Gwen Wagstrom Halaas

Recruitment and Retention of Rural Physicians: Outcomes From the Rural Physician Associate Program of Minnesota

CONTEXT Founded in 1971 with state funding to increase the number of primary care physicians in rural Minnesota, the Rural Physician Associate Program (RPAP) has graduated 1,175 students. Third-year medical students are assigned to primary care physicians in rural communities for 9 months where they experience the realities of rural practice with hands-on participation, mentoring, and one-to-one teaching. Students complete an online curriculum, participate in online discussion with fellow students, and meet face-to-face with RPAP faculty 6 times during the 9-month rotation. Projects designed to bring value to the community, including an evidence-based practice and community health assessment, are completed. PURPOSE To examine RPAP outcomes in recruiting and retaining rural primary care physicians. METHODS The RPAP database, including moves and current practice settings, was examined using descriptive statistics. FINDINGS On average, 82% of RPAP graduates have chosen primary care, and 68% family medicine. Of those currently in practice, 44% have practiced in a rural setting all of the time, 42% in a metropolitan setting and 14% have chosen both, with more than 50% of their time in rural practice. Rural origin has only a small association with choosing rural practice. CONCLUSION RPAP data suggest that the 9-month longitudinal experience in a rural community increases the number of students choosing primary care practice, especially family medicine, in a rural setting.

Comparing rural-trained medical students with their peers: Performance in a primary care OSCE

Background: Although it is well-established and considered successful, there is limited data on how the graduates of a Minnesota rural medical education program (Rural Physician Associate Program [RPAP]) compare with their peers. Purpose: To compare the performance of RPAP students with their peers on a primary care observed structured clinical examination (OSCE). Methods: The performances of RPAP students and a group of non-RPAP Year 4 medical students were compared on the same OSCE. Results: RPAP students performed at least as well as their peers on stations assessing performance on common primary care clinical scenarios but not as well on a small number of stations that assessed applied knowledge of specific content taught in the traditional clerkship curriculum. Conclusions: We provide evidence that rurally trained students at this institution performed at least as well as their peers on OSCE stations testing performance in common primary care scenarios. The broader implications of this study are that medical students may receive high-quality training in rural communities, as documented by their performance on an objective structured clinical examination.

Learning professionalism during the third year of medical school in a 9-month-clinical rotation in rural Minnesota

Background: Professionalism is now an explicit part of the medical school curricula. Aim: To examine the components that are part of developing professionalism during the Rural Physician Associate Program (RPAP) experience, a 9-month rotation in a rural community during the third year of medical school. Methods: Two researchers analysed 3 years of essays for themes. IRB approval was obtained. Results: Themes were organized using Van de Camps model of professionalism. Students described how patients taught them about illnesses, the affects on their lives and the lives of their families. Preceptors role-modelled how to relate to patients with compassion and respect (Professionalism Towards the Patient). As a member of the health care team, clinic and hospital staff taught students how to be a good team member (Towards Other Health Care Professionals). Shadowing preceptors in their roles as physicians and community members, students learned about their responsibilities to the community (Towards the Public). Multiple opportunities for self-evaluation and reflection taught students to know themselves and find balance between work responsibilities and their personal lives (Towards Oneself). Conclusion: The RPAP appears to create a supportive learning environment that incorporates psychological safety, appreciation of differences, openness to new ideas and time for reflection – an ideal environment for developing professionalism.

The Rural Physician Associate Program: New Directions in Education for Competency

The Rural Physician Associate Program (RPAP) has 34 years experience in training 1097 medical students as independent distance learners in a 36-week, community-based continuity primary care experience. This program has been successful in preparing competitive students who select primary care residencies and return to rural practice. The RPAP program has been based on traditional apprentice-style clinical teaching with the support of computer-based resources to enhance distance learning. However while the clinical exposure and development of medical skills was strong, there were weaknesses in evidence-based medicine and managing healthcare, and inconsistencies in community or population health learning. New directions in the educational program for RPAP are described that have been or are being developed to address the competencies as outlined by the Accreditation Council on Graduate Medical Education. They include online and other resources, preceptor education and support, interactive journaling and cases, electronic portfolios, community projects, observed structured clinical exams and examinations. Ongoing challenges to competency-based education include developing meaningful measures and tools to assess competence for areas such as professionalism or systems-based practice; providing faculty development toward being able to practice, teach and evaluate students with an understanding of the competencies; and to build in ways of practicing, learning and improving care that involve effective teams of health-care professionals.

Longitudinal Integrated Clerkships

To the Editor: We wish to share our responses to three recent articles1–3 in Academic Medicine that discussed longitudinal clerkships in light of our own experience with such a clerkship. Each year since 1971, the University of Minnesota’s Rural Physician Associate Program (RPAP) has educated 35 to 40 third-year students in a nine-month longitudinal rural clerkship. They experience continuity with a primary preceptor, health care team, and patient population. An organizing principle is to follow the course of a patient’s care in his or her primary care physician’s panel, learning from primary and specialty clinicians.

Recruitment and Retention of Rural Physicians of Rural Physicians: Outcomes From the Rural Physician Associate Program of Minnesota

CONTEXT Founded in 1971 with state funding to increase the number of primary care physicians in rural Minnesota, the Rural Physician Associate Program (RPAP) has graduated 1,175 students. Third-year medical students are assigned to primary care physicians in rural communities for 9 months where they experience the realities of rural practice with hands-on participation, mentoring, and one-to-one teaching. Students complete an online curriculum, participate in online discussion with fellow students, and meet face-to-face with RPAP faculty 6 times during the 9-month rotation. Projects designed to bring value to the community, including an evidence-based practice and community health assessment, are completed. PURPOSE To examine RPAP outcomes in recruiting and retaining rural primary care physicians. METHODS The RPAP database, including moves and current practice settings, was examined using descriptive statistics. FINDINGS On average, 82% of RPAP graduates have chosen primary care, and 68% family medicine. Of those currently in practice, 44% have practiced in a rural setting all of the time, 42% in a metropolitan setting and 14% have chosen both, with more than 50% of their time in rural practice. Rural origin has only a small association with choosing rural practice. CONCLUSION RPAP data suggest that the 9-month longitudinal experience in a rural community increases the number of students choosing primary care practice, especially family medicine, in a rural setting.

Recruitment and retention of rural physicians

CONTEXT Founded in 1971 with state funding to increase the number of primary care physicians in rural Minnesota, the Rural Physician Associate Program (RPAP) has graduated 1,175 students. Third-year medical students are assigned to primary care physicians in rural communities for 9 months where they experience the realities of rural practice with hands-on participation, mentoring, and one-to-one teaching. Students complete an online curriculum, participate in online discussion with fellow students, and meet face-to-face with RPAP faculty 6 times during the 9-month rotation. Projects designed to bring value to the community, including an evidence-based practice and community health assessment, are completed. PURPOSE To examine RPAP outcomes in recruiting and retaining rural primary care physicians. METHODS The RPAP database, including moves and current practice settings, was examined using descriptive statistics. FINDINGS On average, 82% of RPAP graduates have chosen primary care, and 68% family medicine. Of those currently in practice, 44% have practiced in a rural setting all of the time, 42% in a metropolitan setting and 14% have chosen both, with more than 50% of their time in rural practice. Rural origin has only a small association with choosing rural practice. CONCLUSION RPAP data suggest that the 9-month longitudinal experience in a rural community increases the number of students choosing primary care practice, especially family medicine, in a rural setting.