1. Working for Healthy Communities since 1972 Why Train Health Professionals in Community Health Centers? David N. Katz, MD

2. “Training more Country Doctors” Video: http://www.youtube.com/watch?v=lBN-EB3wlf8&NR=1 http://www.youtube.com/watch?v=lBN-EB3wlf8&NR=1

3. Most of us like to play the notes that we already know.

4. Sometimes, we can do more than we think…

5. What is the PRIME Program? VIDEO: http://www.youtube.com/watch?v=EABi6pdB3Hs http://www.youtube.com/watch?v=EABi6pdB3Hs

6. Don Hilty, M.D. Director, Rural-PRIME Suzanne Eidson-Ton, M.D./M.S. Co-Director, Rural-PRIME UC Davis Rural-PRIME: Curriculum Plan 2011-

7. Rural Prime Curriculum Wheel University of California-Davis School of Medicine (SOM) UC Davis SOM Core A) Rural Health B) Public Health C) Technology CA Health System Inter- professional Education GeriatricsLeadership Business/ Practice Management Emergency Medicine Culture and Diversity Lobby Efforts / Health Reform Chronic Disease Management Specialties at Medical Center Mental Health

8.  Rural-PRIME Orientation  Rural-PRIME Seminar  Healthy Communities and Comm’y Engagement  Health Care Leadership, Technology, Equity & Advocacy  Advising: 3 Meetings With Director/Co-director  Evaluation: 3 Focus Groups With Dr. Rainwater & Annual Survey  Center for Virtual Care Sessions: Phlebotomy, Labor & BLS Doctoring 1 Environmental Health Agricultural Health Rural-PRIME Doctoring Sessions - Rural cases, co-teachers & standardized patients Rural Physician Preceptors 6-week Break Early August2 nd week JanuaryMid DecemberMid May Metabolism/ Reproduction/ Endocrinology, Pathophysiology Pharmacology Human Structure/Function Year 1

9. Doctoring 2 Population-based Health Rural Cases, Co-teachers & Standardized Patients Rural Physician Preceptors USMLE1USMLE1 Neuroscience Systemic Pathology & Pharmacology Cardiology Pulmonary Nephrology Musculo- Skeletal GI Hematology Oncology Late JuneMid SeptMid NovMid DecEnd Feb Rural-PRIME  Seminars: Healthy Communities & Community Engagement, Health Care Leadership, Health Technology, Health Equity, Health Advocacy, Rural California (optional this year)  Center for Virtual Care Sessions  Evaluation: 3 Focus Groups With Dr. Rainwater & Annual Survey  Advising: 3 Meetings With Director/Co-director Year 2

10. SurgeryPedsOb/GYN Primary Care Standard Clerkship (OR 4 wk RURAL & 4 wk regular) & Spec/Gen Inpatient 4 wk RURAL rotation & Inpatient/ University OB/GYN Rotation 8 wk RURAL rotation & Doctoring 3  Topics: Epidemiology, Toxicology, Population-based Health, Economics of Medicine, Doctor- Patient Communication, Cultural Sensitivity, & Clinical Reasoning  Rural Cases, Co-teachers & Standardized Patients (with multi-site group via telemedicine) ATLS–Advanced Trauma Life Support ALSO–Advanced Life Support in Obstetrics 4 wk RURAL rotation & Inpatient, PICU, Oral Health, & Child Ab. Standard Clerkship or 4 wk RURAL & 4 wk regular & Telepsych P/NALS– Ped./Neonatal Advanced Life Support Standard Clerkship & Telemedicine Consults & Visits to Subspec’ties Introduction to Master’s Options/Alternatives: Group & Individual Meetings With Director/Co- director & Visitors, Then Student Completes Applications, Obtains Letters & Notifies Rural- PRIME of Plans Evaluation: 3 Focus Groups With Dr. Rainwater & Annual Survey Year 3 Telemedicine Consults & Visits to Subspec’ties MedicinePsychiatry ACLS-Advanced Life Support

11.  Masters/alternative  MA: Public Health, Medical Informatics or Other OR Research (e.g. T-32) OR Fellowship  Locale: UC Davis or Other  Seminar  Present One Another’s Projects (if on-site)  Advising On- or Off-site  Coursework  Didactics: In-Person or Distance Education  Clinical: Skills Seminars and Volunteering  Field work  Data Collection  Other Year 4

12. Year 5 Clinical Rotation  Required 4-week Rural Clinically-based Rotation: Rural Site or, Telemedicine to Rural Site or Other Approved Rotation Advising  MSPE (“Dean’s Letter”) Advice  Residency Selection  Career Planning Selective: Must Choose One or More of the Following  Doctoring 4 Facilitator for Rural-PRIME group  Rural-PRIME Medical Student Leadership Liaison  Convert School required 4-wk Special Study Module (SSM) or Scholarly Project (SPO) to Rural Focus  Curriculum Development for Rural-PRIME Seminar (e.g., 6 wks)  Community Engagement Project Demonstrating Leadership  Other 4-wk Didactic Credit (e.g., Medical Informatics, Telemedicine, Handheld Devices, Electronic Health Record)  Or Other Activity, Agreed Upon by Student and Director/Co-director Evaluation  Evaluation: 3 Focus Groups With Dr. Rainwater & Annual Survey

13. From the Medical School “Academic--Community Partnerships are the present and the future. In the past, academics shared what they thought was important. Now, the best academics talk at length, and do needs assessments, for research and educational collaborations. The focus of quality medical education has shifted from giving good ideas to students, to showing students clinical skills. In the future, linking those skills to actual patient outcomes in the community will be necessary.” Donald Hilty, MD UC-Davis School of Medicine, Professor of Clinical Psychiatry ”I was hugely excited about starting a program that would generate health care providers for people in rural areas. There are different amenities in rural and urban areas but health care is a basic need and everyone should be able to access it. “ Sneha Patel, MA, Manager, Rural-PRIME and UC Merced San Joaquin Valley PRIME.

14. CommuniCare Health Centers is a private, non-profit, comprehensive health care organization serving the low income, uninsured, underinsured, and ethnically diverse population of Yolo County and surrounding areas. But first…Who is CommuniCare?

15. History in Brief Founded by Dr. John H. Jones in 1972 as the Davis Free Clinic Expanded to include clinic sites in Woodland and West Sacramento in 1994. Moved the Davis Community Clinic site on DHS campus in 1997. Became a Federally Qualified Health Center in 2007.

16. CommuniCare Locations Yolo County CommuniCare Health Centers operates a total of five clinics, three of which are primary care clinics geographically dispersed throughout Yolo County.

17. Ethnicity of our Patients

18. Now back to the Question: How? We say, “I’d like to share my experience with medical students and residents…while providing quality care to my patients.”

19. But some days we feel like this… vs Is this our choice?

20. Why, then, is training medical students and residents important to our Community Health Centers, despite the difficulties? ?

21. % of graduating US medical students choosing specialties Residency Match, 2010 % of graduating US medical students choosing specialties From Tom Bodenheimer, MD UCSF Department of Family Medicine

22. Race/Ethnicity of California Physicians From Tom Bodenheimer, MD UCSF Department of Family Medicine

23. The National Health Manpower SHORTAGE The shortage is hitting community clinics 13% vacancies for family physicians in FQHCs, higher in rural areas (Rosenblatt, JAMA 2006;295:1062) When it hits a clinic, panel sizes go up, with fewer clinicians per patient This reduces access and quality, and increases clinician dissatisfaction As clinician dissatisfaction increases, fewer clinicians will come to FQHCs A death spiral could develop From Tom Bodenheimer, MD UCSF Department of Family Medicine

24. From Tom Bodenheimer, MD UCSF Department of Family Medicine

25. PATIENT CENTERED MEDICAL HOME ? Will we have the Health Manpower to avoid health system collapse? VS

26. “To Teach or Not to Teach…That is the Question.” W. S’peare, M.D.

27. The Medical School’s perspective: Goal #1 Increase Diversity in our Future Healthcare Workforce

28. Increasing the diversity of health sciences faculty and students will:  Enrich the learning environment for all participants  Enhance the overall education and cultural competence of health professionals  Improve access to care for medically underserved groups and communities  Help reduce racial/ethnic health disparities The Case for Diversity in Health Care Education From Cathryn L. Nation, MD Associate Vice President-Health Sciences UC Office of the President

29. The Medical School’s perspective: Goal #2 Increase medical student buy-in to careers in rural primary care

30. Present the CHC as a Role model: student exposure to our successful health care teams The Medical School’s perspective: Goal #3

31. The Community Clinic Perspective: Goal #1 For Our Mission: to pass on our experience and skills to the next generation of safety net healers (It can’t hurt med students who will become specialists, either.)

32. The Community Clinic Perspective: Goal #2 Recruitment and Retention of community clinic clinicians  For the satisfaction and intellectual challenge of being a teacher  hiring our own students and residents

33. The Community Clinic Perspective: Goal #3 Collaboration with the university medical center and medical school bears secondary fruits. For us:  Telemedicine  Increased scope of care through training at the medical center, which providers can use to improve patient care  HCV management  HIV management  Psychiatry  Opthamology

34. Thank you!

35. Visit our website to learn more about us: http://www.communicarehc.org Questions?