1. Creative Integration of Inter-Professional Experiences Into Medical Student Community Projects: The Wisconsin Academy for Rural Medicine (WARM) Experience
Byron Crouse, MD, Kimberly Lansing, MD, PhD, Rebecca Lundberg, Michael Priem, Karyn Cecele

2. Wisconsin Academy For Rural Medicine University of Wisconsin School of Medicine and Public Health
Meeting the health needs of Wisconsin and beyond through excellence in education, research, patient care, and service

3. Wisconsin Academy for Rural Medicine (WARM)
Need

4. Rural counties, rural counties adjacent to metro counties, and urban non-metro counties, according to the Iowa State University Midwest Profiles and based on the USDA Beale Code Definitions.

5. Rural Medicine Pipeline
University of Wisconsin
School of Medicine and Public Health
Rural Medicine Pipeline
Elementary school
student
Established rural physician
Medical
student
Prepare primary and secondary students in basic sciences and expose them to health care professional role models
Enhance college pre-medical experiences and strengthen medical school application portfolio
Recruit students with rural backgrounds and career goals
Ideal
Student
Locate education and training programs within rural communities in Wisconsin
Ideal
Environment
Enhance traditional MD curriculum with relevant rural medicine curriculum
Ideal
Preparation
Promote development of rural GME rotations, residencies, and fellowships
Facilitate recruitment and retention of graduates for employment in rural Wisconsin
Enhance the rural health care environment through support of rural hospitals and clinics
WRPRAP
WCRGME
WiAHEC
RUSCH
WARM
WiOHR
WiAHEC Wisconsin Area Health Education Centers, administered through the SMPH
RUSCH Rural and Urban Scholars in Community Health, a pipeline program of the SMPH
WRPRAP Wisconsin Rural Physician Residency Assistance Program, a program within the SMPH
WCRGME Wisconsin Collaborative for Rural GME, a WRPRAP funded program at the RWHC
WiORH Wisconsin Office of Rural Health, administered through the SMPH

7. WARM Timeline WARM Milestones WARM Funding Streams
Cohort
Graduates
1st WARM Graduates
Begin Practice
WARM Milestones
WI Rural Medical Education Planning
Committee
University Committee Approval
1st
Cohort
Admitted n=5
Marshfield
And Rice Lake Clinical Training Sites Open
La Crosse Clinical
Training Sites Open
Green Bay
Clinical Training Site Opens
Pathway of Distinction in Public Health and Primary Care (PRIME)
Available
8th
Cohort
Admitted n=26
Collaboration Planning Grant
Strategic Initiatives
Grant
Wisconsin Partnership Grant
HRSA
Grant for Pathway of Distinction
State
Expansion
Funds
I moved this slide a little later
WARM Funding Streams

8. Wisconsin Academy for Rural Medicine (WARM)
WARM Graduates
102 Graduates to date
-48 graduates (47%) in WI residencies
-53% in primary care
– 37 in family medicine, 10 internal medicine, 4 pediatrics, 3 med/peds
-- also psychiatry, Ob/Gyn, general surgery, ENT, ophthalmology, orthopedics and urology, radiology, emergency medicine, dermatology, PM&R, anesthesia, internal med/EM
102 students have
graduated from WARM. Fifty-four percent
of graduates are pursuing a primary care
specialty (36 percent in family medicine), and
47 percent are completing Wisconsin-based
residencies in various specialties.

9. WARM Grads in Practice 23 graduates have completed residency
87% are practicing in Wisconsin
52% are serving rural Wisconsin (RUCA > 4)
30% have returned to their home towns

10. WARM Curriculum Map WARM Admissions Committee
Rural Health Topics Course
Rural Regional Clinic Preceptorships
Year 1: Pre-Clinical Curriculum
School of Medicine and Public Health, Madison, WI
Summer: Rural Clinical, Public Health, and Research Externships
Year 2: Pre-Clinical Curriculum
School of Medicine and Public Health, Madison, WI
Year 3: Required SMPH Clinical Immersion Curriculum
WARM Clinical Training Site Regional Hubs*:
Marshfield Clinic, Marshfield, WI
Gundersen Health System, La Crosse, WI
Aurora Bay Care, Green Bay, WI
*Students train at multiple rural clinics within region
WARM
Core Days
Rural Community Engagement Projects
Curriculum includes unique WARM elements
Year 4: Required SMPH Clinical and Elective Curriculum
WARM Clinical Training Sites and
Other Community and Academic Health Centers
Curriculum is same for all SMPH students
Graduation

11. A Rural Experience From Start to Finish…
Rural Health Electives
Rural Medicine Core Skills Days
I am not sure this slide is needed… I will be giving a lead in to the community health projects and I think the flow would be more natural to your next slide

12. Inter-Professional Rural Community Health Projects

13. Why Inter-Professional Projects?
“Once students understand how to work inter-professionally, they are ready to enter the workplace as a member of the collaborative practice team. This is a key step in moving health systems from fragmentation to a position of strength.”


Source: World Health Organization (WHO). (2010). Framework for action on interprofessional education & collaborative practice. Geneva: World Health Organization.

14. A Community Oriented Approach to Local Health Related Issues
Community Oriented Primary Care (COPC) format includes:
Defining the community
Identifying the problem
Develop/implement interventions
Conduct ongoing evaluations
Slight format change… Added GHS logo

15. Project Ideas From Our Students
Sports injury prevention
Cultural health
Older adults

16. More Project Ideas From Our Students
Water fluoridation
Immunizations
Nutrition
Physical activity

17. More Project Ideas From Our Students
Farm Safety
Women’s health
Health Promotion
Disaster Preparedness

18. Identifying Community Resources
Your local AHEC
Public and private schools
Churches or other religious organizations
Boys and Girls Clubs
YMCA/YWCA
Service Organizations like Rotary, Lion’s Club
Hospitals and Clinics
Health Department

19. More Community Resources…
Scouting organizations
Police, Fire, and EMS
Local government
Colleges and Universities
Student service organizations
Park and Recreation Departments
Nursing Homes and Care facilities

20. Community Resources Are Everywhere
Local businesses
Local cultural groups
Agricultural and utility co-ops
Community Transportation
Community Gardens
Local farms
Community Centers

21. Michael Priem Rebecca Lundberg
Disaster Drill
Michael Priem
Rebecca Lundberg

22. Literature
Medical simulations facilitate learning among trainees especially when combined with feedback to learners and opportunities for repetitive practice.
Longitudinally, simulation exercises maximize retention of information and transfer skills to day-to-day practice.
51% of the 109 articles review identified Feedback as a key feature of simulation based education and 39% identified Repetitive Practice as a key feature.
Simulation exercises are important adjunct training for emergency medical providers and technicians who have infrequent opportunity to apply learned emergency medical care

23. Participants Medical Education Community
-Gundersen Health and Mayo Health Emergency Departments
-La Crosse Fire Department w/ Hazmat
-La Crosse Police Department
-Tri-State ambulance
-La Crosse Emergency
Management
-Local Media
-MedLink
-Salvation Army
-UW Medical Students (WARM and traditional)
-Health Science Academy high school students
-Simulation Lab (ICE House) from Gundersen Health Systems
-La Crosse Central High School students
-UW-La Crosse Pre-med students

24. Overview Pre-Drill: Day of Drill: Post-Drill:
Developing goals → Design Drill → Find resources → Victim Preparation → Coordination!
Day of Drill:
Moulage → Drill at High School (3 hrs) → Individual drills at ED
Developing goals: ED wanted burn victims, Fire dept mass casualties, variable injuries (for triage)
Designing the Drill: discuss mass casualty scenario (IED explosion at high school baseball game with unknown gas)
Victim preparation→ talk about number of victims (60) and types of injuries (burns, respiratory distress, blunt force trauma (eye avulsion))
Post-Drill:
Food → Feedback directly after the drill → Cleanup

25. Video https://adobe.ly/2ikqUR8
ℎ𝑡𝑡𝑝𝑠://𝑎𝑠𝑠𝑒𝑡𝑠.𝑎𝑑𝑜𝑏𝑒.𝑐𝑜𝑚/𝑙𝑖𝑛𝑘/8𝑏91𝑑𝑑60−𝑓576−4021−660𝑎−1𝑑𝑒𝑏069𝑎2𝑐𝑐8?𝑠𝑒𝑐𝑡𝑖𝑜𝑛=𝑎𝑐𝑡𝑖𝑣𝑖𝑡𝑦_𝑝𝑢𝑏𝑙𝑖𝑐
I could not get this to run….I wonder if this link only works on your network

26. Value to Community & Education
Medical Education
Community Value
Partnership with community
-relationship building
-knowledge of community resources and abilities
Experience with organization and leadership roles
Simulation Training Experience-Residency Preparedness
Improved disaster preparedness
Hands on experience and address learning goals
Identify weaknesses/ feedback session
Continue educational requirements
Need picture or delete reminder/text

27. Health for the Generations
Karyn Cecele
WARM Community Project

28. Health for the Generations
What it is
Why it matters 
Collaborations

29. What it is Health careers camp
Native American high school students from Pine Ridge 
Health Science Academy Students from La Crosse, WI
5 day health careers camp in La Crosse, WI. 
La Crosse hosts up to 12 NA high school students from communities on Pine Ride reservation in South Dakota.We're returning the favor. The week prior to the camp, students from La Crosse are hosted by Pine Ridge for a week during a health education camp.

30. Why it matters Native American Healthcare Provider Shortage
1.7 % of US population
0.4% of nurses, less than 0.4% of physicians
0.25% of med school matriculants in 2014
Race Concordance
Patients with physicians of the same race have better outcomes
Health Disparities
Life expectancy 4.2 years less than general population
Here's why it matters:
There is a serious shortage of NA healthcare providers. 
That matters because of race concordance. Numerous studies have shown that pts with provides or the same race have better outcomes. 
That matters because of health disparities.To name just one measure, NA life expectancy is 4.2 years less than the general populations. 

31. Pine Ridge Population ~20,000 Unemployment >85%
97% live below federal poverty line
70% dropout of school
Life expectancy  for men: 48 years
Life expectancy for women: 52 years
Diabetes rate 8 times national average
Suicide rate 150% higher than national average for teenagers
That is particularly important for Pine Ridge Reservation, because health disparities are very high among its communities. To tell you a little bit about Pine Ridge, … ... The camp is one of many attempts to address the healthcare provider shortage and these health disparities. 

32. Collaborations: The Committee
There were many collaboration that make the camp possible. There were five organizations that formed a core committee, but as you'll see there were many other collaborations involved. 

33. Collaborations: Pine Ridge (It's Complicated)
There is also work done in Pine Ridge of course. Things like arranging transportation, finding chaperones to come with the campers, selecting campers, shaping curriculum. But even that simplifies a complicated web of relationships that exist between Pine Ridge and La Crosse.And it's that web that helped create this camp. The details are lost, but I can tell you a bit about how collaborations between these two communities work. 

34. How It Really Works
Here's how it really works.At this year's camp we had a trauma rescue simulation with the fire department. A camper was talking about her experiences as a volunteer fire fighter in Pine Ridge.  Leaking truck. No protective equipment. Fire chief was appalled by this.A conversation started and spread. By that evening, there was a plan in place between La Crosse and Pine Ridge to address the issue.  

35. Collaborations: Curriculum
We had a lot going on! In order to make that work,there were a lot of other collaborations involved. 

36. Collaborations: The Camp
Native American Center for Health Professionals – University of Wisconsin
Viterbo University
Native American Pathways Program – University of Illinois
Waterfront Restaurant
The Pearl Ice Cream Shop
Deep Root Farm
University of Wisconsin – La Crosse Exercise and Sports Science Department
University of Wisconsin Book Store
Gundersen Integrated Center for Education 
Gundersen Diabetes Education
La Crosse Parks and Recreation
Tri-State Ambulance/MedLink Air
La Crosse Fire Department
The Manson's 
Don't worry!I'm not going to read the list to you. I just  wanted to give you a sense of what was involved. To wrap up here, I feel so grateful that I had the opportunity to work with people from many different backgrounds and professions. It really helped me grow as a leader, and that's not something I got a lot of experience with elsewhere during med school. Thank you. 

37. “I hear and I forget. I see and I remember. I do and I understand
“I hear and I forget. I see and I remember. I do and I understand.” - Confucius