1. Byron J. Crouse, MD Lisa Grill Dodson, MD Taihung Duong, PhD
Byron will do introductions and depending on number of attendees, will have attendees introduce themselves and provide overview of goals for the session noting we will limit our discussion to medical school innovations as one piece in the rural health pipeline – 5 minutes
Part 1: minutes presentation
Overview of three generations of rural health educational programs 
Intro and overview of early rural programs
Description of three new rural health programs

2. History of Rural Health Programs
First Generation
Jefferson
University of Minnesota-Duluth and RPAP
WAMI
Second Generation
Illinois – RMED
Alabama
Byron – background of rural health programs - 5 minutes

3. Oregon
1992: Required Rural and Community Health (RCHC) clerkship rotation for all MS3 students
50% frontier sites
10% urban underserved
80% FM, 10-15% Peds, 5-10% IM
Originally called Primary Care Clerkship because of faculty resistance to rural label
Lisa – overview of program development in Oregon – 5 minutes

4. Oregon successes
One of the most common reasons for applying to OHSU cited by applicants Consistently the highest rated clerkship Overcame faculty resistance to educational quality issues and rural label Maintained interest among OHSU students in FM as a specialty in the face of declining national interest

5. Oregon failures Decline in # OHSU students matching to FM
No increase in number of students from rural backgrounds
No increase minority students (esp. Native American and Hispanic)
Decreasing # of Oregon(instate) students
Class admitted in 2004, 43% Oregonians
No increase in OR applicants (max 450)
Decreasing percentage of students from rural bkgd

6. Needs assessment OHSU needs:
More Oregon students (legislature and Dean)
More diverse students (faculty, AC, legislature, Dean)
Expansion of class size (Dean, +/-faculty, legislature)
More community based rotations (Dean, legislature, health systems, +/- faculty)
Better relationship with community docs, hospitals
Better relationship with legislature and governor
More state support ($ and other)

7. Figuring it out Champion: Oregon AHEC
Consultants: Local foundation grants funded
Howard Rabinowitz (Jefferson Medical College)
Bob Bowman (University of Nebraska)
Tom Norris and John Coombs (University of Washington)
Joe Ichter (University of New Mexico)
Rural Medical Educators
External partners/beneficiaries
Internal partners/beneficiaries
Make yourself visible, helpful and indispensible!

8. Oregon Rural Scholars Program (ORSP)
Admissions based track (SOM)
5-10 students per year with high likelihood of return to rural practice
Enhanced learning opportunties for rurally interested students (Scholars and others)
Increased support for community preceptors to enhance retention (fac. dev, library, on campus learning, consultation)
Rural recruitment support (locum tenens)

9. Indiana University School of Medicine (IUSM) Rural Medical Education Program
IUSM has one 4-year campus (Indianapolis) and eight 2-year satellite campuses (entering class total of 294).
The new 4-year rural program is based in Terre Haute in West Central Indiana (entering class of 24).
The program is available only to Indiana residents from rural counties.
A rural medicine admissions committee composed of rural community leaders and school of medicine faculty interviews the applicants.
8 students accepted to the first rural medicine class in
Students are assigned to rural physician preceptors and rural patients for all 4 years.
Peter will give overview of Indiana program – 5 minutes

10. University of Wisconsin: Wisconsin Academy for Rural Medicine
Expanding class size from 150 to 175 with 25 new positions for WARM
Need for all specialties
Admissions
Established subcommittee of the SMPH Admissions Committee to address WARM
Curriculum
RHIG
Rural Health Elective during year 2
Years three and four innovations
Rural/Regional educational development
Byron will review initiative in Wisconsin – 5 minutes

11. Rural Admissions Evidence:
Features of medical schools that produce rural physicians (Rabinowitz)
Strong institutional mission
Targeted selection of students
Focus on primary care (esp. FM)
Lisa – 20 minutes - admissions

12. Strengths at OHSU Strong primary care presence
FM dept has significant curriculum time and faculty leadership roles in all 4 years of curriculum
US News and World Report ranking # 2 for OHSU, #3 for DFM (???meaning???)
Rural and urban residency programs, both with rural exposure
Required 3rd yr clerkships in Rural Community Health and Family Medicine
Strong FMIG
Strong AHEC presence around the state
Lisa – 20 minutes - admissions

13. Institutional Commitment
Strengths
Only one med school
Need
Challenges
Fractured relationship between OHSU and the legislature & governor
Poor economy/bad tax structure
Poor support for education,
esp. higher ed
New leadership, unknown bias
Lisa – 20 minutes - admissions

14. OHSU SOM admissions Admissions: MPH, MD/PhD preference
Rising MCAT and GPA scores, heavy “service” weighting
No legislative mandate, declining state $, antagonistic relationship w/legislature
Class of 2008 more than 50% non-Oregon students
Financial implications for SOM (tuition differential)
High quality applicant pool
Strong resistance to “diluting” admissions process
Lisa – 20 minutes - admissions

15. Curricular Innovations
Classroom Experiences
Medical education through a “rural lens”
Rural elective
Content
Timing
Rural Health Interest Group
Byron – 20 minutes on curriculum
Educational
Content
Context
Continuity
Another option to review curricular innovation is more chronologically:
Years one and two
Rural experiences
Classroom experiences
Rural Interest Groups
Summer Clerkship
Years Three and Four
Clerkship location
Electives

16. 1)The Health of Rural People and the Communities
1)The Health of Rural People and the Communities and Environments where they live
2) Rural Health Care Team
3) Rural Links to Public and Population Health 
4) Rural EMS Issues 
5) Rural Obstetric Care 
6) Rural Perinatal and Pediatric Care
7) Surgery - issues of trauma, anesthesia coverage
8) Home Care
- patients sent home from tertiary centers with complex health care services

17. 9) Rural Mental Health and substance abuse 10) Dental Care
11) Rural Hospitals and Networks
- the rural health care 'system
critical access hospitals
rural health centers
community health centers
12) The Economics of Rural Practice
-optimizing utilization of resources
- when/ how to refer/ consult/ communicate with secondary and tertiary centers - clinicians.
13) Community-Oriented Primary
14) Farm health & safety

18. Curricular Innovations
Rural Clinical experiences
MS I and MS II
Rural clinical experiences
Summer experience between MS I and II
Externship
Community/Public Health projects
Research
MS III and MS IV
Geographic innovations
Longitudinal experiences
Rural enrichment opportunities
Byron – 20 minutes on curriculum
Educational
Content
Context
Continuity

19. Faculty Development or
From community physician to clerkship faculty
Taihung Peter Duong, Ph.D.
Peter – 20 minutes on faculty development

20. Identifying clerkship faculty or You are “It”
Clinical faculty for first and second years: continuity into third and fourth years?
Physician preceptors during first and second years: an expanding role in third and fourth years?
Determining common interests/anxieties.
Time management
Linkage with medical school resources
Linkage with medical school faculty
Peter– 20 minutes on faculty development

21. Academics or what do I teach and how?
Expectations of the clerkship director
Understanding the clerkship syllabus
What is the core curriculum?
What is the competency curriculum?
Evaluation tools
Grading practices
Objective Structured Clinical Examination (OSCE)
National Board of Examiners (NBME) Subject Examination
Peter– 20 minutes on faculty development

22. Academics or what do I teach and how?
The didactic material or “do I need to lecture”?
Information technology to the rescue
Polycom to the rescue
What do my students know?
The electronic academic record
Logging patient encounter
Listing clinical skills
Peter– 20 minutes on faculty development

23. Rural Health Programs: The next generation
Innovations in rural health education continuing to evolve
Existing shortages in rural physician workforce significant today and projected to worsen
Summary of key comments from Session
Group thoughts on next steps
Byron will wrap up session, comment on key concepts from presentations and discussion, facilitate brief discussion on needed next steps… 5 minutes