1. CREATING AND IMPLEMENTING A NEW RURAL / UNDERSERVED MEDICAL STUDENT TRAINING TRACK TRUST AT THE UNIVERSITY OF WASHINGTON

2. TRUST: Targeted Rural UnderServed Track  Introduction  TRUST Admissions  TRUST Year 1  TRUST Year 2  TRUST Years 3 & 4  Challenges  Discussion 2

3. 3 The WWAMI Program 1971-2009 66% 61% 70% 59% 17%

4. Rural/Underserved Programs 4  R/UOP: 1988  WRITE: 1996  Underserved Pathway: 2006  Rural required third-year clerkships (Family Medicine, Internal Medicine, OB/GYN)  Rural clinical electives

5. TRUST Continuum 5

6. TRUST Admissions: A Separate Process 6  Where have you lived/worked from birth until present?  How do you imagine your personal and professional lives intersecting ten years from now?  What obstacles have you overcome in your life to get to the point of applying for medical school?  Why have you applied to participate in the TRUST program?

7. Pre-Matriculation Experience 7 Grand Coulee, Washington

8. Pre-Matriculation Experience  2 weeks before starting 1st year 8  Hospital  First observation of a birth  First mentor experience created  EMS  Public Health  Shadowing

9. TRUST: The Students’ First Year Experience 9  TRUST rural health class addressing:  Rural social life  Scope of practice  Benefits/pitfalls  Economics

10. Continuity with the Pre-Mat Site 10  Hands on experience with visits to Pre-mat site  Growth in skills becomes evident to student and preceptor  Mentorship continues  Continuity of care manifests

11. Journal Club 11  Focus on health policy discussions  High student interest evident from lively discussions  Open to other interested students

12. R/UOP 12  Month long immersion clinical experience  Approx 120 of 216 students will participate in Summer 2010  Most students complete a community-oriented scholarly project  Highly rated

13. The Students’ Second Year Experience in Seattle: Building TRUST Scholar Cohesion 13 All TRUST students are together in Seattle for their second year where they:  Continue participation in the Underserved Pathway  Participate in the Rural Health Class  Continue and build relationship with School of Medicine college mentor

14. Underserved Pathway Diagram Pre-Clinical Electives, Selectives, RUOP, Preceptorships in underserved sites Clinical Block Rotations, Core Clerkships, Electives in underserved sites Web Module Service Learning – CHAP, SITC, Volunteer activities Mentorship – Quarterly contacts with mentors, faculty/staff support Web Module Independent Investigative Inquiry 14 Year IYear IIYear IIIYear IV

15. Underserved Pathway Core Curriculum (web-based) 15  Teaches fund of knowledge in underserved medicine  12 web-based modules with interactive elements  Pathway students complete two modules per year  In person/video conferencing sessions to build community with mentor and others

16. 16 UP Provides Core Support for TRUST Scholars  Pathway as curricular base  Pre-matriculation Mentor’s role  New courses (rural health)  Community building and support  Journal Club across years  “Face to face” module completion  Social gatherings

17. Mentorship: TRUST Scholars Have Many Opportunities 17  Pre-matriculation site mentor  Regional Dean - home state mentor  School of Medicine College mentor with underserved service background  Underserved Pathway faculty

18. Mentorship Purposes 18  To establish a long-term mentoring relationship between student and healthcare provider working in an underserved setting  To nurture the student’s career goals  To provide career and educational counseling  To introduce students to working in an underserved setting

19. 19 TRUST: The Students’ Third Year Experience  15 WRITE (WWAMI Rural Integrated Training Experience) sites across the region  20 weeks of integrated training  Immersion experience - Significant clinical responsibilities  Significant outcomes  Two thirds of students choose primary care  One third of students choose rural practice

20. 20 15 WRITE Sites in 5 WWAMI States Note: Alaska not to scale W Sandpoint Libby McCall Hailey Powell Wasilla Ellensburg W Lewistown Grand Coulee Juneau Boise Anchorage Cheyenne Spokane Lander WRITE Site WWAMI Regional Office W W W W Whitefish W Port Angeles W Moses Lake Chelan Helena W W W W W W W W W

21. TRUST: The Students’ Fourth Year Experience 21  Work on career development  Participate in sub-internships  Establish links with regional residency programs  Explore integrated residency

22. Challenges 22  Funding  Program administration costs  Student scholarships and/or loan repayment  Student travel costs  Program evaluation  Faculty Development  Regional challenges - students across four years, faculty across four states

23. Challenges  Pipeline starting with K-12  Connections with communities including training site support  Balance of rural and urban opportunities  Engaging other medical specialties  Linkages with regional residency programs 23