Rural Health Care Curriculum Assessment Ruth Westra DO, MPH University of Minnesota Medical School Duluth STFM April 29, 2006

Department of Family Medicine and Community Health Duluth University of Minnesota Medical School Duluth established in 1972 Funding received from Title VII HRSA Academic Administrative Grant

The University of Minnesota Medical School Duluth is a campus of the University of Minnesota Medical School mandated by the state legislature with the first class of medical students matriculating in 1972. Department of Family Medicine and Community Health 2005

Duluth MN Great University on a Great Lake-Lake Superior

Mission: Duluth Campus The mission of the University of Minnesota Medical School Duluth is to educate students who will practice family medicine and other primary care specialties in rural Minnesota and American Indian communities, to provide high quality academic and clinical education programs for professional, graduate and undergraduate students, and to create distinguished research programs that advance knowledge in the health sciences, including rural and American Indian health issues.

Duluth Campus NRMP Residency Match 2005 Family Medicine 42.1% 2005 Primary Care 64.9% 2006 Family Medicine 35.9% 2006 Primary Care 64.2%

Family Medicine Outcomes Duluth Campus

Duluth Campus

Admissions Criteria Rural background Service Desire to become a rural family physician MCAT/GPA

Changes in Curriculum Rural Course to reinforce the choice for rural family medicine began 2002 HRSA Grant Objective to augment Rural Preceptorship 2002-2005 Summer elective course connected to rural hospitals began 2003 Rural Course began in 2002 Expansion of Rural Preceptorship from 9 days to 12 days. New session at the end of the first year. Continuation of the 3-3 day experiences in the second year. Addition of assignments and community service.

Rural Curriculum Intro to Rural Primary Care Medicine Rural Preceptorship Rural Community Service Summer Internship in Medicine Program Behavioral Medicine and Clinical lectures with emphasis on rural health

Timeline Year 1: Rural Course June RP Summer Internship in Medicine Program Year 2: Nov RP Feb RP March RP

Introduction to Rural Primary Care Medicine Rural Course 20 Hours Community Experience Lectures Small groups Panel of Rural Physicians Community Presentation by the medical students Site visit to 3 Rural Communities: Grand Rapids, Hibbing and Moose Lake

Euclid-Hibbing Mining

Wabasha MN

Rural Preceptorship Expanded from 9 days to 12 days Assignments with wrap-up sessions Community Service 2002: 9 days (3-3 day session in 2003) 2003 and 2004: 12 days (4-3 days sessions with first session the end of the first year of medical school) Assignments: Clinic Information, Respiratory Infections, Occupational Injuries, Diabetic Foot Exam: Diabetes, Community Service (giving back to the community) Community Service: Kids into Health, Brain Awareness, Miscellaneous Projects-Nursing Homes Medical Students stay with Rural Family Physicians during the Rural Preceptorship (Dr. Jim Boulger-outstanding matching of rural physicians and medical student…many of the rural physicians are alumni of the University of Minnesota Medical School Duluth campus

Rural Preceptorship

Rural Preceptorship

Summer Internship in Medicine Program Elective rural clinical/research opportunities during the summer session between Year 1 and 2 Clinical: assigned to a rural community hospital and clinic to observe rural patient care with interprofessional experiences 2003: 20 students 2004: 16 students 2005: 34 students

Study Sample Base 2002 Second Year 53 students 2002 Pre and Post Test 55 students 2003 Pre and Post Test 54 students 2004 Pre and Post Test 54 students Comparison 2002/2003/2004 163 medical students Base line: 2nd year class in 2002 Pre-test in November Post-test in April (Preceptorship 9 days) 2002: Rural Course + 9 days Rural Preceptorship 2003 & 2004: Rural Course, 12 day Rural Preceptorship and Summer Internship Program (20 in 2003 and 16 in 2004)

Data Sources Rural Health Care Assessment* Pre and Post-test Rural Course Evaluation Rural Preceptorship Evaluation Summer Internship Evaluation For this presentation, concentrate on the Rural Health Care Assessment

Rural Health Care Assessment Attitude of gain in knowledge on 18 rural health care topics Pre and Post-test Information on future practice plans Pre-test completed by first year medical students prior to the Introduction to Rural Primary Medicine Course. Post-test completed at the end of the second year. Likert scale from (1) not familiar (2) aware of issue (3) moderate knowledge (4)very knowledgeable (5) extensive knowledge Topics: Rural Community Assessment, Demographics, Compassion, Community physician roles, Health Care structures, Access, Policy and legislation, Tertiary Care, Telemedicine, Interdisciplinary team, Infectious diseases, Occupational Injuries, Environmental Health, Mental Health, Chronic Disease, Alternative and Complementary Medicine, Pharmaceutical Costs, Elderly Health Care

Rural Health Care Topics Rural Assessment Demographics Compassion Physician Roles Care Structures Access Policy and Legislation Tertiary Care Telemedicine Interdisciplinary Team Infectious Diseases Occupational Injuries Environmental Issues Mental Health Chronic Diseases A & C Medicine Pharmaceutical costs Elderly Care Issues Alternative and Complimentary Medicine Pharmaceutical costs and coverage Attitude of knowledge increase. Selected the topics included as they were covered in the Rural Course and in the Rural Preceptorship assignments.

Results Base line 2002 Second Year Medical Students increased their attitude of knowledge prior to new additions in the rural curriculum

Results With addition of new curriculum, further increase in knowledge Three issues of greatest knowledge: telemedicine, interdisciplinary team and tertiary care support Least knowledge gain in policy and legislative issues

Analysis of Total Attitude Score Sum of all ratings for comfort level of knowledge items) By Group: Pre and Post-test Positive values show pairs of means that are significantly different.

Pre and Post-test Total Attitude Scores Pre and Post-test Total Attitude Scores for Medical Students (2002-2004)

RPAP Selection In the 2004 class, 35/54 students have elected to participate in the Rural Physician Assistant Program (RPAP) in their third year. Is this a reflection of the changes to the Rural Curriculum? Increase in the number of students choosing to participate in RPAP. The 2002 class: The 2003 class: 19 medical students

Discussion Continue to evaluate and improve the rural curriculum Difficult to determine if additions to the rural curriculum will sustain the number of students choosing to practice medicine in rural Minnesota Rural Role Mentors vital component of the rural curriculum

Acknowledgements Dr. James Boulger Phyllis Lindberg Sue McLeod