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

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

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

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.

Communities

Teaching-Learning

Res

earc

h

Service

ETSU Approach to Rural Curriculum

Teaching-Learning

Res

earc

hService

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 onfuture professional value and senseof civic responsibility

Adding to the knowledge of regional community

health issues

ETSU Rural Programs – Community Partnerships

Continuum of Educational ExperiencesCommunity 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

• 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

Key Concepts of the RPCT

Emphasis on: Clinical experience in context of the

community Health Promotion, Disease Prevention Community Based Participatory

Research Community Assessment and Projects Inter-professional Training (Medicine,

Nursing, Public Health, Pharmacy, Social Work, Clinical Psychology, Respiratory Therapy, Chaplains)

• 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

RPCT Medical School Curriculum M1 M2 M3 M4

Fall

Rural Case Oriented Learning and Preceptorship 1 (45 hours)

Thursday

The Practice of Rural Medicine 1 (45 hours)

Tuesday

Rural Primary Care ClerkshipCombines 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 1 Alternative 2

12 weeks consecutively in Rogersville or Mountain City

8 – 10 weeks consecutively in Rogersville or Mountain City and2 – 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)

Rural Primary Care TrackAs 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%

Role of the Rural Community-based Faculty

Crucial to successEstablishes the learning environment Mentor and

Coach

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.

Interprofessional ObjectivesAccreditation 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

• 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

• 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

– 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

– 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

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

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.

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

– Exemplary clinical practice• Private practice – solo and group• CHC• RHC• Health Department• Hospital• Extended, long term care • Hospice

Develop community sites and foster Partnership

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

RURAL PROGRAM DEVELOPMENT

A Quality Improvement Process

Institute for Healthcare Improvement

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

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

Rural training best practices

In RuralBy Rural

About RuralFor Rural

With Partnership

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…….