Providing Rural Physicians for Illinois A Proposal for a Simulation-Based Comprehensive Rural Program Sara Rusch, MD, MACP Regional Dean University of Illinois Peoria

Setting the Stage Peoria Healthcare Community Approximately 150 M2, M3 and M4 medical students 268 residents and fellows with our partner hospitals OSF-SFMC and Unity Point Health Methodist Both hospitals are part of larger hospital systems which include rural hospitals Regional Referral destination – 1/3 of patients from outside the Tri-County Healthcare and Caterpillar Tractor Company are the two largest employers in the Peoria area

The College of Medicine’s two major affiliate hospitals, OSF Saint Francis Medical Center and UnityPoint Methodist contain over 900 hospital beds and are within just three blocks of the UICOMP campus.

Table 1. Number of Residents in UICOMP specialty programs Resident number/program + ProgramUICOMP Family Medicine30 Emergency Medicine36 Internal Medicine30 Medicine/Pediatrics32 General Surgery15 OB/Gynecology12 Neurology10 Neurosurgery7 Radiology16 Pediatrics30 Psychiatry16

7

A $25 million joint gift to UICOMP and OSF HealthCare resulted in the Jump Trading Simulation and Education Center (Jump). Completed in April 2013, and has more than 60,000 square feet devoted to simulation and education.

Steps to maintaining a rural physician work force 1.Identify and nurture promising secondary school and undergraduates who grew up in rural communities 2.Consider likelihood of practicing in a rural community during the medical school admission process 3.Sustain the rural interest during medical school 4.Recruit into a residency which specifically provides rural learning opportunities and enhances resident comfort with rural practice 5.After the resident graduates and enters a rural practice, sustain them with specific learning/interactive opportunities

Steps to maintaining a rural physician work force 1.Identify and nurture promising secondary school and undergraduates who grew up in rural communities Diversity Initiative 2.Consider likelihood of practicing in a rural community during the medical school admission process - RIMSAP 3.Sustain the rural interest during medical school 4.Recruit into a residency which specifically provides rural learning opportunities and enhances resident comfort with rural practice 5.After the resident graduates and enters a rural practice, sustain them with specific learning/interactive opportunities

Comprehensive Rural Physician Program 3. Sustain the rural interest during medical school - Rural Student Physician Program 4. Recruit into a residency which specifically provides rural learning opportunities and enhances resident comfort with rural practice - Rural Residency Interdisciplinary Hub 5. After the resident graduates and enters a rural practice, sustain them with specific learning/interactive opportunities Rural Physician Scholar

Challenge Students who are initially interested in rural medicine – Fail to find role models – Are in a hospital-based culture which may not value primary care – Don’t have an opportunity to experience the joys and challenges of rural medicine

Rural Student Physician Program (RSPP) - Previously Currently a third year experience RIMSAP students are encouraged but not required to participate 4 weeks each of medicine, pediatrics, OB, psychiatry and surgery (20 weeks) and then 28 weeks of rural site continuity experience Has been very successful in returning physicians to rural communities

Rural Student Physician Program (RSPP) – Enhanced and in Progress In addition to the third year experience, embed components of rural health throughout all four years Add components of rural/global simulation related experiences and an interest group Increase number of students who can participate and make mandatory for RIMSAP students

4. Recruit into a residency which specifically provides rural learning opportunities and enhances resident comfort with rural practice Current Challenges – Training in tertiary care setting Don’t gain needed procedural skills Learn to rely on consultants Separation from providers in other disciplines Don’t gain culturally and content relevant training – Fewer role models Train in a setting that values specialization Living in urban setting (added spousal effect)

Rural Residency Interdisciplinary Hub Develop an interdisciplinary rural/mission training “track” within current ACGME approved residencies (family medicine, general surgery, psychiatry, medicine/pediatrics, pediatrics, medicine) Utilize this as a recruitment tool to our own RSPP students and all students with rural/mission interest Utilize simulation to provide specialized rural/mission interdisciplinary training during the course of their usual residency Provide electives, continuity experiences and required rotations (maintaining compliance with RRC guidelines) in rural communities Provide rural role models during the simulation training by use of the Rural Physician Scholar

Sample Curricular Components Deciding who, when and how to transfer a patient Technical skills – Complex lacerations, central lines, intubation, trauma assessment, severe pulmonary edema Use of telemedicine Taking a good history while using a translator Relying on your clinical skills

Rural Physician Scholar - Challenges Rural Physicians may – feel isolated from their peers – lack access to added training and/or opportunities to practice rarely used skills – miss a teaching environment – want resources to help teach “best practices” in their communities

Rural Physician Scholar Use simulation to teach interested rural physicians new or refreshed skills Teach rural physicians how to use simulation to become the local “Rural Scholar” – return to their communities using simulation to teach technical skills or improved treatment processes to health care providers – Serve as rural faculty for students/residents in the comprehensive rural program Become role models for residents and students

Steps to maintaining a rural physician work force 1.Identify and nurture promising secondary school and undergraduates who grew up in rural communities 2.Consider likelihood of practicing in a rural community during the medical school admission process 3.Sustain the rural interest during medical school 4.Recruit into a residency which specifically provides rural learning opportunities and enhances resident comfort with rural practice 5.After the resident graduates and enters a rural practice, sustain them with specific learning/interactive opportunities

Status of Proposal RSPP enhancement moving forward Rural residency hub gathering substantial support in concept but currently lacks implementation resources (primarily time for faculty) Rural physician scholar dependent on the presence of the rural residency hub curriculum