Medicine should first of all do no harm
Medical Education should hold to the same values...
Communities and practitioners are often asked to assist in medical education. Their response has been overwhelming. Rarely have communities or practitioners asked for much in return, but they should look out for their communities, and medical education can help. This can include long term medical student exposures, shorter term exposures for residents or fellows, local faculty development, and community projects.
There is an aspect of the community driven approach I like to call community friendly medical education. In this aspect, medical students stay more than 4 months, preferably 9 months or longer in a rural area for training. Verby documented that this was equal to or better than academic in 23 measures. Given the deterioration of medical school education in the past 15 years since this was done (especially hands on decision making) I suspect that the same studies would be even more dramatic. The MN RPAP students before the experience were average or below in the standard measures. Remember that any US mention of RPAP is in Minnesota and you should also remember that the 2 year Duluth school selects for rural background and FP interest and this makes up 20 of the 40 RPAP students each year.
1. Students can enhance workforce. Verby noted that sites with students compared to years without billed for $40,000 to $60,000 more. This does not mean that students billed directly for patients but the practice as a whole did work more efficiently and effectively. Personal observations also reveals some interesting interactions at the clinic and nurse level regarding phone calls, patient follow up, satisfaction, etc., but others could respond better to this. Australian studies reveal a break even point at about a 4 month rural experience. Longer rural rotations clearly are better for communities and practitioners. You have to do more global and detailed studies to show this, more than just the number of hours of teaching, etc. http://www.unmc.edu/Community/ruralmeded/model/medsch/RPAP_and_Duluth.htm
2. Residents can enhance workforce - The Nebraska CORE rotation for family practice residents is designed as much for communities as it is for our convenience. http://www.unmc.edu/Community/ruralmeded/model/gradu/core_program.htm
CORE, as designed an implemented by our program director Jim Stageman, is a state and community tool to assist shortage communities in need of 1 or 2 physicians. Faculty screen at on site visits for physicians who can supervise the residents and teach them, but choose sites in need. This is better for the site and better for the residents in terms of utilization and volume and variety seen. Typically in Nebraska this is a 2 - 4 doctor site in a county of less than 10,000 people. We continue to send a stream of residents each 2 months for up to 3 years and sometimes a bit longer if needed. If the site recruits a new provider, they sometimes do choose to terminate the CORE rotation.
I like to describe this as stabilizing the front lines rather than a device such as the National Health Service Corps or J-1 Visa waiver where the new recruits are parachuted in to isolated locations to get chopped up in a short time.
The nurses at our clinics regularly note that residents go out as trainees and come back as practitioners.
Most, if not all US residencies are more arbitrary about rural rotations and there are often gaps between residents. This method is more appropriate for someone to check out one of the final choices for a permanent location, but is not as helpful for the community.
3. Community Projects Often practitioners are busy doing service and take less time for reflection. This may particularly include the preventive parts of practice. Students can be an ideal source of workforce and inspiration to explore areas of the community or populations that may make patients prone to disease, injuries, disability, or other problems. Some projects might include medical services to underserved areas or populations. Others may relate the practice to the community or some facet. This can be a state project, a preceptor project, or a nationally funded effort. SEARCH NHSC National Web site other projects can be a part of efforts of Rural Student Interest Groups Students can often act to bridge the gap between rural and academic communities.
4. Community - Friendly faculty development - again RPAP (the Minnesota version) has us all beat because students doing the M-3 RPAP rotation are getting faculty development for their time as preceptors to the next generation of RPAP. My next favorite model is gathering 2 or 3 local rural docs together and a few key community people and a student and resident and asking 3 questions Involvement is the key to a great preceptorship
AFMO Document, community contributions of graduate training Page 6 Perry Pugno http://www.uams.edu/afpa/vol16_4.pdf
CRIB Summary - see above link for full text - preferred choice
Competence What do you do well in your practice, what do others in the community such as physicians, other providers, local leaders, do well? Consider the usual practice stuff (procedures, obstetrics, office management, organize local physicians, counsel patients) but also look beyond (public health, work with the schools, participate in local organizations)?
Rural Living What are the best parts of your community (schools, churches, organizations, public health, community-minded people or projects, community events or celebrations)?
Involvement How can I involve students with the above? Best done in a group session with many of these people in the community coming together.
Best of your community Do those around you have some special skills or talents that students could learn about (skills of other doctors, office manager, nurses, hospital administrator, community leaders, ministers, senior citizens)?