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An Innovative Predoctoral Curriculum in Rural Medicine for the 21st Century

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Assistant Dean for Rural Medicine. Director, Division of Rural Medicine ... Discuss why these are important to the practice of medicine in a rural community ... – PowerPoint PPT presentation

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Title: An Innovative Predoctoral Curriculum in Rural Medicine for the 21st Century


1
An Innovative Predoctoral Curriculum in Rural
Medicine for the 21st Century
  • John R. Bowling D.O. FACOFP
  • Assistant Dean for Rural Medicine
  • Director, Division of Rural Medicine
  • Department of Family and Community Medicine
  • University of North Texas Health Science Center
  • Texas College of Osteopathic Medicine

2
Texas College of Osteopathic Medicine
  • Vision
  • To be a recognized academic leader in primary
    care and rural medicine for the state of Texas
    and the nation
  • January 2006

3
Historical Background
  • Total Graduates 1974-2000 2154
  • FP in Texas 36 772

4
F.P. by Town Size 0f 772
  • 10,000-25,000 107 14

5
Historical Background
  • Total Graduates in Primary Care (all states)
  • 1974-2004
  • 1400 53.93
  • 44.58 in Family Practice
  • Towns of
  • FP 25.7
  • IM 14.6
  • Peds 13.9

6
Graduates in FP in TX by Class
  • 1974 50
  • 1984 35
  • 1994 41
  • 1996 47
  • 1997 34
  • 1998 37
  • 1999 50
  • 2000 51

7
Rural Track Studentsand Residency Match
  • FP IM P OB S R Other
  • 2004 6 1 3 2 3
  • 2005 5 1 2 1 0 2 4

8
  • Division of Rural Medicine
  • Department of Family Medicine
  • University of North Texas Health Science Center
  • College of Osteopathic Medicine

9
Mission Statement
  • Preparing the osteopathic graduate for practice
    in a changing rural environment in the 21st
    century.

10
Goals
  • To provide a foundation for life and practice in
    a rural community.
  • To provide an educational curriculum that will
    prepare the graduate for acceptance into premier
    graduate medical education programs.

11
Time Line for Implementation
  • Recruit and Accept Applicants for Class of 2010
    (entering 2006)
  • 13 dedicated seats
  • April-Dec. 2005
  • Pre-matriculation Phase Class of 2010
  • June-August 2006
  • Begin New Curriculum
  • August 2006
  • Pilot Modules in 05-06

12
Application Process
  • Standardized Texas Application
  • On line
  • TCOM Supplemental Application
  • Indicate applying for the rural curriculum
  • Screening for Interview
  • GPA /MCAT
  • Must meet basic admissions criteria
  • 13 seats in class allocated

13
Interviews
  • Rural Division
  • Other HSC Faculty Member
  • Rural Site Interview
  • Shadowing Experience
  • 1 day

14
Pre-matriculation Phase
  • 1-2 days
  • Rural Location
  • Primary Care Physician
  • Shadowing

15
Semester 1- 4
  • Systems Courses
  • With regular curriculum
  • Rural Medicine I, II, III, IV
  • Selected topics /skills relative to rural
    medicine
  • 1-4 contact hours in each systems course
  • Rural Clinical Experiences
  • Community Based Research Project

16
Rural Medicine I-IV
  • Format
  • Seminar / Workshop
  • Individual and group self study
  • Research in rural communities
  • On-line / WEB based
  • Case based studies

17
Rural Medicine I Modules
  • Navigating the Rural Information Highway
  • Rural America and Community Health in Texas
  • Professional Development
  • Epidemiologic Issues for Rural Communities

18

Navigating the Rural Information Highway
  • Learning Objectives
  • Access web sites pertinent to rural health
    issues.
  • Search web-based information for answers to
    specific questions related to rural health
    issues.
  • 1 hour Web-based tutorial

19
Rural America and Community Health
  • Learning Objectives
  • Define what is meant by the terms demographic
    and rural
  • Comprehend the context in which rural medicine is
    practiced in rural America
  • Describe the rural environment and issues
    relevant to the health and health care of Texans
    in rural communities.
  • Discuss why these are important to the practice
    of medicine in a rural community
  • Classroom presentation/facilitated group
    discussion

20
Professional Development
  •   
  • Learning Objectives
  • Describe personal and professional boundaries the
    physician needs to establish when living and
    practicing medicine in a rural community.
  • Discuss issues that a rural physician must deal
    with that relate to time management of
    professional and personal responsibilities.
  • Identify obstacles to patient management that may
    be encountered.
  • Identify issues and risks associated with
    professional isolation.
  • Case studies with facilitated small group
    discussion

21
Epidemiologic Issues for Rural Communities
  • Learning Objectives
  • Define epidemiology.
  • Describe examples of epidemiologic methods which
  • benefit the rural health professional.
  • Describe health issues specific to rural
    communities.
  • Discuss epidemiologic patterns of cancer in
    rural Texas.
  • Case studies
  • Guest Faculty- Dr. Billy Philips PhD Cancer
    Epidemiologist

22
Rural Clinical Correlation
  • Neurotoxic injuries in rural communities
  • Learning Objective
  • Discuss potential risks and sequelae of
    neurotoxic injuries likely to occur in a rural
    community

23
Skills Lab
  • Interviewing the Rural Patient
  • Emergency immobilization and transport in a rural
    environment

24
Rural Hospital Observation
  • 24 hour experience in rural hospital emergency
    department observing health care delivery and
    interaction

25
Final Exam
  • OSCE
  • Will evaluate interviewing and other skills
  • Written Exam

26
Rural Medicine II Modules
  • Medical Information Resources and Search
    Strategies
  • Evidence-Based Medicine Searching the Literature
  • Cultural Competency in the Practice of Rural
    Medicine
  • The Nature and Scope of a Rural Primary Care
    Practice
  • Ethical Issues in Rural Medicine

27
Medical Information Resources and Search
Strategies
  • Purpose
  • To provide the student with knowledge of the
    information resources and tools available to
    support lifelong learning and to use information
    technology to locate existing data sources
    relative to a clinical question or formal
    hypothesis.
  • Directed Student Assignment /Hands on instruction

28
Evidence-Based Medicine Searching the Literature
  • Purpose
  • To teach the student advanced literature and
    database searching strategies and knowledge of
    data sources, such as clinical guidelines and
    evidence-based point-of-care tools to support
    lifelong learning. To use available information
    technology in locating existing data sources
    relative to a clinical question or formal
    hypothesis.

29
Cultural Competency in the Practice of Rural
Medicine
  • Purpose
  • To increase the students awareness of the role
    of cultural bias and rural culture on the
    practice of medicine.
  • Directed Student Assignments / Discussion

30
Nature and Scope of Rural Practice
  • Purpose
  • To introduce the student to the nature and scope
    of a rural primary care practice through
    exploration of a rural practice profile services
    offered and the relationship and resources
    available in the rural community.
  • Directed Student Assignments / Interviews
  • Division /Rural faculty

31
Ethical Issues in Rural Medicine
  • Purpose
  • To increase the students awareness of the
    ethical issues and dilemmas likely to arise in
    rural medicine and to identify and describe some
    of the resources and strategies available in
    assisting with these issues.
  • Ethicist / course faculty
  • 1 hour small group 1 hour seminar

32
Community Project
  • Purpose
  • To give the student experience in community
    responsiveness and leadership through the
    identification and development of a plan to
    address a relevant community concern.
  • Assignment
  • The student will produce a plan to address a
    community-related problem

33
Rural Clinical Correlation I
  • Smoking Cessation for Rural Patients
  • PurposeTo introduce the student to issues
    related to smoking cessation for the rural
    patient.
  • This will parallel the respiratory systems course

34
Rural Clinical Correlation II
  • Colorectal Cancer
  • PurposeTo introduce the student to issues
    related to colorectal cancer for the rural
    patient.
  • This will parallel the gastrointestinal systems
    course

35
Rural Clinical Correlation III
  • Gynecological Cancers in the Rural Patient
  • PurposeTo introduce the student to issues
    related to gynecological cancers in the rural
    patient.
  • This will parallel the reproductive systems
    course

36
Trained Patient Labs
  • Purpose To allow the student to practice
    focused history and physical examination skills
    needed in the rural environment.
  • DVD created for each student

37
Skills labs
  • Direct fiber optic laryngoscopy
  • EKG
  • Pap Smear
  • Flexible Sigmoidoscopy
  • Dental Emergencies

38
Rural Hospital
  • 24 hour experience in rural hospital emergency
    department observing health care delivery and
    interaction

39
Rural Medicine III
  • Public Health issues in Rural Texas
  • Rural Health Needs and Resources
  • Special Patient Populations and their Unique
    Challenges to the Rural Physician

40
Public Health issues in Rural Texas
  • Environmental and Occupational Health
  • Toxicology
  • Traffic and Farm Safety
  • Disaster Care and Bioterrorism
  • Health and Infectious Diseases

41
Rural Health Needs and Resources
  • Emergency Medical Services
  • Health Care Facilities
  • Water Resources-Conservation and Contamination
  • Rural Disabilities

42
Special Patient Populations and their Unique
Challenges to the Rural Physician
  • Farm workers
  • Nursing Home
  • Mental Health

43
Rural Medicine IV
  • Rural Health Policy
  • Other Roles of the Rural Physician
  • Advanced Medical Information Resources and
    Telemedicine

44
Early Clinical Experiences
  • Simulation experiences
  • Beginning Semester 1
  • Community offices
  • Beginning semester 1 (prematriculation)
  • Rural hospital
  • Beginning semester 1
  • Rural community
  • Beginning after Semester 2

45
Competencies Prior to Yr. 3
  • History and Physical
  • ACLS
  • Insertion of Foley catheter
  • Casting and Taping
  • Venapuncture
  • Insertion of N/G tube
  • Giving Injections
  • Skin testing
  • Telemedicine consultation
  • Interpretation of basic
  • x-ray exams
  • Proper use of microscope
  • Clinical lab procedures
  • Sterile technique
  • Rx writing
  • CDLS, BDLS

46
Evaluation of Competencies
  • OSCE
  • Written tests
  • Direct Observation

47
Year 3 4
  • Urban and Rural training sites will be used.
  • Traditional block rotation experiences may be
    combined where possible.
  • On line didactic material with on line testing
  • Students will be accountable for all didactic
    material required in conventional curriculum, as
    well as additional ROME requirements.

48
Year 3 (Phase 3) 52 weeks
  • 8 wks Family Practice
  • (rural)
  • 8 wks Internal Med
  • 4 wks Critical Care
  • 4 wks Inpatient and ambulatory
  • 6 wks Peds
  • 6 wks OB/Gyn
  • 8 wks Gen/Surgery
  • (rural)
  • 4 wks Emerg Med
  • (major trauma center)
  • 4 wks Vac/study
  • 4 wks Psych
  • 4 wks OMM

49
Year 4 (Phase 4) 32-weeks
  • 8 wks PCP/Geriatrics
  • Rural site
  • 4 wks Rural Hospital
  • Emergency Medicine
  • Critical Care
  • 4 weeks Surgery
  • Orthopedics
  • Sports medicine
  • 4 wks Cardiology
  • 4 wks Neurology
  • 4 wks Public Health
  • 4 wks Electives
  • International
  • Occ. Med
  • Research
  • Vacation

50
Longitudinal
  • Dermatology
  • Radiology
  • Clinical path
  • Cancer Competencies
  • These will be on-line courses with specific time
    frame and competency evaluation at the end.

51
COMLEX Level 1Average Score
  • RT 515.89
  • TCOM 510.38
  • National 504.94

52
COMLEX Level 2Average Score
  • RT 519.51
  • TCOM 508.8
  • National 498.35

53
NBME subject exams comparison scores
  • IM RT TCOM
  • OB/Gyn RT TCOM
  • FM RT TCOM

54
Program Evaluation
55
Matriculation Phase
  • Zip code location 1st 18 years of life
  • Age
  • Sex
  • Matriculation Data (e.g. MCAT scores, GPA)
  • Personal Background/ experiences
  • Prior Education

56
U M E Phase
  • Comparisons between rural and traditional
    students
  • Grades on comparable courses
  • Rotation Evaluations
  • Competency Assessment
  • COMLEX Level 1,Level 2, and COMLEX-PE
  • Community participation (clubs, student
    government, community service activities,
    research, etc.)
  • Measures of student perception of confidence
    pre and post curriculum experiences
  • Site visits
  • Student critiques
  • Exit interviews
  • Pre and Post Curriculum Student Surveys

57
G M E Phase
  • Comparisons between Rural and Other students
  • Residency Selection
  • AOA vs. ACGME
  • University vs. Community
  • Rural vs. Suburban vs. Urban
  • Medically Underserved vs. not
  • Primary Care vs. Other Specialties
  • COMLEX Level 3
  • In-training GME examination scores
  • Feedback from Residency Evaluations on
    attainment of Core Competencies
  • Career Choice Satisfaction Data

58
Practice Phase
  • Longevity in Specialty
  • Incorporation of Osteopathic Philosophy
  • Location
  • Scope of Practice
  • Income
  • Debt Burden
  • Career Satisfaction
  • Preparation for Practice
  • Ongoing Competency Assessment, Board
    Certification, Licensure, Privileging Information
  • Academic Careers

59
www.hsc.unt.edu/Ruralmed/
60
Our Vision
  • State wide rural faculty
  • Didactic teaching
  • Clinical precepting
  • Mentoring
  • Utilize distance learning video connectivity
  • Rural Residency in Family Practice
  • Collaboration with other Colleges of Osteopathic
    Medicine
  • Curriculum development
  • Shared courses

61
Questions
62
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