1. The University of Kansas School of Medicine: FAPR 900 Rural Preceptorship Orientation Michael Kennedy, MD Course Director Debra Lea Course Administrator

2. Medical Education Network Sites

3. Goal of Rural Preceptorship Provide students with an opportunity in rural primary care practice outside significant influence of a tertiary care center. The focus is on the following themes: – Development of autonomy when dealing with common and serious conditions in rural primary care – Exploration of other roles played by physicians in the rural community – Service learning particularly as applied to rural underserved care – Understanding referral and consultation relationships in a rural environment

4. Rural Definition “Rural” for the purpose of this course is defined as anywhere in Kansas outside the counties of: – Wyandotte – Johnson – Douglas – Shawnee – Sedgwick A distance of 45 miles (per map software) from the nearest tertiary care medical center will also be used to eliminate the urban influence.

5. Excluded Counties

6. To Accomplish the Rural Preceptorship Goals Students should expect to see patients in a variety of settings: – Ambulatory clinic – Acute inpatient (hospital) – Emergency department – Nursing home – Home Visits In addition to direct patient care, the student will participate in all related patient care activities as requested by the preceptor, for example: – Hospital committee meetings – Medical supervision at sporting events The student is strongly encouraged to participate in non-medical community activities with their preceptor. – Local service organization meetings – Chamber of Commerce events – School Board meetings

7. Live in the Community Students are expected to live in their assigned community throughout the month- long course.

8. Student Activities Participate in all clinical activities with your preceptor including: – Ambulatory clinic – Hospital rounds – Surgeries – Other procedures – Nursing home visits Committee meetings Participate at least one weekend in your rural community on call.

9. Student Evaluation Based on: Divided into subsections parallel to the evaluation of competency form for the School of Medicine There are six areas in which the student will be evaluated. – Patient Care – Medical Knowledge – Professionalism – Interpersonal and Communication Skills – System-based Practice – Practice-based Learning and Improvement

10. There are 2 objectives in Phase II that are specific to the Rural Preceptorship. 1. Prepare appropriate written and other communications between health professionals and organizations. 2. Appropriately adapt to participate in patient care in rural communities, addressing priorities, opportunities, and constraints in that setting.

11. Student Evaluation To complete the requirements for the Rural Preceptorship the student will fulfill requirements in 5 areas. They are: 1. Clinical Performance Rating -Graded by the Preceptor (US to Sup) per SOM standards PLUS 2. Letter of consultation pass/fail 3. Reflective assignment pass/fail 4. Patient encounter logs pass/fail 5. Service project pass/fail

12. Paperwork Requirements Website has links to the needed forms – http://www2.kumc.edu/orme/required_rural.html http://www2.kumc.edu/orme/required_rural.html Absence Request forms Mileage Forms Mid-Rotation Feedback Form – Due by Third Wednesday – May fax or e-mail Final Evaluations: – Student evaluation of FAPR 900 Rural Preceptorship – CPR form by Preceptor (Please fill this out with them on your last few days, remember, you will not be there Friday.) All Paperwork needs to be completed and turned in to the RP Office during the last day of the rotation at the Friday debriefing.

13. Letter of Consultation Write a letter of consultation for one of the patients referred to a specialist. It is up to the Rural Preceptor to decide whether the letter is to be actually used for the referral. The letter should be copied and de-identified for submission to the Office of Rural Medical Education. It can be faxed or delivered to the office otherwise. It MUST be de-identified to remain HIPPA compliant. Letters that are not de-identified will be shredded and the student notified to resubmit a letter that has been de-identified. The letter should include: - An introduction - A brief synopsis of the appropriate patient history - A description and summary of the evaluation of the problem in question to date - Specific questions that you would like the consultant to address - Closing The letter of consultation will be graded pass/fail but is a requirement for credit in the Rural Preceptorship. There is no length requirement. The letter will be due at the debriefing.

14. Reflective Assignment The purpose of this paper is to have the student examine their rural experience in retrospect. Even though most students are not going to return to rural areas to practice medicine, the personal growth and the professional perspective gained by the Rural Preceptorship can be extraordinary. There is no minimum length requirement. Due date for all of the above is at the end of your Rural Preceptorship. The paper is graded pass/fail and is required for credit in the Rural Preceptorship. The reflective paper should include the areas listed below: – Compare/contrast medical decision-making in the rural vs urban setting – Describe an episode that represents resiliency of rural physicians or people – Describe the physician roles by your preceptor in a rural setting – Describe the referral/consultation relationships in the rural vs. urban practice – What are the priorities, opportunities, and constraints in the rural setting compared with urban settings. – Provide an overview of your project, please attach any slides or material you created to supplement your project (packaged presentations do not need to be included- ie: Tar Wars). Additional suggestions can be found on the website.

15. Service Project In order to fulfill the requirements of the Rural Preceptorship, all students will be required to complete a community-based project. The are several suggestions for a service project on the website. You should work with your Rural Preceptor to find out which of these projects would be best for you and the community. Participation in this experience should be discussed in the Reflective Assignment This is a pass/fail project which must be completed to receive credit for the rotation.

16. Patient Encounter Logs As with the other clerkships, during the Rural Preceptorship you will be asked to keep a log of your patient encounters. This will be done in the same manner as the other clerkships. The submission of the log is a requirement for completion of the Rural Preceptorship. It is graded pass/fail. The log will be reviewed by the Course Director.

17. Course Grades The grade for your Rural Preceptorship will be based on the following: – CPR form that your Preceptor uses to assign your grade – The 4 other areas will need to be completed before credit is given Unsatisfactory or incomplete grades will require repeating the rural preceptorship

18. Questions?