What is the PRIME Program? VIDEO: http://www.youtube.com/watch?v=EABi6pdB3Hs http://www.youtube.com/watch?v=EABi6pdB3Hs
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-
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
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
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
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
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
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
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.
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?
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.
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.
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.”
But some days we feel like this… vs Is this our choice?
Why, then, is training medical students and residents important to our Community Health Centers, despite the difficulties? ?
% 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
Race/Ethnicity of California Physicians From Tom Bodenheimer, MD UCSF Department of Family Medicine
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
From Tom Bodenheimer, MD UCSF Department of Family Medicine
PATIENT CENTERED MEDICAL HOME ? Will we have the Health Manpower to avoid health system collapse? VS
“To Teach or Not to Teach…That is the Question.” W. S’peare, M.D.
The Medical School’s perspective: Goal #1 Increase Diversity in our Future Healthcare Workforce
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
The Medical School’s perspective: Goal #2 Increase medical student buy-in to careers in rural primary care
Present the CHC as a Role model: student exposure to our successful health care teams The Medical School’s perspective: Goal #3
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.)
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
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