1. Training our Future Country Doctors Interprofessional community-based public health education: An Introduction to the Community Partnership model as a best practice Presented by Joe Florence, MD, RPCT Director At China-ETSU Health Education Institute November 16, 2011

2. Objectives At the end of this presentation, participants will have knowledge of “best practices” for preparing health care professionals for future rural practice: 1.the Rural Primary Care Track of the Quillen College of Medicine. 2.the Community Partnership 3.Interprofessional community-based public health education

3. Rural Experience Rural community based origin – James H. Quillen’s Legacy Rural mission and Institutional Purpose : – with emphasis on community based and inter-professional education – special emphasis on addressing the needs of Southern Appalachia in the area of rural health care

4. US News and World Report Rural Medicine Best Medical Schools ETSU Quillen College of Medicine – Ranked #3 in the US in 2011 There is a growing need in the U.S. for rural medicine doctors. Through these programs, students train to be physicians in rural and underserved communities.

5. Communities

6. Teaching- Learning Research Service ETSU Approach to Rural Curriculum Teaching- Learning Research Service Community-based Scholarship Community Services Interdisciplinary Leaders Partnerships Using the principles of community based participatory research to address community identified issues and opportunities Student reflection on future professional value and sense of civic responsibility Adding to the knowledge of regional community health issues

7. ETSU Rural Programs – Community Partnerships Continuum of Educational Experiences Community Schools –High School Summer Camp –School Based Projects –Career Fairs College –PreMed-Med Program (PMMD) –Summer health related jobs with rural communities for Premed students Medical School –Rural Primary Care Track –Community Preceptorships –International Experiences –Rural Health Fairs –Rural 4th year Electives –Service Requirements in communities –Extra curricular experiences – FMIG, RAM, etc. –SEARCH (NHSC – TPCA experiences) -Summer research opportunities -Appalachian Preceptorship -Rural Preceptors Dinner Residency –Block and longitudinal rotations -Rural Experiences -Supervision of Medical Students at Rural Health Fairs –Tennessee Rural Health Recruitment and Retention Center Activities (TRHRRC) – The Rural Partnership –Placement activities – NHSC, HPSA/ MUA -Rural Recruitment Dinner Fellowship -Rural Primary Care Fellowship Rural Preceptor Faculty Development -HRSA Faculty Development Grant Activities -Preceptor Advisory Group CME -Rural location -Primary Care Research Day -RHAT Regional, National and International Experiences -Electives, Selectives -Volunteer experiences

8. Increase Rural Primary Care Physicians Train Physicians to Function in Health Care Teams Equip Physicians To Become Effective Agents (Leaders) of Community Change Rural Primary Care Track (RPCT) Goals

9. Key Concepts of the RPCT Emphasis on: Clinical experience in context of the community Clinical experience in context of the community Health Promotion, Disease Prevention Health Promotion, Disease Prevention Community Based Participatory Research Community Based Participatory Research Community Assessment and Projects Community Assessment and Projects Inter-professional Training (Medicine, Nursing, Public Health, Pharmacy, Social Work, Clinical Psychology, Respiratory Therapy, Chaplains) Inter-professional Training (Medicine, Nursing, Public Health, Pharmacy, Social Work, Clinical Psychology, Respiratory Therapy, Chaplains)

10. Elect to participate. Formal application process which includes – online application, essays and interview. Limited to 25% of the COM Class. Partner with Rogersville, Mountain City and Another rural community Rural Primary Care Track (RPCT) Medical Students

11. RPCT Medical School Curriculum M1M2M3M4 Fall Rural Case Oriented Learning and Preceptorship 1 (45 hours) Thursday The Practice of Rural Medicine 1 (45 hours) Tuesday Rural Primary Care Clerkship Combines 6 weeks of Family Medicine and 6 weeks Community Medicine Specialty/ Subspecialty Clerkship (6 weeks – 3 x 2 week clerkships; may be taken in a rural community) Rural Selectives (2 – month block rotations in rural community with clinical focused primary care; international rotations accepted with approval of academic affairs) Communications Skills for health Professionals (Interprofessional) (45 hours) Rural Community Projects (Interprofessional) (45 hours) Alternative 1Alternative 2 12 weeks consecutively in Rogersville or Mountain City 8 – 10 weeks consecutively in Rogersville or Mountain City and 2 – 4 weeks in rural site with FM focused maternal child care Spring Rural Case Oriented Learning and Preceptorship 2 (45 hours) The Practice of Rural Medicine 2 (90 hours) Rural Health Research and Practice (Interprofessional) (45 hours)

12. Rural Primary Care Track As of March 2011 Total practicing in primary care - 64% Total in rural practice location - 57% Total in Tri Cities TN practice (non-rural) -8% Total in Tennessee practice - 56% Tennessee natives - 77% Select Tennessee residencies - 50% Tennessee natives, TN residency and TN practice - 30% Tennessee natives in Tennessee practice - 57% Tennessee natives in out of state practice - 43% Out-of-state native in Tennessee practice - 26% Out-of-state natives in out-of-state practice- 74%

13. Role of the Rural Community-based Faculty Crucial to success Establishes the learning environment Mentor and Coach

14. The Interdisciplinary Rural Primary Care Community Partnerships Since 1992 enrolled 700 students from Medicine, Nursing, Public Health, Environmental Health, Social Work and Psychology. Received the National Rural Health Association “Outstanding Rural Health Program” in 2007.

15. Interprofessional Objectives Accreditation Competencies Shared by Health Professions Knowledge – Health Promotion and Disease Prevention – Determinants of Health – IRB and HIPAA training – Theories and conceptual models for promoting change – Roles of various health professions – Health status indicators from primary and secondary data sources – Cultural Competency – Health Disparities Skills – Research – Community Based Participatory Research and Translational Research – Quality Improvement – Community Assessment of health and health assets – Project planning, implementation, evaluation – Communication Behaviors – Interdisciplinary team collaboration – Collaborative community partnerships – Serving the Underserved – Caring

16. Mentoring –campus based faculty who promote rural especially family medicine center faculty –specialists who promote rural –rural physicians –Instill confidence to work in rural communities - demystify rural medicine Rural Health Training – best practices

17. Immersion –Involvement civic activities nurture leadership “Longitudinal” rural experiences provide more accurate “feel” for what practices in rural communities compared with “Block” Rural Health Training – best practices

18. –Knowledge unique to or more common in rural Occupational Environmental Recreational Socio-economic Cultural Spiritual – issues of trust and safety for self, others, nature and God Barriers to health (access) Rural Health Training – best practices

19. –Skills unique to or more common in rural patients’ life in rural Office procedures Management practices, billing, budgeting, QI Stabilization and triage –Experiences which promote understanding rural patients in their context Home visits Work place – occupational health evaluations; service delivery – E&M; risk assessment Rural Curriculum - best practices

20. Community projects Service Learning Community Based Participatory Research Inter-professional, Interdisciplinary Health Careers Education Population Based - School aged, Senior Citizens Occupationally based - Farming, logging, mining, etc. Recreationally based- Hunting, fishing, hiking, camping, etc. Rural Curriculum - best practices

21. Immersion in Rural life and practice –Typical life outside of practice recreational things to do good/desirable lifestyle raising a family in rural community – Support – Professional Personal and family –Practice options in a rural community Financial perspectives – incomes, expenses Exposure to various practice styles – CHC, RHC, Private, etc.

22. Develop community sites and foster Partnership Partner with –Rural physicians individually and their organizations –Rural clinical service facilities: family practice centers, CHC’s, RHC’s, Health Departments, long term care, rural hospitals –Specialists serving the rural communities

23. –Exemplary clinical practice Private practice – solo and group CHC RHC Health Department Hospital Extended, long term care Hospice Develop community sites and foster Partnership

24. Technology: optimize Tele-health experiences Patient care - team care –Electronic Medical Records – Regional Health Information sharing (RHIOs) –Tele-medicine clinics Information Access – evidenced based care –WEB based data bases, libraries –Continuing education –Promote students/residents as teachers to “give back” to rural health care providers

25. RURAL PROGRAM DEVELOPMENT A Quality Improvement Process Institute for Healthcare Improvement

26. Developing Rural Competence Competence is a habit Health care is a cooperative art; performance occurs in relationships; competence in relationships Competence is developed along a continuum Knowing the rules is not enough; values are important Adapted from “Residency Training and Systems Based Practice” (2004) David C. Leach, MD, Exec Director ACGME

27. Principles for Rural Success recruiting rural students into the health professions giving admissions preferences for rural students implementing rural training tracks training in rural communities preferences for rural primary care

28. Rural training best practices In Rural By Rural About Rural For Rural With Partnership

29. You Can’t Fall in Love with Something You Never Experience! If you want a Rural Health Workforce, you need to provide Medical Students and other Health Professional Students with Rural Experiences…….