1. Tejal Parikh, MD Paul Gordon, MD, MPH Frank A. Hale, PhD
Fellows as Peer Consultants: An Educational Site Visit Program for Rural Faculty Scholars
Tejal Parikh, MD
Paul Gordon, MD, MPH
Frank A. Hale, PhD

2. Background Information
The University of Arizona Faculty Development Program (FDP) has been training teachers for many years.
Arizona is a relatively rural state with many of our preceptors (130) spread throughout the state
Rural faculty face barriers to participating in our FDP

5. Tucson

7. Participating Sites 2006: COMMUNITIES Chinle White River Tuba City
Three Points
Safford
Payson
Benson
Florence
Douglas
MILES TO TUCSON
353
184
333 34
138
185 57 61
130

8. Peer Consultant Program: The Process
Fellows site visit a colleague’s practice
Gather descriptive materials/information
Personal observation/interactive discussion
Observe teaching IF a student is on site
Prepare a consultant report/SWOT analysis on the teaching program at the site
Host fellows present practice & submit written response to SWOT analysis

9. Teaching Program Evaluation
Illustrative Educational Site Visit Topics
Teaching site orientation & supervision
Clinical & non-clinical learning experiences available
Teaching methodologies used
Opportunities to develop cultural competency

10. Value added to Rural Faculty Development Program
Rural fellows meet face-to-face
Provides leadership experience in site evaluation and analysis (Consultant)
Provides leadership experience in site presentation & report response (Host)
Provides practicum for application of small group teaching and feedback techniques
Provides opportunity for exchange of information to improve teaching programs

11. PEER CONSULTANT TOOL SWOT Analysis

12. TEACHING ENCOUNTER OBSERVATION

13. DOCUMENTATION

14. CHINLEE IHS HOSPITAL

15. CHINLEE TEACHING CONF

16. NAVAJO MURAL

17. CHINLEE HEALING HOGAN

18. SWOT ANALYSIS
SWOT analysis is a useful and flexible objective assessment tool for fellows.
Its use structures their roles as outside observers.

19. Ex: Chinle Internal Strengths
CONSULTANT
Unique culture stretches societal & epidemiological foundations of student
Team approach that extends beyond work
HOST
Consultant recognized importance of teaching the art of medicine
Consultant recognized unit & potluck experience

20. Ex: Chinle Internal Weaknesses
CONSULTANT
1. Limited teaching space in busy facility
2. Too many changes among different medical specialties; make experience patient-centered & not physician-centered
HOST
Need to address teachable moment space challenges
Hope to change structure to most student time with single preceptor

21. Ex: Chinle Ext. Opportunities
CONSULTANT
1. Teaching program helps recruitment
2. Use team approach to schedule learners to follow patients through mid-level & allied health visits
HOST
Yes, but hope is for a majority Dine staff
Loved the suggestion and have already implemented it

22. Ex: Chinle External Threats
CONSULTANT
Navajo Nation may take over Chinle Service Unit & limit teaching program
Federal funding cuts may reduce resources for student housing
HOST
1. & 2. Need to sustain institutional memory of teaching program benefits by dealing with provider burnout and turnover

23. Barriers and Issues SCHEDULING VISITS DISTANCE AND LOGISTICS
REPORT WRITING/REACTION
COST-BENEFIT ISSUES – 4 visits/year provide all fellows opportunity to play role of either consultant or host

24. Summary of Experiences of First 18 Months
Face-to-face meetings uniformly enhance evaluation of Rural Fellowship
Site visit practicum of greatest value to leadership experience of consultant
Consultant reports identify physician burnout as the most crucial threat to the quality of the rural teaching program
Consultant reports identify a quality rural teaching program as a key opportunity for physician recruitment and retention

25. Fellows as Peer Consultants: Future Recommendations
Address scheduling & logistics at first meeting
Match the clinical interests of consultant & host, eg IHS physicians
Provide specific report expectations as to SWOT analysis and response

26. THREE POINTS

27. FLORENCE

28. FLORENCE EMR

29. Strengths: Florence
New, clean, efficient clinic with diversity of patients
EMR experience
Clinic owner Dr. X, grew up in community and the practitioners have gained the respect of the local population
Dr. X received his MD from the U of AZ College of Medicine and knows the faculty there and he completed the faculty development fellowship

30. Weaknesses: Florence
Busy clinic with practitioners seeing an average of 20 patients per day may not allow ample teaching time for student
No inpatient experience for students
This site has never had a student rotate through the clinic although they will receive one this summer
Housing for the student is an unknown
Limited partnership with other clinics in the community

31. Opportunities: Florence
Opportunity to work with immigration and prison health
EMR allows for easier research on common primary care topics

32. Threats: Florence
Lack of specialists in community as an additional teaching opportunity
Lack of organized CME either through the clinic or county
The members of the medical community are not unified
High level of uninsured or under-insured in the community could impact funds and future of the practice
Additional providers moving into the area would increase competition