JME RPAP 1988

Verby JE  The Minnesota Rural Physician Associate Program for Medical Students  Journal of Medical Education 63:427- 437 June 1988  RPAP moves into 69 of MN's 87 counties

Outcomes - 

  1. First 23 students, 21 in rural areas, 
  2. Drop in rural graduation from 80% at start to 57% felt to be due to increase in residency training by 2 years after 1975. Tom Bruce also noted this in his works.
  3. All 87 counties in MN with an acceptable ratio of one FP/GP per 2500 for the first time ever.
  4. Ten students removed for a variety of personal and interpersonal reasons. Communities changed due to preceptor substance abuse, amoral behavior, or incompatibility
  5. 33% of RPAP preceptors have been RPAP students
  6. 95% of preceptors next to or in hospital building in 1987 as compared to 5% in 1971, with RPAP director a major factor.
  7. Computers placed at sites beginning 1984
  8. Evaluations see  Garrard Comparison 1977

Goals 

  1. Influence rural practice
  2. Experience rural practice
  3. Teach to be independent learners and problem solvers
  4. Give confidence and proficiency in primary health and disease care
  5. Develop awareness and sensitivity beyond biological and procedural
  6. Encourage balance, ethical behavior, become patient advocates, be adaptable to new modes of health care (50% MN managed care)

Obstacles 

  1. Faculty unwilling to act on negative evaluations of certain students
  2. Preceptor tendency to give inappropriately high grades
  3. Cancellation of faculty visits due to weather
  4. Tardy evaluations by preceptors
  5. Lack of full credit given in core courses (improving over time)

Advantages

  1. Ambulatory training as in practice
  2. Continuity of care taught
  3. Continuity of evaluation and teacher
  4. Greater confidence in above areas Garrard Comparison 1977
  5. More patients seen and still time for reading daily
  6. Enhanced computer literacy
  7. Far more family physicians and primary care physicians
  8. 21st century requirements met for General Professional Education of the Physician (S Muller chair, J Med Ed 59:Part 2 November 1984)  including a physician with values and attitudes that promote concern for the individual and society, skilled in collecting info and developing rapport with patients, and skilled in applying scientific methods to analysis, synthesis, and management of clinical data