What is an RTT? Randall Longenecker MD Senior Project Advisor RTT Technical Assistance Program
Objectives Explain a variety of definitions for the phrase rural training track Review the operational definition of a 1-2 RTT now in use by the RTT Technical Assistance program Describe a variety of ways that this prototype has been implemented in practice
RTT = Rural Training Track Generally, used loosely to describe programs in both medical school ( rural tracks ) and residency ( rural training track ) Specific to the 1-2 RTT prototype established in Spokane, WA, in 1985, as a strategy to better prepare physicians professionally and personally to practice and live in rural places
RTT - General Track a defined pathway, yet integrated within a larger program Training designed to prepare learners for rural practice Rural located in a rural place or with a rural focus (Although used primarily in reference to physician training, it has been used to refer to health professions training of all types)
1-2 RTT - Specific First recognized through formal ACGME accreditation 1996, but only as a waiver from the usual requirements: Separate accreditation number from the main program, but with the same sponsoring institution Self-designation in a separate Program Information Form (PIF) as a rural training track
1-2 RTT - Specific Requirements continued: One year in the larger urban program; then two years in the smaller more rural place A minimum of two residents in the smaller, more rural place (a waiver from the minimum of 4 residents/yr in a regular Family Medicine residency Mandated 24 months of continuity practice in the rural site, with the exception of 2 elective months away in each of the 2 nd and 3 rd years
Operational Phrase: 1-2 and other integrated rural training tracks Section 407(c) of Public Law 106 113 which allows an urban hospital that establishes separately accredited approved medical residency training programs (or rural training tracks) in a rural area or has an accredited training program with an integrated rural track.. Federal Register August 1, 2000 (BBRA 1999) 7
CMS Definitions ACGME accredited program in the 1-2 format (alternative tracks established in law by BBRA 1999, and as a final rule in 2000) Integrated RTT any accredited residency program, MD or DO, established in collaboration with an urban residency, where greater than 50% of the resident s training occurs in a rural place (e.g. 19 months out of 36 months established in law by BBRA 1999, and as a final rule in 2003)
Integrated RTT The OSU Rural Program Three Year Curriculum Intensive immersion experiences embedded in a continuing rural practice 1 2 3 4 5 6 7 8 9 10 11 12 13 YEAR 1 (Shared) Pediatrics Inpatient (NRP) Special Nursery OB Newborn Cardiology (Wound Healing) MICU (ATLS) Peds ER Scholarly Activity (Shared) MRH MRH CHC MRH OSUH MRH MRH OSUH MRH OSUH MRH CHC MRH Mad River Family Practice -- Periodic office patient care, daily hospital rounds 2 Half-days 2 Half-days 1 Half-day 2 Half-days 1 Half-day 2 Half-days 1 Half-day 2 Half-days 1 Half-day 2 Half-days 1 Half-day 3 Half-days YEAR 2 Ambulatory Cardiology Elective OB - Newborn OB Newborn (High Risk Immersion) Dermatology Pediatrics Outpatient ICU Intern Med Orthopedics Medical Sub - specialty MRH/Offic MRH MRH Office Office MRH MRH/Office MRH/Office Office The OSU Rural Mad River Family Program Practice -- Periodic office Three patient care, daily Year hospital rounds Curriculum Scholarly Activity and Community Medicine 4 Office 0-4 Halfdays 2 Half-days 2 Half-days 4 Half-days 2 Half-days 8 Half-days one week 4 half-days 4 Half-days 0-4 Halfdays 3 Half-days Half-days None the next Intensive immersion experiences embedded in a continuing rural practice YEAR 3 Elective GYN Elective 0-4 Halfdays Geriatrics, Physical Medicine, and Psychiatry GYN Elective Surgical Subspecialiies Opthalmology, ENT, Urology, Podiatry Elective Sports Medicine Office Office Office OSU Sports Ctr Mad River Family Practice -- Periodic office patient care, daily hospital rounds Practice Management and Community Intervention 5 Office Half-days 4 Half-days 0-4 Halfdays 5 Office Half-days 0-4 Halfdays [Gray shaded rotations occur at least in part in Columbus, Ohio] Elective 4 Half-days 0-4 Halfdays Medical Sub - specialty MRH/Office 0-4 Halfdays
Integrated RTT The OSU Rural Program Three Year Curriculum Intensive immersion experiences embedded in a continuing rural practice 1 2 3 4 5 6 7 8 9 10 11 12 13 YEAR 1 (Shared) Pediatrics Inpatient (NRP) Special Nursery OB Newborn Cardiology (Wound Healing) MICU (ATLS) Peds ER Scholarly Activity (Shared) MRH MRH CHC MRH OSUH MRH MRH OSUH MRH OSUH MRH CHC MRH Mad River Family Practice -- Periodic office patient care, daily hospital rounds 2 Half-days 2 Half-days 1 Half-day 2 Half-days 1 Half-day 2 Half-days 1 Half-day 2 Half-days 1 Half-day 2 Half-days 1 Half-day 3 Half-days YEAR 2 Ambulatory Cardiology Elective OB - Newborn OB Newborn (High Risk Immersion) Dermatology Pediatrics Outpatient ICU Intern Med Orthopedics Medical Sub - specialty Elective GYN MRH/Offic 4 Office Half-days 0-4 Halfdays MRH MRH Office Office MRH MRH/Office MRH/Office Mad River Family Practice -- Periodic office patient care, daily hospital rounds Scholarly Activity and Community Medicine 2 Half-days 2 Half-days 4 Half-days 2 Half-days 8 Half-days one week None the next 4 half-days 4 Half-days 0-4 Halfdays Office 3 Half-days YEAR 3 Elective 0-4 Halfdays Geriatrics, Physical Medicine, and Psychiatry GYN Elective Surgical Subspecialiies Opthalmology, ENT, Urology, Podiatry Elective Sports Medicine Office Office Office OSU Sports Ctr Mad River Family Practice -- Periodic office patient care, daily hospital rounds Practice Management and Community Intervention 5 Office Half-days 4 Half-days 0-4 Halfdays 5 Office Half-days 0-4 Halfdays [Gray shaded rotations occur at least in part in Columbus, Ohio] Elective 4 Half-days 0-4 Halfdays Medical Sub - specialty MRH/Office 0-4 Halfdays
Prior to July 1, 2010* 4-4-4 Closed Active *RTT Technical Assistance Program Updated 12-28-2013, Randall Longenecker, Senior Project Advisor
RTT Technical Assistance Program A consortium of organizations and individuals committed to sustaining RTTs as a strategy in rural medical education Office of Rural Health Policy http://www.raconline.org/rtt/
As of March 1, 2013 Developing 4-4-4 Active Accredited, not active *RTT Technical Assistance Program Updated 3-1-2013, Randall Longenecker, Senior Project Advisor
Continuing Definition of a 1-2 RTT (2013) A residency training program that is either: An alternative training track integrated with a larger more urban program and separately accredited as such, with a rural* location, a rural mission, or a major rural service area, in which the residents spend approximately two of three years in a place of practice separate and more rural or rurally focused than the larger program. *Rural by Rural Urban Commuting Area (RUCA) code of 4 or greater, except 4.1, 5.1, 7.1, 8.1, and 10.1, which are urban
Continuing Definition of a 1-2 RTT (2013) Or: An identified training track within a larger program, not separately accredited (i.e. without a separate accreditation program number), in which the tracked residents meet their 24-month continuity requirement** in a rurally located continuity clinic or Family Medicine Practice site (FMP). **Continuity requirement as defined by the ACGME Family Medicine Review Committee and the American Board of Family Medicine.
26 (30) Active 1-2 RTTs as of January 2014* Active 1-2 RTTs 1-2 like RTTs *RTT Technical Assistance Program Updated 12-28-2013, Randall Longenecker, Senior Project Advisor
Creative Variations Structure: Varying degrees of integration, from 4-15 months in the urban place; Spider plant configurations Funding: Teaching Health Centers (e.g. Boise, ID; Silver City, NM; Redding, CA) Faculty Development: NIPDD Rural Fellows; annual RTT Conclave; peer consultation Emerging Support Network: The RTT Collaborative www.rttcollaborative.net
Adaptability and Resilience 26 (30) Active 1-2 RTTs as of January 2014 Colville, Washington Blackstone, Virginia Urban Rural Active 1-2 RTTs 1-2 like RTTs Urban Rural RTT Technical Assistance Program Updated 12-30-2013, Randall Longenecker, Senior Project Advisor 18
References RTT Technical Assistance Program www.raconline.org/rtt/ Train Rural www.traindocsrural.org The RTT Collaborative www.rttcollaborative.net OU-HCOM Rural and Underserved Programs www.oucom.ohiou.edu/oru/index.htm
Contact Information Randall Longenecker MD Professor of Family Medicine Assistant Dean Rural and Underserved Programs, Ohio University Heritage College of Osteopathic Medicine Grosvenor Hall 255, Athens, Ohio 45701 740-597-3058 longenec@ohio.edu