Medical School Rural Tracks A study of all known U.S. programs as of 2013 Mark Deutchman MD 1
Disclosure This brief was funded through a cooperative agreement from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Federal Office of Rural Health Policy, as administered by the National Rural Health Association (Grant U16RH03702). 2
Background RME Conclave paper in 2011 reported 5 essential elements of RME programs A study to document existing RME programs was proposed at the 2011 RME meeting and proposed to HRSA/ORHP/NRHA Study was conducted in 2011/2012 Preliminary results reported in 2012 and presented at 2013 RME Conclave Final results submitted in April 2013 3
Goals Find programs Describe program features Describe outcomes Assemble/share toolkit of curriculum resources 4
RT Working Definition A program within an existing medical school designed to identify, educate and nurture students who have an inclination toward future rural practice. 5
Target information Background/program description Admissions Curriculum Outcome Administration and Funding Pipeline Publications Toolkit materials to share 6
Study Contacts 60+ Individuals known or suspected to be involved in RT s representing 48 unique U.S. SOM s 36 Unique programs identified in N. America 3 Canadian programs; different systems 35 U.S. programs meet the study definition 16 programs 2005 and older + 3 branch campuses 7 programs 2006-2008 7 programs 2009-2012 5 programs Under development 7
16 programs 2005 and older Location Program name Year RT size Degree U. Alabama Rural Medical Scholars Program 1996 20/176 MD U. Arizona Rural Health Professions Program 1997 22/195 MD U. Colorado Rural Track 2005 16/160 MD U. Illinois Rural Medical Education Program 1993 18/300 MD Mich. State U. Upper Penin. Rural Physician Program 2001 20/200 MD University of Missouri Rural Track Pipeline Program 1995 18/96 MD SUNY Upstate Rural Medical Scholars Program 1989 25/160 MD Thomas Jefferson U. Physician Shortage Area Program 1974 11/255 MD East Tennessee State U. Rural Primary Care track 1992 12/72 MD Texas Coll. Osteop. Med. Rural Scholars Program 1994 18/230 DO U. North Dakota Rural Opportunities in Med Educ 1998 9/60 MD U. Kansas Wichita Scholars in Rural Health 1951 30/235 MD U. Minnesota Rural Physician Associate Program 1971 34/170 MD U. Minnesota Duluth Rural Medical Scholars Program 1972 60/220 MD Louisiana State U. Rural Scholars Track 2002 10/200 MD U. of Louisville Trover Rural Track 1998 10/150 MD 8
7 programs 2006-2008 Location Program name Year RT Size Degree U. California Davis Rural Medical Scholars Program 2007 10/105 MD Florida State U. Marianna Rural Program 2006 4/120 MD Indiana U. Rural Medical Education Program 2008 10/321 MD U. Kentucky Rural Physician Leadership Program 2008 10/120 MD U. Washington Targeted Rural and Underserved Track 2008 15/220 MD U. Wisconsin Wisconsin Academy for Rural Medicine 2007 25/175 MD Tulane U. TRuMed and TRIP 2007 6/180 MD 9
7 programs 2009-2012 Location Program name Year RT size Degree Oklahoma State U. Rural Track 2012 13/97 DO Oregon Health and Science U. Rural Scholars Program 2009 11/125 MD U. Iowa Service Distinction Track 2012 4/150 MD Rocky Vista U. (Colorado) Rural and Wilderness Medicine Track 2009 15/160 DO West Virginia U. Rural Track 2012 4/100 MD U. of Florida Local and Global Health Equity Track U. Texas Medical Branch 2012?/133 MD 10
4 programs being developed Location Program name Year RT size Degree Ohio University Rural and Urban Scholars Pathways 2014 8/140 DO U. South Dakota Frontier and Rural Medicine 2014 6/56 MD U. Nebraska Central Michigan U. 2013 1 program unknown age: Des Moines University DO 11
Findings Program features Outcomes 12
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Figure 2 Rural Track Admissions Process RT director serves on the SOM Admissions Committee Applicants required to submit additional material Students are interviewed as part of selection process Preference given to students who express a commitment to primary care Preference given to students committed to Family Medicine RT students have a different GPA or MCAT profile than the rest of the students in the SOM 26 Yes, 8 No 23 Yes, 3 No 27 Yes, 7 No 26 Yes, 8 No 20 Yes, 14 No 10 Yes, 14 No, 9 Unknown Dedicated scholarships for RT students 14 Yes, 17 No 14
RT curriculum elements Most commonly reported : Timing in curriculum Classroom seminars on rural topics Years 1-4 Summer rural clerkship Between years 1 and 2 Primary care clinical clerkship Year 3 Rural instead of urban sites for required clinical clerkships Year 3 Longitudinal, integrated clinical clerkships Years 3 and 4 Student interest group and social events All years Elective clinical clerkships in rural sites Years 3 and 4 Less commonly reported : Required Master s degree Pre-matriculation clinical clerkship Assigned Family Medicine advisor Longitudinal patient assignment State Rural Health Conference attendance Service-learning activities Rural research/scholarly activity requirement Extra clinical procedural skills workshops Prematriculation Prematriculation All years Throughout all 4 years Varies Varies Varies Varies 15
Funding sources 16
Payment to Preceptors 17
Outcomes = Definition trouble Longevity in the SOM program Residency choice By individual specialty By primary care By needed in rural Practice location choice and longevity Definition of rural At what point in time 18
Primary care residency choice Mean of 29 programs = 65% Range of 29 programs = 31% to 100% Median = 65% Mode = 60 to 65% 19
Rural practice location Mean of 18 programs = 44% Range of 18 programs = 20% to 73% Range of 8 middle programs = 30% to 55% 20
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Best practices summary Select students from rural backgrounds and/or with commitment to rural life and primary care Have influence to admit Early and frequent rural-oriented classroom experience and group support Branch campus! As many months of rural clinical experience as possible? dedicated scholarships 22
Post-SOM Pipelines 23
http://ruralmeded.org homepage 24
Toolkit 25
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Lessons Learned We need a standard set of tracking and evaluation parameters Program administration and finance information is hard to get The NRHA RME group is currently working on a common dataset for tracking results of our medical school rural tracks 27
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