Rural Emergency Medicine: A New Elective for Real World Experience Delaney Kinchen, DO 2, Carly Eastin, MD 1, Travis Eastin, MD, MS 1, Rawle Seupaul, MD 1 1 Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 2 Department of Emergency Medicine, Unity Health, Searcy, AR BACKGROUND The development of this rural EM rotation began in the fall of 2014 with assistance from faculty at programs with existing rural EM rotations. Site selection was based on targeted needs to ensure an optimal educational experience and from recommendations made by the Trauma/Injury and Violence Prevention Branch of the ADH. Key steps in the development of the rotation included: Planning Secure funding (salary, malpractice, housing, etc.) Identify rural site/rotation director (ACGME Requirements) Develop educational goals/objectives On-site visit by residency leadership Frequent updates to local GME Institution Affiliation Agreement and Program Letter of Agreement Implementation Meet with resident prior to rotation to review expectations, housing, etc. Establish reproducible process for credentialing, EMR training, etc. Identify educational resources for resident to utilize while away from home institution (teleconference, asynchronous resources, etc.) Maintenance Frequent contact with site director and residents to identify potential issues/work toward resolution Debrief with each resident post-rotation to identify strengths and areas for improvement METHODS There currently exists a shortage of board certified (ABEM/ABOEM) emergency physicians in the state of Arkansas: Arkansas population: 2.97 million Rural Arkansas population: 1.15 million (39%) 150 ABEM/ABOEM physicians 25% in cities <50,000 population 15% in cities <25,000 population Approximately half of Arkansas hospitals do not have a BC/BE EP on staff Having EM-trained physicians practicing in these rural communities would be an invaluable resource for these communities. A rural rotation exposes EM residents to the unique aspects of rural EM practice and may facilitate recruitment of highly trained board eligible clinicians to these medically underserved areas. In accordance with the Trauma System Act of the Arkansas Legislature, the Arkansas Department of Health (ADH) developed a grant program to support evidence-based initiatives aimed at improving trauma care and injury prevention. Given the need for EM-trained physicians in underserved areas, this financial support provided the impetus for the creation of en elective rural rotation. Funds from this grant are used to support resident housing, travel, and salaries during this month-long experience.

Rural Emergency Medicine: A New Elective for Real World Experience RESULTS Beginning in July 2015, the elective rotation in rural EM became available to PGY-3 residents. Residents were required to work 120 clinical hours for the month with an equal assortment of days, nights, and weekend shifts, directly supervised by a board certified emergency physician. To ensure residents met educational program requirements, teleconference technology, asynchronous resources, and on-site grand round opportunities were made available. To date, half (four) of the third year class has completed the EM rural rotation as their senior elective with a fifth planned for Spring Feedback from residents has been unanimously positive. They report: more autonomy; a better understanding of difficulties present in rural EM; added insight into what they may encounter in independent practice. Of the four residents who completed the rotation, one signed a contract to join the ED staff at the rural site upon completion of residency. POTENTIAL CHALLENGES Based on our experience, several potential challenges exist when implementing a rural EM rotation: Identifying a truly rural site with sufficient number of residency- trained emergency physicians to support rotation Rural hospitals’ lack of familiarity with GME Role of trainees in patient care Credentialing process, licensure Lab/pharmacy orders Documentation IAA/PLA Funding (salary, malpractice, housing, meals, etc.) CONCLUSIONS A rural EM rotation offers a valuable educational experience and can positively influence residents to practice in rural locations. Delaney Kinchen, DO 2, Carly Eastin, MD 1, Travis Eastin, MD, MS 1, Rawle Seupaul, MD 1 1 Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 2 Department of Emergency Medicine, White County Medical Center, Searcy, AR