1. Rural, Longitudinal, Interdisciplinary, Curricula for year 03: what have we learned?
Roger W. Schauer, MD, FAAFP
ROME Director
Dept of Family & Community Medicine
Until 1998 UND had the traditional Department-centered basic science
curriculum for the 1st two years, with independent clinical clerkships during
yr 03, and electives plus a required 2 mo Family Medicine clerkship in yr 04.
new Dean - challenge to revise curriculum
We moved from basic science courses to Patient-Centered Learning for
the 1st two years, & moved the 2 month Family Medicine clerkship to yr 03.
The dean also challenged us to develop a continuity-based, rural experience
for highly motivated students. We reviewed & visited a number of schools,
but the success rate of the Rural Physician Associate Program (RPAP)
at U of M caught our attention, and was the model that seemed to fit our
needs best, with some modification.

2. Goals
Provide the student with a comprehensive, broad-based primary care medical education;
Provide the student an opportunity to experience the lifestyle of rural health care providers.

3. ROME- Rural Opportunities in Medical Education
Dean & Administration Support
Office of Medical Education Support
Steering Committee
ROME Program Director
Clinical Chairs/Clerkship Directors
Campus deans
Clinical coordinators in each community
ROME is a collaborative interdisciplinary, continuity experience involving five core clerkships, including Surgery, Internal Medicine, Pediatrics, Obstetrics/Gynecology, and Family Medicine. The ROME director is responsible for directives of the ROME Steering Committee, which consists of the sis core clinical clerkship director and/or. department chairs, the campus deans, the associate deans for medical education and student affairs. The ROME director reports to the Office of Medical Education.
-Steering Committee from planning stages to develop the ROME curriculum and set curriculum-related policies
-Includes ROME Program Director, which has been either the DFM Chair and/or the Predoc Director
-Also includes the Chairs of the clinical department/ Clerkship Directors, Bismarck & Fargo campus deans, Associated Dean for Medical Education, as well as the on-site physician coordinators

4. Yr 03 Curriculum
ROME Students Rural setting, 28 weeks Traditional campus, 20 wks
Full credit for Family Medicine & Surgery;
Four weeks credit IM, Peds, OB/Gyn IM
Peds
OB/
Gyn
Neuro
science*
Traditional Students rotations, each 8 weeks
Traditional students meet all core clinical clerkship requirements on one of three 3rd year campuses, including Fargo, Bismarck, and Grand Forks
Internal
Medicine
Pediatrics
Surgery
Obstetrics
Gynecology
Family
Medicine
Neuro
science

5. ROME Sites Hettinger - 1,307 Devils Lake -7,222 Jamestown – 15,527
Williston - 12,512
Dickinson – 15,632
ROME Sites
Canada
Devils
Lake
Minot
Williston
Grand
Forks
Minnesota
Fargo
Dickinson
ROME sites
- Hettinger - 1,307
- Devils Lake -7,222
- Jamestown – 15,527
- Williston - 12,512
- Dickinson – 15,632
Other ND population information ,000, four cities over 35,000
- 36 of 53 ND counties are designated as Frontier
(<6 persons/square mile)
- 43 of 53 ND counties are full or partial Primary Care HPSAs
Med School located at Grand Forks, for all MS1 & MS2
MS3 campuses in Fargo, Bismarck, and Grand Forks.
MS4 students are assigned to Fargo, Bismarck, Grand Forks, and Minot (about 15 to each campus)
Jamestown
Bismarck
Montana
Hettinger
Yr campuses
South Dakota

6. Outcomes Exam scores* Subject exams USMLE Step 2 Career choices
MCATs , vs 30-31
Subject exams
USMLE Step 2
214– 219 vs
Career choices
49% primary care; with Sx -66%
FM– 19 (29%); IM– 8 (12%); Peds– 4 (6%); Med/Peds– 1; Gen S – 11 (17%); Ob/Gyn– 7 (10.7%); EM-4 (6%)
Other – 11 (17%) in NeuroSx, Neuro, Derm, Psych, Path, Radiol, 5 transitional /subspec
9 of 27 completing residencies are in practice in ND

7. Support by Clerkship directors
Initial support Current support ++++ Family Medicine Surgery Pediatrics Internal Medicine Obstetrics/Gynecology Neuroscience* - * Not participating in ROME

8. LCME findings (2006) – 6 strengths
*Rural Opportunities in Medical
Education (ROME)
Patient Centered Learning (PCL)
Volunteer Faculty
Indians into Medicine (INMED)
Other two were the research program and the Clinical Education Building

9. Why community-based teaching & learning?
“Real world” medicine
see more patients
wider variety of patient problems
more acute care
more procedures
closer supervision
one-to-one teaching

10. Why smaller, remote communities?
Practice and population unmodified by tertiary care practice
To increase awareness of needs and opportunities for future practice

11. Why Ambulatory Setting?
That ‘s where the patients are
Requires unique skills
Teachers possess unique skills/knowledge
Authentic role models
Influences careers

12. Additional reported benefits
Common office-based problems
Chronic disease management (continuity)
Health maintenance
Prevention & screening
Doctor-patient relationship

13. Situation Prevalence of psych problems
Dept of Neuroscience will not engage in teaching during ROME
Longer continuity experiences have better outcomes*

14. Conundrum
How can we best engage the Dept of Neuroscience to participate in this longitudinal, continuity, clinical education experience?
Conundrum may refer to:
A riddle whose answer is or involves a pun or unexpected twist
A logical postulation that evades resolution, an intricate and difficult problem