Tracking of Medical Students and their Attitudes and Career Intents West Virginia Rural Health Education Partnership

Tracking of Medical Students and their Attitudes and Career Intents C. K. Shannon, MD, PhD WVU Department of Family Medicine shannonk@rcbhsc.wvu.edu April L. Vestal, MPH WVU Office of Rural Health avestal@hsc.wvu.edu

Presentation Objectives Explain the goals and organization of the West Virginia Rural Health Education Partnership (WVRHEP) Explain the developing research agenda for WVRHEP

WVRHEP Mission The West Virginia Rural Health Education Partnership will educate, recruit and retain quality health care professionals for service to rural communities to improve the health of the people of West Virginia

Interdisciplinary training in rural underserved areas The West Virginia Rural Health Education Partnership/Area Health Education Centers (AHEC) Interdisciplinary training in rural underserved areas Blend strategies of training and financial incentives with community recruitment and retention Both WVRHEP and AHEC are core components of the health professions training pipeline in the state. All these programs target, track, and encourage trainees to prepare for practice in rural areas. The education is focused on rural health needs and the underserved. We have been successful in blending training and financial incentives for these trainees and to date, of the 488 professionals in rural underserved areas of the state, 25% have received these financials incentives. It is important to know that only physicians, physician assistants, nurse practitioners, and certified nurse midwives are eligible for these programs according to federal regulations. In these disciplines the percentage receiving these awards is over 40% in each discipline.

The contribution and uniqueness of this Partnership Degree-required rural rotations of all state- supported health sciences students Unique collaboration of health sciences schools, private schools and local communities Recruitment of health professionals contributes to economic development through the creation of jobs (in rural WV 1 doc= 4.3 jobs) More stable economy for attracting and sustaining other industries and business. This partnership also gives each set of partners a unique way to contribute to our state’s economic development through collaboration of many, many groups. Just one physician placement in a rural county contributes new or maintains jobs in the area. New industries and business are attracted to areas with a stable health care system.

State & Federal Governments Partnership State & Federal Governments Healthy WV Citizens Community WV’s Pipeline Programs are partnerships of state and federal government funding sources, the higher education system, and local communities; all with the vision to improve the health of WV’s people. Campus/Higher Education

2007 WVRHEP/AHEC Infrastructure 476 training sites in 55 counties 100 student (eight disciplines) rotations per month 682 clinical field faculty; 306 medical preceptors 8 regional consortia with local boards and 4 AHEC Centers with local/campus boards 13 site coordinators, 4 AHEC center directors, program and support staff 8 Learning Resource Centers RHEP now serves 50 counties with the same number of staff positions. The number of rural field faculty increased to 610, and our funding levels have remained the same less the state imposed reductions.

Partnership Training Sites Total of 476 partnership training sites: 374 in HPSAs or MUAs 148 sites have both designations

Types of Training Sites 45 CHCs 47 FQHCs 8 RHCs 28 small rural hospitals 25 dental offices 37 pharmacies

Training Sites, con’t. 14 county health departments, 40 physical therapy agencies or rehabilitation center sites, 15 healthcare for the homeless facilities, 13 school based health centers, 3 free clinics, and 1 migrant health center

WVRHEP/AHEC Infrastructure State level Rural Health Advisory Panel specified in legislation serves both state and federal functions $2.5 million per year to communities, $4.5 million to schools for rural health training $200K per AHEC center in federal funding

WV RHEP/AHEC Service to the State Over 50,000 weeks of student training since 1992 More than 1M community members participating in a variety of community service activities provided by students since 1997 $15 million in uncompensated dental care to 60,000 patients since 1995 820 RHEP/AHEC grads confirmed to be practicing in rural areas of the state in 2006 The Performance, Evaluation, and Research Division within the Legislative Auditor’s office completed an 8 month review of the Rural Health Advisory Panel and the RHEP program this year. Their recommendations include reauthorization of the Panel and the program for another 4 years to 2008. This report also cited the value and contribution of the program to health promotion and disease prevention activities given by the students while in training. We continue to track the amount of uncompensated dental care and the number of patients receiving this care, which now is up to $6 million since 1995.

Observations 39% WV medical school graduates stay in the state following residency 79% primary care residents who complete WV residency stay in the state In past 9 years, retention in primary care has increased by 74%

Observations State has eliminated 8 HPSA counties in 10 years; all 91 health professionals (including 19 physicians) in these counties completed rural community rotations In 8 years, rural WV physicians who completed this training increased by 142%

WVRHEP Research: Moving from “Observations” to “Outcomes” What is the effect of the WVRHEP rural curriculum on R&R in rural WV? WVRHEP evaluation and tracking projects currently in progress Ultimate outcomes will include practice site selection, retention, and associations of R&R It is possible to assess selected intermediate outcomes at present through evaluation of data from on-line questionnaires, since 20011 1. Shannon CK, Baker H, Jackson J, et al., Evaluation of a required statewide interdisciplinary rural health education program: student attitudes, career intents and perceived quality. Rural and Remote Health 5:405 (online)

Table 1: Summary table of analyses for significant factors found to be predictive of reported medical student ‘increased interest in rural health’ after the first rotation Factor p-value Higher rating for overall quality of rotation <0.01 Plan to live in WV 0.02 Anticipated practice in a smaller town Higher anticipated accessibility of practice to the indigent 0.03 Specific WV medical school 0.01 ‘Rural’ home town 0.04

Table 2: Summary table of analyses for significant factors found to be predictive of reported medical student ratings on ‘anticipated practice in a smaller town’ after the first rotation Factor p-value Specific WV medical school <0.01 ‘Rural’ home town Anticipated primary care career choice Higher rating for overall quality of rotation 0.04 Increased interest in rural health

Table 3: Summary table of analyses for significant factors found to be predictive of reported healthcare discipline student ‘confidence in becoming an active part of the community’ after the first rotation Factor p-value Higher rating for overall quality of the rotation <0.01 Anticipated practice in a smaller town Discipline

Increased interest in rural health <0.01 Table 4: Summary table of analyses for significant factors found to be predictive of healthcare discipline student rating on ‘importance of meeting unique needs of the poor’ after the first rotation Factor p-value Female gender <0.03 Discipline Increased interest in rural health <0.01

Discussion Future WVRHEP research initiatives include: - tracking students in placements; ultimate outcomes - assess predictive validity of career “intent” - use of student input for curricular modification

West Virginia Rural Health Education Partnerships Visit us on the Web West Virginia Rural Health Education Partnerships www.wvahec.org www.wvrhep.org www.wv-hsta.org

Tracking of Medical Students and their Attitudes and Career Intents Discussion