Competencies for Rural Health: An Overarching Framework for Interprofessional Learners Holly Montjoy, MD and Joyce Hollander-Rodriguez, MD Cascades East Family Medicine Residency Klamath Falls, Oregon

Disclosures Joyce Hollander-Rodriguez receives compensation for her position as a Board member of Cascade Health Alliance, a local Coordinated Care Organization

At the end of this session, you will Recognize how an interprofessional model will strengthen the education and experience of learners Discuss a set of educational objectives that can be applied to a variety of rural interprofessional disciplines Integrate developed competencies into a rural interprofessional experience in your institution

Cascades East Family Medicine Residency University-administered by Oregon Health & Science University in Portland, OR Three year, rurally-based residency program in Klamath Falls, Oregon (8-8-8)

Why we started branching out... Oregon FIRST Oregon Rural Scholars Program Graduate Feedback OHSU Campus for Rural Health 3rd year medical students for weeks, started co- placing PA students Integrating 4th year medical students into the rural residency environment Forming with an interprofessional vision! How do we lead interprofessional teams in practice?

What learning objectives are relevant to and shared across health professions learning about and preparing for rural practice? Envisioning a Rural Campus for Interprofessional learners PA Students Medical Students Nursing Students Advanced Practice Nursing Dental Students Medical Residents Pharmacy Students

Why interprofessional? Concerns about interfering with resident learning –Former ACGME rule: “Efficiency and education of the family medicine residents must not be compromised by training of other health care professionals” Evidence for utility in clinical practice Evidence for effectiveness in recruitment The need to collaborate with shared/limited resources

What have others done? Review of the Literature Clinical learning objectives usually unique to one profession –some experiences with just one or two professions Non-clinical learning experiences –immersion experiences more likely to be interdisciplinary (Deutchman, et al. Rural and Remote Health, 2012)

Our process Developed key themes from literature and current goals and objectives, then moving to competencies Reviewed through an interprofessional lens Presented to interprofessional faculty and learner focus groups for feedback Discussed at medical student rural immersion weekend

Framework for Rural Learning Objectives and Competencies: see handout Clinical skills and knowledge Ethics and Professionalism Equity, diversity, and cultural competency Professional growth, development and support Systems of Care Rural context and experience

More from the literature… Five “fundamental elements” for IPE success Staff Ownership/Co mmitment HEI Structural Support Faculty Development HEI Funding HEI Funding Government Funding Lawlis, Anson, Greenfield 2014 HEI = Higher Education Institution

Other considerations: IP learners need unique as well as shared learning experiences clinical experiences unique to profession non-clinical experiences shared Ensuring broad geographic relevance Urban vs rural ownership of the learning and concepts Elective vs. required experiences

Discussion Questions: How do these learning objectives resonate with your experiences? What are you doing in your institutions? What pearls and pitfalls do you anticipate?

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References: Lawlis T, et al. Barriers and enablers that influence sustainable interprofessional education: a literature review. Journal of Interprofessional Care, 2014; 28(4): Oandasan I. Reeves S. Key elements for interprofessional education. Journal of Interprofessional Care, 2005, Supplement 1: Deutchman M., et al. Interdisciplinary rural immersion week. Rural and Remote Health, 2012;12: GME for Rural Practice: AAFP Position Paper/NRHA Policy Brief. Longenecker R, et al. AAFP reprint No. 289A, Lin, IB et al. Developing competencies for remote and rural senior allied health professionals in Western Australia. Rural and Remote Health, 2009; 9: 1115.