Montana TRUST Targeted Rural Underserved Track Lisa Benzel Montana WWAMI TRUST Director W W A M IW W A M I

Develop specific rural medical education programs “Medical educators and policy makers can have the greatest impact on the supply and retention of rural primary care physicians by developing programs to increase the number of medical school matriculates with background and career plans that make them most likely to pursue these career goals.” Howard K. Rabinowitz, MD, et al., Journal of the American Medical Association, 2001

Rural/Underserved Communities TRUST takes students from rural/underserved communities, nurtures connections and returns physicians to practice.

Summary of Montana TRUST The overall goal of the TRUST Program is to increase the number of Montana WWAMI students choosing primary care or other needed specialties and then returning those practitioners to the rural and underserved areas within the state of Montana.

Admissions Student admitted to UWSoM via separate process

Components of Montana TRUST 1.Admissions + Admit 33% 10/30 TRUST students to first year class + Selected by the University of Washington School of Medicine Admissions Committee ( 4 members are Montana physicians)

Components of Montana TRUST 1.Admissions Suggested Guidelines: + rural and/or disadvantaged background + prior career experience in health related work + significant volunteer experience in rural or underserved medical settings + strong commitment to service + Montana rural high school graduate and + graduate of a Montana public college/university.

First Summer Experience Continuity Community orientation

Components of Montana TRUST 2. First Summer Experience + Trust students are matched with a physician mentor in a rural community, or in clinic which serves underserved populations (FQHC) + Prior to matriculating in medical school the students spend 2 weeks observing the rural or underserved physician and exploring the health community of the rural or underserved location.

Foundations Phase Continuity Community visits Underserved Pathway Rural Health Course I Rural/Underserved Opportunity Continuity Community Oriented Scholarly Project

Components of Montana TRUST 3. Foundations Phase of Medical School; TRUST Student Pathway The TRUST students: + spend two 4-day weeks with previously assigned rural or underserved physician mentor (continuity visits) + enroll in the University of Washington School of Medicine Underserved Pathway + be assigned a College mentor with significant rural or underserved background + participate in rural health elective at MSU (Med 560) + Journal Club + Osler’s Evenings + encouraged to attend a national, regional or state rural health conference/meeting

Components of Montana TRUST 3. Foundations Phase of Medical School; TRUST Student Pathway The TRUST students: +The TRUST students participate in the Rural/Underserved Opportunity Program (R/UOP) of the UWSOM. +This is a one month assignment in a rural or underserved community under the supervision of their previous physician mentor and takes place during the summer following completion of the first two terms of medical school (During this time students complete a community research project – iii3).

Clinical Phase Continuity Community linkages Underserved Pathway Rural Health Course 2 WRITE (18+ weeks)

Clinical Phase The TRUST students will: + continue site visits + participate in Underserved Pathway activities + participate in weekly College mentor teaching sessions + Rural Health2 elective + Journal Club +encouraged to attend a national, regional or state rural health conference/meeting

Career Exploration Phase Continue Continuity Community Linkages Underserved Pathway Rural Clinical Elective Residency Linkages

Components of Montana TRUST TRUST students will: + Continue with community linkages and underserved pathway + Rural Clinical Elective electives to help establish practice specialty + Residency Linkages + encouraged to attend a national, regional or state rural health conference/meeting

Residency (Including Rural Training Tracks) TRUST graduates match into rural/underserved residency programs

Components of Montana TRUST TRUST Scholars will be encouraged to: Choose a primary care residency program, or a residency program in selected specialties that complement rural or underserved practices TRUST works to develop close connections with regional residency programs Continue Continuity Community Linkages

Rural/Underserved Communities TRUST takes students from rural/underserved communities, nurtures connections and returns physicians to practice.

Components of Montana TRUST 9. Upon completion of their residency training: The TRUST students will be encouraged to select a rural practice site in the state, or to practice in a Federally Qualified Health Center within Montana. Physicians choosing these underserved locations will have access of up to $100,000 of loan repayment through the Montana Rural Physician Incentive Program (MRPIP) as well as NHSC programs.

Success in meeting rural physician workforce needs Specific rural focused programs that: 1. Provide pipeline programs 2. Select the right students 3. Provide the necessary rural educational components 4. Rural exposure and mentorships 5. Close contact and advising 6. Links with residency programs 7. Programs to assist with return to the state 8. Programs that retain providers after employment