Rural Medical Scholars Program (RMSP) Rendez-Vous Thunder Bay, Ontario, Canada 10 October 2012 Raymond G Christensen, MD

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1 Rural Medical Scholars Program (RMSP) Rendez-Vous Thunder Bay, Ontario, Canada 10 October 2012 Raymond G Christensen, MD

2 Conflict Disclosure Conflict Disclosure Information: Presenter: Raymond G Christensen, MD Title of Presentation: Rural Medical Scholars Program Employee University of Minnesota Medical School Duluth, MN, USA, and Gateway Family Health Clinic, Moose Lake, MN, USA I have no financial or personal relationships to disclose

3 U of M Med School Duluth

4 Mission Duluth Regional Campus The mission of the University of Minnesota Medical School-Duluth Campus is to be a leader in educating physicians dedicated to family medicine who serve the health care needs of rural Minnesota and American Indian communities, and to discover and disseminate knowledge through research.

5 Rural Medical Scholars Program The Rural Family Medicine, Native American, & Minority Health Scholars Program at the University of Minnesota Medical School Duluth (also known as the RMSP) is an ongoing longitudinal experiential clinical immersion course for UMD students during their first two years of medical school.

6 French River Bridge

7 Today s Topics Structure traditional preceptorship with health system and community participation BlackBag curriculum support Survey and preparation skills Student deliverables H&Ps, SOAPs, CHA, Project, Presentation Reflections Lessons learned

8 Lake Superior Storm

9 Curriculum Revision Duluth has moved to a system based curriculum now matriculating our third class Demand from rural to increase on-site training Design with five experiential clinical learning breaks during the basic science years Reflects an increase from four three day Preceptorships of the past, with goal of improving our mission outcomes

10 RMSP Goal Medical school competency self management; participation, professionalism, and reflection in rural Family Medicine, Native American, and Minority acute and longitudinal health care delivery in Interprofessional clinical, cultural, and community settings.

11 RMSP Description As a health care professional in-training the learner will participate in acute and longitudinal rural health care with their local Family Medicine Preceptor and Clinical Faculty Advisor to develop an understanding of rural medicine and educational competencies. The experience will occur in the Preceptors Office, Hospital, and Community.

12 Summer Sunrise Lake Superior

13 Preceptorship Selection Build on success Vet preceptors Match student requests with sites Look for sites that can provide the RMSP components-preceptorship, health system, community Local Health System Full Service (OB, ER, etc) Community receptivity elder availability Housing

14 Community Rural MN Communities have requested that med students spend more time in their communities Supportive community and community leadership - housing Home visits receptive community and if possible multigenerational family on longitudinal basis Supportive community professionals and leadership

15 BlackBag University of Minnesota Medical School Web Curriculum Support System Contains Schedule with uploaded attachments for each course Students upload assignments Faculty corrects assignments on BlackBag

16 RMSP Surveys All RMSP Students complete an On-Line BlackBag Survey pre and post participation Knowledge of Community Assessment, demographics and geography Rural Family Medicine Rural Support Systems Interprofessional Teams Rural Illnesses Infectious, Mental Health, etc.

17 RMSP I Schedule January RMSP is two weeks. Week one is a skill and cultural competence week. Week Two at Rural RMSP I Site April RMSP I one week includes 3 days with preceptor and two days health system and community June Two weeks. Second week on site or at the MN Rural Summit. Community presentations and assignment completion.

18 RMSP I Schedule January Week One January RMSP is two weeks. Week one on campus BLS/AED/CPR, Suturing, Scrubbing, blood drawing and handling, immunizations, intubation, ECG/Xray, Cultural Competency Discuss assignments and BlackBag Pre-participation survey

19 RMSP I January Week Two On Site in Rural MN or a Native American Site Meet Preceptor, etc. Business card exchange with ~ 20 identified leaders health and community Admission H&P with attendance at Interprofessional assessments and care. SOAP follow-up H&P on Elder to follow for two years Home visit Begin work on CHA

20 RMSP I April One week RMSP with Preceptorship three days see patients and present to preceptor Admission H&P with follow up SOAP Geriatric Patient visit and SOAP Community visit CHA work and completion if possible Reflection

21 RMSP I June Two Weeks Week one on site with same assignments as April Complete Project if done in RMSP I Complete CHA Week Two M-W onsite, Thursday present community to Learning Community, Friday Debrief and complete RMSPI assignments

22 RMSP II One week in October and February H&P and SOAP on and admission, SOAP on Geriatric Patient Complete Project Community visits and reports Reflections Say Goodbye to community

23 Requirements All assignments uploaded BlackBag H&P each visit Business Card exchange and Interprofessional signature list SOAPs each visit CHA (community health assessment) Home visits Community presentation Projects Reflections Final site evaluation by student, and site if willing

24 RMSP I Healthcare Professional Checklist Preceptor Nurse/Medical assistant to your Physician Director of Nursing Psychologist or Social Worker Public Health Nurse Pharmacist Hospital Administrator Chaplain or parish nurse Physical or Occupational Therapist Lab Technician Medical Director or Chief of Staff Dietician Clinic Manager Veterinarian Dentist Midwife Nurse Practitioner /Physician Assistant Child/Adult Protection School Nurse Domestic Violence Advocate Hospice Director

25 Grading Pass/fail Faculty site visits H&P, Soaps, home evaluations, Elder, etc. all deidentified and uploaded to BlackBag CHA Project Reflections Survey Faculty Advisors read and grade submissions

26 Lake Superior

27 Reflections RMSP I 1. Fall 2012 A. Summer Professionalism Essay (Clinical and Basic Science Faculty Advisors) 1. Write a short introductory paragraph about yourself. 2, Building on what we did at the summer orientation in April, describe what being a professional in the field of medicine means to you and how you described yourself in #1 above. B. Cadaver Reflection (BSFA) Describe your experiences with your cadaver in the Skin/MS Course C. Reflection on Professionalism Feedback from Peers (combine Milestone1) (CFA) Describe your reaction to the feedback you received from your peer in your LC. D. Reflection on your first semester of medical school (CFA)

28 Reflections RMSP I Spring/Summer 2013 A. Reflection on a patient who has a neurological disorder in the RMSP (CFA) B. Reflection about an interaction with a patient who is dealing with a mental health problem (BSFA) C. Reflection of professionalism feedback from students (Milestone 1) (CFA) D. Reflection on how your clinical care of a cancer patient related to an understanding of the basic science you have learned in the Immunology, Hematology and Oncology (BSFA) E. Reflection on your firs year as a medical students (CFA)

29 Reflections RMSP II 1. Fall 2012 A. Goals Based on your first year and summer experiences, what are your goals for the coming year? (CFA) B. Reflection on how your clinical care of a patient with cardiac or respiratory Problems relates to your understanding of the basic science in CRRAB. (BSFA) 2. Spring/Summer 2013 A. Reflection on your experiences thus far in medical school, evaluate and revise your goals based on your unique strengths and particular limitations. (CFA)

30 H&P and SOAP Rubric Grid with Dimensions on the vertical axis and emerging, developing, and proficient on the horizontal (1-3 pts. with 10 or more to pass) Style of writing Content Organization Nomenclature Conclusions A/P

31 H&P and SOAP Rubric References References: Herman, J., Aschbacher, P, & Winters, L. (1992) A practical guide to alternative assessment. Association for Supervision and Curriculum Development, Alexandria, VA. Dirlam, D. K. (1980). Classifiers and cognitive development. In S. & C. Modgil (Eds.), Toward a Theory of Psychological Development. Windsor, England: NFER Publishing, Grubb, Mel. (1981). Using Holistic Evaluation. Encino, Cal.: Glenco Publishing Company, Inc. Goodrich, H. (1996). Understanding Rubrics. Educational Leadership, 54 (4), Enhancing Education Carnegie Mellon University

32 Reflection Rubric Grid Horizontal non-reflective, thoughtful action or introspection, reflection, critical reflection. Vertical Writing spectrum, Presence, description of conflict or disorienting dilemma Attending to emotions Analysis and meaning making Attention to assignment Academic Medicine v 87 no 1 Jan 12 pp41-50 Wald et al

33 Faculty Advisors Six Family Physicians Ten students in Learning community Basic Science Advisors Grade H&P, Soaps, Reflections Course director learning contract Preceptor director vet preceptors and sites Oral presentations preceptor all visits In planning: Modules (time in program??)

34 Lessons Identify sites early, NA sites very difficult Trashed the signature lists for business card exchange Expensive and intensive, but faculty visits helpful Learning contract Reflections Failed matches and sites Deceleration and its conflict on sites Preceptor standardization and satisfaction

35 Site problems "Failures" needs a little definition. If we look at all the sites used over the past two years, we have had to shift 5 (of approximately 120) students for the following reasons: 1. Preceptor left practice 2. Bad student/preceptor "chemistry" over first visits (N = 3) or preceptor too negative a role model for that student 3. Switch Native American student from rural, non-native site to IHS site

36 Percent Passing 000 USMLE Step 1 Exam Performance First Time Exam Takers Pass Rates UM-TC US & Canada UM-DU 100% 99% 98% 97% 96% 95% 94% 93% 92% 91% 90% 89% 88% 87% 86% 85% 84% 83% 82% 81% 80%

37 Mean Score USMLE Step 1 Exam Performance First Time Exam Takers Mean Scores UM-TC US & Canada UM-DU

38 Contributors References in Abstract and previous slides Contributing Colleagues James Boulger, PhD, Emily Onello, MD, Ruth Westra, DO, MPH, Jane Hovland PhD, Joy Dorscher, MD, and Richard Hoffman, PhD

39 Questions?

40 Thank You Raymond G Christensen, MD Associate Dean for Rural Health, Associate Professor of Family Medicine University of Minnesota Medical School 1035 University Drive 131 SMED Duluth, MN, USA

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