1. 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

2. 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

3. 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

4. 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%

5. 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.  2013 Rural Health Professions Program started at UA COM-Phoenix STFM 2016

6. PRIMARY CARE SHORTAGE STFM 2016

7. 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

8. TOTAL RURAL ROTATIONS (ALL STUDENTS)

9. RURAL PHYSICIAN ASSOCIATE PROGRAM (RPAP) UNIVERSITY OF MINNESOTA STFM 2016 http://www.flickr.com/photos/jimbrekke

10. 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

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

12. 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

13. 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

14. POLL EVERYWHERE STFM 2016 Join the session: Text Phone #: 22333 Message: RHPP Join the session: Internet Web address: www.PollEv.com/RHPP

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

16. 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)  https://www.ruralhealthinfo.org/topics/what-is-rural#major- definitions STFM 2016

17. ARIZONA STATUTE 15-1754  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

18. NEEDS ASSESSMENT STFM 2016

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

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

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

22. 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:  2008-2012 average rural FCM clerkship students:  2015-2016 academic year rural FCM clerkship students:

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

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

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

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

27. STFM 2016 WHO NEEDS TO BE ON YOUR TEAM?

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

29. 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

30. 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

31. SUSTAINABILITY STFM 2016

33. THANK YOU! Thank You! J.Cartsonis@email.Arizona.edu K.Brite@email.Arizona.edu kdbrooks@umn.edu S.Hillman@email.Arizona.edu