1. Meeting Rural Community Needs: The Community Health Project in Rural Medical Education and The Value of Public Health in the PreMedical Education of Future Rural Physicians Taihung Duong, PhD Robin Danek, MPH Priya Abhyankar Indiana University School of Medicine – Terre Haute Indiana State University

2. Active Patient Care Physicians: 194.5/100,000 (34 th /50 states) National Median: 215.1 Massachussetts: 314.8/100,000 (1 st /50) Active Patient Care Primary Care Physicians: 71.2/100,000 (36 th /50 states) National Median: 80.4 Vermont: 111.5/100,000 (1 st /50) Active Physicians By Selected Age Groups Under Age 40: 16.5% Age 60 or older: 23.4% Physician Workforce in Indiana (2010) Active Physicians per 100,000 Population Active Primary Care Physicians per 100,000 Population

3. Physician Access in Indiana The darkest shading indicates the best access and the lightest colors indicate poor access.

4. Indiana State University/ Indiana University School of Medicine – Terre Haute Rural Health Initiative B/MD program Established in 1997 Recruit high school students from rural areas of Indiana High school GPA 3.5 minimum SAT 1200 minimum or ACT 27 minimum Entering class of 10 admitted to Indiana State University Undergraduate College with full-tuition waiver. Conditionally accepted to IU School of Medicine Undergraduate college GPA 3.5 minimum MCAT score equal to the mean of the entering class from the previous year

5. Graduates from ISU/IUSM B/MD Program Total Number of Physicians34 Primary Care20 (59%) Family Medicine 13 Internal Medicine / Pediatrics1 Pediatrics5 Obstetrics/Gynecology1 General Surgery 3 (8%) Specialties11 (32%) Anesthesiology6 Diagnostic Radiology1 Emergency Medicine2 Neurology1 Orthopedic Surgery1 In Residency Programs11 Practicing in Indiana: 19 (83%) Practicing in Rural Indiana:6 (3%) Practicing Out-Of-State:4 (17%)

6. Indiana University School of Medicine – Terre Haute Rural Medical Education Program Established 2008 Recruit medical school applicants from rural areas of Indiana College graduates apply to IUSM and then to IUSM- Terre Haute RMEP program. 2 separate admissions interviews RMEP Interview Committee include rural community members. Medical students are based for all 4 years of medical school in Terre Haute.

7. Graduates from the IUSM-Terre Haute Rural Medical Education Program Total Number of Physicians31 Primary Care23 (74%) Family Medicine:15 Internal Medicine /Pediatrics:1 Internal Medicine:3 Obstetrics/Gynecology:1 Pediatrics:3 Specialties8 (26%) Anesthesiology:3 Emergency Medicine/Pediatrics:1 Emergency Medicine: 2 Neurology: 1 Physical Medicine and Rehabilitation:1

8. Primary Care Physicians as Change Agents Physicians need training in: Community Engagement Leadership Population Health to prepare them to work with partners within the community and to adapt medical care to address population health needs. Sheline et al. Academic Medicine 2014 May 13 [Epub ahead of print]

9. Improving Population Health Manage chronic disease Redesign clinical care delivery systems Collaborate with interdisciplinary teams in the community to develop and implement health initiatives

10. Action Items of the Rural Medical Education Program (RMEP) Year 1: Rural Medicine through the Eyes of a Rural Patient and a Rural Practice Year 2: Understanding the Community Context of Rural Medicine Year 3: Problem-Solving in the Rural Community: Research and Planning to Meet Community Needs Year 4: Leadership in Rural Medicine: Implementing Change

11. RiCOH and CHP Research in Community Health (RiCOH) Designed for undergraduate sophomore college students in the B/MD program. Immersion population health research experience in hometown rural community. Partnership with local health departments, community hospitals or regional Area Health Education Center (AHEC). Community Health Project (CHP) Designed for fourth-year medical students in the IUSM-Terre Haute Rural Medical Education Program. Research project on health assessment and intervention.

12. “The overuse of U.S. emergency departments is responsible for $38 billion in wasteful spending each year.” New England Health Institute (2010)

13. Purpose Identify and analyze the characteristics of frequent users of the emergency department. Identify potential solutions to this issue.

14. Materials and Methods Define frequent user Identify frequent users from May 2012 to May 2013 Collect patient information from ER records using HPF Webstation Analyze the data in Microsoft Excel

15. Age Distribution of Frequent Users

16. Frequent User Gender Ratio

17. Mental Health History 43% of frequent users claim having a history of mental health issues. Of these: 67% claim anxiety 56% claim depression 23% claim substance abuse 17% claim bipolar disorder 8% claim they have had suicide ideations

18. Top 5 Principal Diagnoses of Frequent Users

19. What I have learned How to think independently How to write and read research papers Research requires patience The mechanics of an ER visit The behind-the-scenes details of hospital work The difficulties of emergency health care treatment The value of primary care physicians

20. RiCOH and CHP RiCOH provides students with initial exposure to research and public health CHP extends experience: Longitudinal Spring of 3 rd year-Spring of 4 th year Encouraged to return to hometown/community

21. CHP details Objectives: Demonstrate how to select study design Evaluate available health ed materials Write literature review Recruit clinic staff and participants Design or choose appropriate survey Design appropriate intervention tool (if applicable) Complete CITI training and IRB protocol Collect and analyze data Write final report

22. Previous Community Health Projects Topics included: Nutrition related(6) Sexual Health (2) Smoking Cessation (2) Emergency Department Usage (2) Resources for Autistic Families Alcohol Abuse among College Students Coronary Artery Disease Fall Prevention in the Elderly

23. Highlights Emergency Room Study 2 studies spanning two different years Terre Haute Clinton Tele-Health Education and Coronary Artery Disease Effectiveness of using tele-health in educating patients on the risk factors of CAD

24. Benefits Insight into Public Health Population health versus medicine Interprofessional Education (IPE) component Sustainable projects “Big picture” of particular topic in Indiana Research experience required for most residencies Increases competitiveness

25. Contact Information Robin Danek, MPH, Robin.Danek@indstate.eduRobin.Danek@indstate.edu Taihung Duong, Ph.D. tduong@iupui.edutduong@iupui.edu Priya Abhyankar pabhyankar@sycamores.indstate.edupabhyankar@sycamores.indstate.edu