NBME Step 2CK 239.0 228.3 Match %: Family Med 10.5% 51.3% Match %: Internal Med 16.8% 9.0% Match %: Pediatrics 8.8% 7.0% Match %: Surgery 23.7% 11.5% Practice Location Less Than 20,000 Not Available 34.0% Practice Location: Urban/Suburban 31.2%

University of Minnesota Medical School Duluth Campus

University of Minnesota Medical School Duluth Campus Opened in 1972 as a separately accredited 2-year, pre-clinical campus; 24 students in each class Now has 1810 graduates, 861 (47.6%) are Family Medicine, another 19% in Internal Medicine or Pediatrics Preponderance of alumni practices are in non-urban locations

University of Minnesota Medical School Duluth Campus Admissions process has been holistic and evidence-based since 1972 Emphasis on selecting strong applicants from frontier, rural and small communities and from Native American population Entering MCAT scores are below those of University of Minnesota Twin Cities Students; Board scores do not reflect this difference Admissions committee comprised of faculty, family physicians and community members

University of Minnesota Medical School Duluth Campus Outcome statistics have been carefully tracked since the school opened 38 Graduating classes, 1810 Graduates Great partnership with the Rural Physicians Associate Program – typically, more than half the RPAP positions are filled by Duluth matriculants, 60% over the past three classes. Rural Medical Scholars Program and the local Family Medicine Preceptorship match students with family physicians through the first two years of medical school.

Within the required Rural Medical Scholars Program, each student spends five non-consecutive weeks in a smaller rural or frontier community.

861 Family Physicians

University of Illinois, Rockford Campus

RMED Program RMED Students take the regular curriculum as well as the supplemental, required Rural Health Professions (RHP) curriculum. RHP is a longitudinal, interprofessional based course designed to teach concepts in community health needs and interventions as well as rural-specific health issues. The RMED Capstone is an M4 16-week preceptorship where students live in a rural community, participate in primary care learning and healthcare delivery as well as conduct a community-oriented primary care (COPC) project. Rural Medical Education Program (Illinois RMED), housed on the Rockford Regional Campus is “a medical education training program designed to recruit students from rural areas, who will upon completion of residency training, return to rural Illinois for practice.”

Methods The RMED Office longitudinally tracks practice specialty, location, and other demographics of all RMED Graduates. For the purpose of an earlier publication, the full campus data was obtained for specialty selection and practice location, but not broken down into as much detail as the RMED data. This information was extracted for this presentation. Please note that the RMED data is current as of 2014, but the remaining campus data is present to 2007. We do not expect any significant shift in the trends, however as no curricular changes were made during that time.

Results Specialty Choice breakdown Practice Location

Summary Our findings clearly indicate that the University of Illinois COM-Rockford Regional Campus, coupled with the Rural Medical Education Program, is successful in recruiting and training graduates who choose to pursue primary care specialties and practice in rural, underserved locations at a higher rate than the “Main Campus.” Graduates are about 2-3 times more likely to choose training in a primary care specialty and about 8-10 times more likely to practice in rural locations upon completion of the training.

University of Alabama, Tuscaloosa Campus

University of Alabama Medical School, Tuscaloosa Campus Intervention Components of the Rural Medical Scholars Program Program Component Main Branch RMSP FM Medical Director X Pipeline Recruitment Program X Admissions Program Regular Committee X X Rural Subcommittee X Special Requirements 8 years in rural AL X FM/PC Intent X GPA/MCAT thresholds X Rural Values/Identity X Prematriculation Master’s Program Biochemistry X Rural Community Health X Rural FM Preceptor X Medical School Location Preclinical in Birmingham X X X Clinical in branch campus X X Combined FM/CM in rural community X

University of Alabama Rural Program’s Study of Alabama County Data

University of Alabama Rural Medical Scholars: Where they are from University of Alabama Rural Medical Scholars: Where they are from and Where they practice

UA Rural Medical Scholars Program Relative Effect on FM Choice and Rural Practice 1997 - 2005, 2012 Main Branch campus campus RMSP N 840 296 84 Rural (%) 15.1 22.3 43.2 MCAT 30.1 29.2 25.7 4-Yr Grad (%) 88.7 87.8 90.5 FM choice (%) 3.9 18.9 44.0 Rural Practice (%) 7.3 54.5 JABFM Vol. 24 (1):93-101, 2011. UASOM institutional data.

University of Alabama Rural Medical Scholars: Their rural economic impact, 2004-2013.

Indiana University School of Medicine – Terre Haute

Rural Medical Education Program Admissions Recruit applicants using rural zip codes. Evaluate applicant’s short essays on rural life and rural medicine. Request letter(s) of recommendation by applicant’s rural community members. Include rural physicians and rural community leader in interview committees. Offer scholarships specific for the rural track

Rural Medical Education Program Yearly Curricular Themes Year 1: Through the eyes of rural physicians and rural patients Year 2: Understanding the Community Context of Rural Medicine Year 3: Problem-solving in the Rural Community Year 4: Leadership in rural medicine: Implementing change

Rural Medical Education Program Curricular Highlights Rural Student Interest Group in year 1 Rural Physician Preceptors in years 1 & 2 Longitudinal Patient Project through all 4 years of medical school Primary care physicians as course directors in key Introduction to Medicine courses in years 1 & 2. Family Medicine clerkship rural rotation in year 3. Incorporate rural component in as many clerkships in years 3 & 4 as possible. Required Critical Access Hospital rotation in year 4 Completion of a Community Health Project graduation requirement.

Residency choices of 31 graduates (2012-2014)

Concluding Comments Institutional Commitment to Mission Admissions, Admissions, Admissions… Mission Supportive Decisions – Data Driven Pipelines for Rural Applicants Early Clinical Exposure in Family Medicine Strong Family Medicine Influence throughout Curriculum Continuous Rural Presence and Exposure In Curriculum Need For Continuous and Consistent Data Collection

Comments and Questions

Disclosures None

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