1. Rural Family Medicine Residency Training and Developing a Rural Area-of-Concentration Carl Rasmussen, MD OHSU Family Medicine Residency Portland, OR rasmusca@ohsu.edu

2. Disclosures I have no disclosures.

3. Objectives 1. Define the traditional models of rural family medicine residency training. 2. Describe a rural area-of-concentration as an innovative training model for rural family medicine. 3. Identify both challenges and opportunities for developing competency-based rural family medicine education.

4. Background

5. See references: 1. Patterson et al.

6. 1. Urban-based residency with rural rotations 2. Rural training track 3. Rural-based residency 4. Rural health fellowship Traditional models of rural family medicine training

7. Developing our rural AOC

8. Needs assessment An area-of-concentration (AOC) is: “…common framework around which residents, program directors and faculty may design additional training that is above and beyond the core training in family medicine.” 2 OHSU Family Medicine transitions to 4-year curriculum –AOC and capstone components –Further support of rural training A new model of rural training –No literature identified –Few reported programs How do we create a framework for rural training? –What are the competencies of rural practice?

9. Building a curriculum Lack of research on rural practice competencies AAFP/NRHA rural GME guidelines –Clinical skills and knowledge –Leadership and practice management –Population health management –Public health, including social determinants of health –Scholarship in rural setting –“The rural experience”

10. Building a curriculum “A common framework” to: –Foster interest and support careers in rural family medicine –Develop skills in rural clinical and community medicine, leadership and scholarship Centered on: – AAFP/NRHA guidelines –Ongoing competency research Implemented through: –Required rural rotations –AOC rotations Modifiable blocks for clinical experiences relevant to AOC –Electives Allow for continuous “away” experiences –Longitudinal curricula PCMH, practice management, population health, leadership, advocacy

11. A work in progress Opportunities: –Development of our 4-year curriculum –Robust training opportunities at OHSU –Strong affiliations throughout rural Oregon Challenges: –Identifying and evaluating rural competencies –Balancing competencies with adaptable framework –Continuity clinic commitments, travel to rural sites Next steps: –Ongoing implementation –Developing an evaluation process –Opportunities for further research

12. Future directions

13. Creating a competency-based framework OHSU Family Medicine research –Analysis of P4 Project data P4 Project: Preparing the Personal Physician for Practice National data on practice of recent residency grads –Evaluate practice differences based on community size to inform rural practice competencies Scope of practice PCMH features Behavioral health integration Community engagement

14. Additional rural competency research National survey by Dr. Longenecker et al. -A Rural Training Track Collaborative study -Determine relative importance of proposed rural practice competency domains -Soliciting sub-competencies and useful metrics -https://ohio.qualtrics.com/SE/?SID=SV_6AmTVvx CoLq346Vhttps://ohio.qualtrics.com/SE/?SID=SV_6AmTVvx CoLq346V -Email: longenec@ohio.edu

15. Discussion

16. Take-home questions How do we apply research to create evidence- based rural practice competencies? What metrics do we use to evaluate such competencies? How is your institution supporting innovation in rural training?

17. References 1.Paterson, DG, et al. Policy brief: training physicians for rural practice: capitalizing on local expertise to strengthen rural primary care. Policy brief. Seattle, WA: WWAMI Rural Health Research Center, University of Washington; 2011. 2.Nancy Youssef. Introducing Areas of Concentration into your Residency. STFM Spring Conference, April 2012. Poster presentation. 3.Chen, FM, et al. Family medicine residency training in rural locations. Policy brief. Seattle, WA: WWAMI Rural Health Research Center, University of Washington; 2010. 4.Paterson, DG, et al. Outcomes of Rural-Centric Residency Training to Prepare Family Medicine Physicians for Rural Practice. Policy brief. Seattle, WA: WWAMI Rural Health Research Center, University of Washington; 2016. 5.Schmitz D, et al. Graduate Medical Education for Rural Practice. Position paper. Washington, DC: American Academy of Family Physicians; 2013.

18. Acknowledgements Thanks to all those assisting with this project, including: Joe Skariah, MD, MPH Becca Cantone, MD Anthony Cheng, MD Pat Eiff, MD Holly Hofkamp, MD Amy Wiser, MD Roger Garvin, MD David Buckley, MD, MPH Contact: rasmusca@ohsu.edu