2. CLINICAL MENTORSHIP WITH COMPUTER SUPPORT David P. Yens (dyens@nyit.edu) Elizabeth DiNapoli (edinapol@nyit.edu) Cheryl Evans (cevans2@nyit.edu) New York College of Osteopathic Medicine New York Institute of Technology Supported in part by a Predoctoral Training grant from HRSA edinapol@nyit.edu

3. PROBLEM A decreasing number of medical school graduates are selecting primary care careers and rural practice. A decreasing number of medical school graduates are selecting primary care careers and rural practice.

4. PURPOSES Encourage more students to select primary care by providing a mentorship experience to first (and second) year medical students with local or rural primary care physicians. Encourage more students to select primary care by providing a mentorship experience to first (and second) year medical students with local or rural primary care physicians. Combine the humanity of the primary care physician with technology to demonstrate the responsibilities, rewards and benefits of primary care and to obtain an introduction to clinical medicine. Combine the humanity of the primary care physician with technology to demonstrate the responsibilities, rewards and benefits of primary care and to obtain an introduction to clinical medicine.

5. RATIONALE National data continue to indicated a decrease in the number of medical school graduates selecting a residency in primary care. National data continue to indicated a decrease in the number of medical school graduates selecting a residency in primary care. NYCOM has typically had large percentage of graduates entering primary care residencies (31% selecting Family Practice from the class of 1999). NYCOM has typically had large percentage of graduates entering primary care residencies (31% selecting Family Practice from the class of 1999). However, for the class graduating in 2002, only 13% selected a family practice residency! However, for the class graduating in 2002, only 13% selected a family practice residency! Yet, most applicants to NYCOM claim that they desire a primary care career. Yet, most applicants to NYCOM claim that they desire a primary care career.

6. RATIONALE We believe that an exposure in the MSI and II years to the advantages and lifestyle of primary care will reinforce the early interest in primary care and Family Practice. We believe that an exposure in the MSI and II years to the advantages and lifestyle of primary care will reinforce the early interest in primary care and Family Practice.

7. LITERATURE/BACKGROUND Many medical schools presently provide clinical experiences, frequently in primary care settings, during the preclinical phase of training. Many medical schools presently provide clinical experiences, frequently in primary care settings, during the preclinical phase of training. All schools participating in the Interdisciplinary Generalist Curriculum Project (IGC) established longitudinal clinical experiences in the first or second year (Colwill, 1997). At a 1997 Association of American Medical Colleges meeting all participants in the IGC project reported excellent responses by students - and preceptors - to an early clinical preceptorship, but it was too early to assess results (personal discussion). No recent literature has been found regarding primary care medical mentorships. All schools participating in the Interdisciplinary Generalist Curriculum Project (IGC) established longitudinal clinical experiences in the first or second year (Colwill, 1997). At a 1997 Association of American Medical Colleges meeting all participants in the IGC project reported excellent responses by students - and preceptors - to an early clinical preceptorship, but it was too early to assess results (personal discussion). No recent literature has been found regarding primary care medical mentorships.

8. PROJECT OBJECTIVES Establish a program where first and second year medical students will spend a half day in a primary care physicians office at least once every four weeks (local track) Establish a program where first and second year medical students will spend a half day in a primary care physicians office at least once every four weeks (local track) Create a curriculum for monthly visits for the two-year clinical program. Create a curriculum for monthly visits for the two-year clinical program.

9. PROJECT OBJECTIVES Establish an upstate program where first year medical students spend four weeks in an upstate rural primary care physicians office during the summer following the MS1 year. Establish an upstate program where first year medical students spend four weeks in an upstate rural primary care physicians office during the summer following the MS1 year. Create a curriculum for students in the four week rural clinical program. Create a curriculum for students in the four week rural clinical program.

10. PROJECT OBJECTIVES Integrate computer activities into this clinical program to provide an added introduction to clinical medicine, to introduce students to the environment of the practice of primary care, and describe where primary care fits into the medical milieu. Integrate computer activities into this clinical program to provide an added introduction to clinical medicine, to introduce students to the environment of the practice of primary care, and describe where primary care fits into the medical milieu.

11. STUDENT OBJECTIVES Through observation and interaction with their primary care Physician Mentor, the NYCOM Medical student will: Through observation and interaction with their primary care Physician Mentor, the NYCOM Medical student will: Observe the delivery of medical treatment of patients Observe the delivery of medical treatment of patients Observe office/hospital functions and management Observe office/hospital functions and management Observe diagnostic procedures and use of medical equipment Observe diagnostic procedures and use of medical equipment Observe the interaction between healthcare team members Observe the interaction between healthcare team members

12. STUDENT OBJECTIVES After adequate experience, the student may be permitted to do history-taking and possibly physical exams under the direct supervision of the mentor, depending upon the comfort level of the mentor. After adequate experience, the student may be permitted to do history-taking and possibly physical exams under the direct supervision of the mentor, depending upon the comfort level of the mentor.

13. METHODS Provide a structured mentorship experience with a primary care physician starting in the first year of medical school. Provide a structured mentorship experience with a primary care physician starting in the first year of medical school. Local year-long program Local year-long program Upstate summer program Upstate summer program Provide a comprehensive curriculum manual Provide a comprehensive curriculum manual Supplement the mentorship with computer-based content Supplement the mentorship with computer-based content Foster continuation of the mentorship experience by encouraging and facilitating the use of e-mail for continuing communication. Foster continuation of the mentorship experience by encouraging and facilitating the use of e-mail for continuing communication.

14. The basic assumption of this project is that we can successfully encourage students to select primary care at an earlier point in their training and maintain this goal throughout their medical training. The basic assumption of this project is that we can successfully encourage students to select primary care at an earlier point in their training and maintain this goal throughout their medical training.

15. STRUCTURED LOCAL MENTORSHIP EXPERIENCE Questionnaires created for students and potential mentors to permit matching and optimize compatibility Questionnaires created for students and potential mentors to permit matching and optimize compatibility Letters about the program sent to all osteopathic primary care physicians in the NYC area Letters about the program sent to all osteopathic primary care physicians in the NYC area E-mails about the program sent to all 1 st year NYCOM students E-mails about the program sent to all 1 st year NYCOM students Respondents completed the questionnaires Respondents completed the questionnaires

16. STRUCTURED LOCAL MENTORSHIP EXPERIENCE All potential mentors and students interviewed by the Mentor Coordinator (Ms. DiNapoli). Expectations about the program conveyed to both parties. All potential mentors and students interviewed by the Mentor Coordinator (Ms. DiNapoli). Expectations about the program conveyed to both parties. Mentors and mentees matched Mentors and mentees matched Times of visits arranged by the mentors and mentees Times of visits arranged by the mentors and mentees Visits initiated and continue Visits initiated and continue

17. STRUCTURED UPSTATE MENTORSHIP EXPERIENCE Questionnaires created for students and potential mentors specially designed to address the rural environment Questionnaires created for students and potential mentors specially designed to address the rural environment Letters about the program sent to osteopathic primary care physicians in New York north of Westchester County Letters about the program sent to osteopathic primary care physicians in New York north of Westchester County As above, E-mails about the program sent to all 1 st year NYCOM students, respondents completed the questionnaires, and all potential mentors and students interviewed by the Mentor Coordinator. All potential upstate mentors interviewed. Mentors and mentees matched. As above, E-mails about the program sent to all 1 st year NYCOM students, respondents completed the questionnaires, and all potential mentors and students interviewed by the Mentor Coordinator. All potential upstate mentors interviewed. Mentors and mentees matched.

19. STRUCTURED UPSTATE MENTORSHIP EXPERIENCE Mentors and mentees arranged starting dates with the Mentor Coordinator. Mentors and mentees arranged starting dates with the Mentor Coordinator. Students spent one month at the rural sites. Housing was either provided or arranged. Students received a stipend of $930 for the month. Students spent one month at the rural sites. Housing was either provided or arranged. Students received a stipend of $930 for the month. Daily activities included learning about the physicians office and practice, learning to interview and perform physical exams, rounding with the mentor in a hospital, observing (and practicing) the use of osteopathic manipulation, learning about the rural community and rural medicine, etc. Daily activities included learning about the physicians office and practice, learning to interview and perform physical exams, rounding with the mentor in a hospital, observing (and practicing) the use of osteopathic manipulation, learning about the rural community and rural medicine, etc.

20. COMPUTER AUGMENTATION A manual of information was prepared for both mentors and mentees. Many Internet sites exist for topics to be addressed in the mentorships. We provide references to these sites. A manual of information was prepared for both mentors and mentees. Many Internet sites exist for topics to be addressed in the mentorships. We provide references to these sites. The manual has been converted to a Powerpoint presentation that can be shared with mentors via a video plus audio format, to be initiated during the summer. The manual has been converted to a Powerpoint presentation that can be shared with mentors via a video plus audio format, to be initiated during the summer. To encourage continuity of the mentorship, we expect the mentor and student to maintain contact via e-mail. Although the students are highly knowledgeable about e-mail, many mentors use it only occasionally. We have initiated training of mentors. To encourage continuity of the mentorship, we expect the mentor and student to maintain contact via e-mail. Although the students are highly knowledgeable about e-mail, many mentors use it only occasionally. We have initiated training of mentors.

21. EVALUATION All participants in the project through June, 2005 (5 Groups) were asked to complete a questionnaire concerning their attitudes about the program. Results were tabulated and are below. All participants in the project through June, 2005 (5 Groups) were asked to complete a questionnaire concerning their attitudes about the program. Results were tabulated and are below.

22. RESULTS OF QUESTIONNAIRES COMPLETED BY 5 GROUPS OF STUDENTS STUDENT RESPONSES TO SELECTED ITEMS Question LOCALRURAL Period 2002- 2003 2003- 2004 2004- 2005 2002- 2003 2003- 2004 2004-2005 Number of students/responses 10/813/1118/104/38/8 NO DATA YET 15 students registered Felt comfortable working in mentors office 100%91%100%100%88% Learned as much as expected, or more 37%73%70%66%88% Exceeded expectations 100%64%80%100%88% Would strongly recommend to other students 75%91%90%100%88% Program very valuable 87%91%100%100%100% Increase in self-confidence 66% Plan to continue in primary care 75%73%70%100%88%

23. RESULTS OF QUESTIONNAIRES COMPLETED BY 5 GROUPS OF MENTORS MENTOR RESPONSES TO SELECTED ITEMS Question LOCALRURAL Period 2002- 2003 2003- 2004 2004- 2005 2002- 2003 2003- 2004 2004- 2005 Number of mentors/responses 10/811/617/134/35/2 NO DATA YET Student better prepared than expected 50%50%31%66%0% As prepared as expected 50%50%69%33%50% Student showed a real interest in my practice 83%67%100%100%50% Felt student strongly enthusiastic about primary care 50%0%8%66%0% Felt student was enthusiastic about primary care 50%83%23%33%50% Felt student had a strong interest in rural practice 100%0% Felt well prepared to be mentor 83%83%100%100%50%

24. DISCUSSION The value of the project will be determined by the percentage of students participants who enter primary care compared with those who did not participate. Its too early to determine this yet. The value of the project will be determined by the percentage of students participants who enter primary care compared with those who did not participate. Its too early to determine this yet. Almost all students would strongly recommend the program to other students. Almost all students would strongly recommend the program to other students. 69% of local and 100% of rural students indicated plans to continue in primary care. HOWEVER, self-selected sample. 69% of local and 100% of rural students indicated plans to continue in primary care. HOWEVER, self-selected sample. The survey results indicate a strongly positive response to the program from all groups. The survey results indicate a strongly positive response to the program from all groups. However, a small number of students had time problems or conflicts However, a small number of students had time problems or conflicts

25. DISCUSSION In the 3 rd year of the project: In the 3 rd year of the project: –Mentoring manuals were completed and distributed this year, but 4 students and 1 mentor used the manuals (9 mentors did not recall receiving manuals). –3 students used internet as part of project. –1 student and 1 mentor communicated by e-mail NOTE that this is a volunteer program, which may limit the number of participants. NOTE that this is a volunteer program, which may limit the number of participants. Long term goal – most students will participate Long term goal – most students will participate –Required activity or –Elective with credit given In a new problem-based learning track, 30-40 MS1 students will participate in a mentorship In a new problem-based learning track, 30-40 MS1 students will participate in a mentorship

26. MS3 FOLLOWUPS Followups with 3 rd year students from the rural component found one (of 4) doing all rotations upstate and one doing several upstate rotations; both were very positive about the experience and felt they were more likely to select a rural primary care practice. Rural mentees were more likely to have a significant clinical exposure than local mentees. Followups with 3 rd year students from the rural component found one (of 4) doing all rotations upstate and one doing several upstate rotations; both were very positive about the experience and felt they were more likely to select a rural primary care practice. Rural mentees were more likely to have a significant clinical exposure than local mentees. Rural mentors were positive about the students they had and would take more students if space is available. Rural mentors willing to work with students are in demand for clinical electives. Rural mentors were positive about the students they had and would take more students if space is available. Rural mentors willing to work with students are in demand for clinical electives. Most mentors use e-mail but few have maintained contact with students – something we need to emphasize in the future. Most mentors use e-mail but few have maintained contact with students – something we need to emphasize in the future.

28. REFERENCES Colwill, et.al. Modifying the Culture of Medical Education: the First Three Years of the RWJ Generalist Physician Initiative. Acad Med 1997 Sept; 72(9), 745-53. Colwill, et.al. Modifying the Culture of Medical Education: the First Three Years of the RWJ Generalist Physician Initiative. Acad Med 1997 Sept; 72(9), 745-53. See also: See also: –Cronau, H. & Haines, D.J. Medical Students Summer Externship Program: Increasing the Number Matching in Family Practice. Med Educ Online, 2004:9:3 –Veitia, M; McCarty, M; Kelly, P; Szarek, J; Harvey, H. The Interdisciplinary Generalist Curriculum Project at Joan C. Edwards School of Medicine at Marshall University. Acad Med 2001 Apr; 76(4 Suppi);S97-9. –Ricer, RE; Fox, BC; Miller, KE. Mentoring for Medical Students Interested in Family Practice. Fam Med 1995 Jun;27(6), 360-5. This project is funded in part by Title VII Grant # 1 D16 HP 00149-01 from the Bureau of Health Professions, USPHS. This project is funded in part by Title VII Grant # 1 D16 HP 00149-01 from the Bureau of Health Professions, USPHS.