Tejal Parikh, MD Paul Gordon, MD, MPH Frank A. Hale, PhD Fellows as Peer Consultants: An Educational Site Visit Program for Rural Faculty Scholars Tejal Parikh, MD Paul Gordon, MD, MPH Frank A. Hale, PhD

Background Information The University of Arizona Faculty Development Program (FDP) has been training teachers for many years. Arizona is a relatively rural state with many of our preceptors (130) spread throughout the state Rural faculty face barriers to participating in our FDP

Tucson

Participating Sites 2006: COMMUNITIES Chinle White River Tuba City Three Points Safford Payson Benson Florence Douglas MILES TO TUCSON 353 184 333 34 138 185 57 61 130

Peer Consultant Program: The Process Fellows site visit a colleague’s practice Gather descriptive materials/information Personal observation/interactive discussion Observe teaching IF a student is on site Prepare a consultant report/SWOT analysis on the teaching program at the site Host fellows present practice & submit written response to SWOT analysis

Teaching Program Evaluation Illustrative Educational Site Visit Topics Teaching site orientation & supervision Clinical & non-clinical learning experiences available Teaching methodologies used Opportunities to develop cultural competency

Value added to Rural Faculty Development Program Rural fellows meet face-to-face Provides leadership experience in site evaluation and analysis (Consultant) Provides leadership experience in site presentation & report response (Host) Provides practicum for application of small group teaching and feedback techniques Provides opportunity for exchange of information to improve teaching programs

PEER CONSULTANT TOOL SWOT Analysis

TEACHING ENCOUNTER OBSERVATION

DOCUMENTATION

CHINLEE IHS HOSPITAL

CHINLEE TEACHING CONF

NAVAJO MURAL

CHINLEE HEALING HOGAN

SWOT ANALYSIS SWOT analysis is a useful and flexible objective assessment tool for fellows. Its use structures their roles as outside observers.

Ex: Chinle Internal Strengths CONSULTANT Unique culture stretches societal & epidemiological foundations of student Team approach that extends beyond work HOST Consultant recognized importance of teaching the art of medicine Consultant recognized unit & potluck experience

Ex: Chinle Internal Weaknesses CONSULTANT 1. Limited teaching space in busy facility 2. Too many changes among different medical specialties; make experience patient-centered & not physician-centered HOST Need to address teachable moment space challenges Hope to change structure to most student time with single preceptor

Ex: Chinle Ext. Opportunities CONSULTANT 1. Teaching program helps recruitment 2. Use team approach to schedule learners to follow patients through mid-level & allied health visits HOST Yes, but hope is for a majority Dine staff Loved the suggestion and have already implemented it

Ex: Chinle External Threats CONSULTANT Navajo Nation may take over Chinle Service Unit & limit teaching program Federal funding cuts may reduce resources for student housing HOST 1. & 2. Need to sustain institutional memory of teaching program benefits by dealing with provider burnout and turnover

Barriers and Issues SCHEDULING VISITS DISTANCE AND LOGISTICS REPORT WRITING/REACTION COST-BENEFIT ISSUES – 4 visits/year provide all fellows opportunity to play role of either consultant or host

Summary of Experiences of First 18 Months Face-to-face meetings uniformly enhance evaluation of Rural Fellowship Site visit practicum of greatest value to leadership experience of consultant Consultant reports identify physician burnout as the most crucial threat to the quality of the rural teaching program Consultant reports identify a quality rural teaching program as a key opportunity for physician recruitment and retention

Fellows as Peer Consultants: Future Recommendations Address scheduling & logistics at first meeting Match the clinical interests of consultant & host, eg IHS physicians Provide specific report expectations as to SWOT analysis and response

THREE POINTS

FLORENCE

FLORENCE EMR

Strengths: Florence New, clean, efficient clinic with diversity of patients EMR experience Clinic owner Dr. X, grew up in community and the practitioners have gained the respect of the local population Dr. X received his MD from the U of AZ College of Medicine and knows the faculty there and he completed the faculty development fellowship

Weaknesses: Florence Busy clinic with practitioners seeing an average of 20 patients per day may not allow ample teaching time for student No inpatient experience for students This site has never had a student rotate through the clinic although they will receive one this summer Housing for the student is an unknown Limited partnership with other clinics in the community

Opportunities: Florence Opportunity to work with immigration and prison health EMR allows for easier research on common primary care topics

Threats: Florence Lack of specialists in community as an additional teaching opportunity Lack of organized CME either through the clinic or county The members of the medical community are not unified High level of uninsured or under-insured in the community could impact funds and future of the practice Additional providers moving into the area would increase competition