The Combined Outstate Rural Experience sends family practice residents in their second or third year of training for a two months training experience in small towns. This experience began shortly after the initiation of the residency in 1970. The benefits of the program are far-reaching:
The Combined Outstate Residency experience is also an example of how the department has gone beyond other departments and programs to meet the needs of rural Nebraskans. Most rural rotations send residents intermittently and electively to rural locations. This provides little help to the rural communities or physicians. Most of the time is spent in orienting the resident and very little service delivery occurs.
CORE not only trains residents how to be physicians, it also trains communities how to recruit good practitioners, something that many rural communities have forgotten.
The department also delivers direct rural physician services. The CORE component plus an innovative rural moonlighting program for residents and the services of the rural training track residents results in nearly 10 FTE of rural physician services a year provided directly to underserved rural locations in the state.
Many times academicians have expected rural communities to provide experiences for students and residents with little notice or preparation or support. Others have taken a different approach. The Combined Outstate Residency Experience (CORE) is a two month rural preceptorship. Three residency programs in Nebraska have combined their efforts to insure that there is a constant stream of family practice residents going to 4 small towns for up to a 3 year period. Towns are selected based on the need for physicians, the willingness of the hospital to support the program, and the ability of preceptors to teach.
CORE residents have stood in the gap to assist rural practitioners and health systems with much needed FTE in exchange for hands-on learning experiences. As much as possible within billing and training guidelines, residents function as rural physicians. Rural communities also learn using hands-on techniques, in this case by practicing recruitment on CORE residents. In the past decade, only one CORE site has failed to recruit a practitioner. Over 60 of the graduates of the RPAP (Duluth Plus RPAP) long term preceptorship have returned to the community where they did their rural experience. The savings in recruitment and orientation costs are enormous in such situations.
Rural medical education also can add to workforce far more than the education of students costs. CORE is just one example where residents share call, see patients, and help satisfy community expectations. This may stabilize the most vulnerable systems and preserve access. Such medical education programs also help rural health systems in need to sustain or even build market share. Medical education also works directly to serve rural communities. Rural residency programs, rural training tracks, and rural satellite sites serve over a hundred rural communities across the nation, but there is even more potential. Some 800 of 2500 family practice faculty have been rural physicians. Many of these might have been able to stay in their rural practices if the training had moved to their location rather than vice versa. Trainees experiencing the bond between rural practitioners and communities firsthand might well value this long after graduation.
Each year family practice residents provide 4 FTE of rural physician services in the CORE rotation and another 4 FTE at clinics at rural training tracks. Additional rural services come from rural electives taken by residents and weekend emergency room services provided by residents for pay. Chances are that some rural doctors have been retained by the support of the residents that have helped with call and practice and other issues. Time and studies will tell more....
Rural Graduate Med Ed Programs