Presented by Joe Florence, MD, RPCT Director At China-ETSU Health Education Institute November 16, 2011

1. Training our Future Country DoctorsInterprofessional community-based public health education: An Introduction to the Community Partnership model as a best practice Presented by Joe Florence, MD, RPCT Director At China-ETSU Health Education Institute November 16, 2011

2. Objectives At the end of this presentation, participants will have knowledge of “best practices” for preparing health care professionals for future rural practice: • the Rural Primary Care Track of the Quillen College of Medicine. • the Community Partnership • Interprofessional community-based public health education

3. Rural Experience • Rural community based origin • James H. Quillen’s Legacy • Rural mission and Institutional Purpose: • with emphasis on community based and inter-professional education • special emphasis on addressing the needs of Southern Appalachia in the area of rural health care

4. US News and World Report Rural Medicine Best Medical Schools • ETSU Quillen College of Medicine • Ranked #3 in the US in 2011 • There is a growing need in the U.S. for rural medicine doctors. Through these programs, students train to be physicians in rural and underserved communities.

5. Communities

6. ETSU Approach to Rural Curriculum Teaching-Learning Teaching-Learning Adding to the knowledge of regional community health issues Student reflection on future professional value and sense of civic responsibility Community-based Scholarship Community Services Interdisciplinary Leaders Partnerships Service Research Service Research Using the principles of community based participatory research to address community identified issues and opportunities

7. ETSU Rural Programs – Community PartnershipsContinuum of Educational Experiences

8. Rural Primary Care Track (RPCT)Goals • Increase Rural Primary Care Physicians • Train Physicians to Function in Health Care Teams • Equip Physicians To Become Effective Agents (Leaders) of Community Change

9. Key Concepts of the RPCT Emphasis on: • Clinical experience in context of the community • Health Promotion, Disease Prevention • Community Based Participatory Research • Community Assessment and Projects • Inter-professional Training (Medicine, Nursing, Public Health, Pharmacy, Social Work, Clinical Psychology, Respiratory Therapy, Chaplains)

10. Rural Primary Care Track (RPCT) Medical Students • Elect to participate. • Formal application process which includes – online application, essays and interview. • Limited to 25% of the COM Class. • Partner with • Rogersville, • Mountain City and • Another rural community

11. RPCT Medical School Curriculum

12. Rural Primary Care TrackAs of March 2011 Total practicing in primary care - 64% Total in rural practice location - 57% Total in Tri Cities TN practice (non-rural) - 8% Total in Tennessee practice - 56% Tennessee natives - 77% Select Tennessee residencies - 50% Tennessee natives, TN residency and TN practice - 30% Tennessee natives in Tennessee practice - 57% Tennessee natives in out of state practice - 43% Out-of-state native in Tennessee practice - 26% Out-of-state natives in out-of-state practice - 74%

13. Role of the Rural Community-based Faculty Mentor and Coach Crucial to success Establishes the learning environment

14. The Interdisciplinary Rural Primary Care Community Partnerships • Since 1992 enrolled 700 students from Medicine, Nursing, Public Health, Environmental Health, Social Work and Psychology. • Received the National Rural Health Association “Outstanding Rural Health Program” in 2007.

15. Interprofessional ObjectivesAccreditation Competencies Shared by Health Professions • Knowledge • Health Promotion and Disease Prevention • Determinants of Health • IRB and HIPAA training • Theories and conceptual models for promoting change • Roles of various health professions • Health status indicators from primary and secondary data sources • Cultural Competency • Health Disparities • Skills • Research – Community Based Participatory Research and Translational Research • Quality Improvement • Community Assessment of health and health assets • Project planning, implementation, evaluation • Communication • Behaviors • Interdisciplinary team collaboration • Collaborative community partnerships • Serving the Underserved • Caring

16. Rural Health Training – best practices • Mentoring • campus based faculty who promote rural • especially family medicine center faculty • specialists who promote rural • rural physicians • Instill confidence to work in rural communities - demystify rural medicine

17. Rural Health Training – best practices • Immersion • Involvement • civic activities • nurture leadership • “Longitudinal” rural experiences provide more accurate “feel” for what practices in rural communities compared with “Block”

18. Rural Health Training – best practices • Knowledge unique to or more common in rural • Occupational • Environmental • Recreational • Socio-economic • Cultural • Spiritual – issues of trust and safety for self, others, nature and God • Barriers to health (access)

19. Rural Curriculum - best practices • Skills unique to or more common in rural patients’ life in rural • Office procedures • Management practices, billing, budgeting, QI • Stabilization and triage • Experiences which promote understanding rural patients in their context • Home visits • Work place – occupational health evaluations; service delivery – E&M; risk assessment

20. Rural Curriculum - best practices Community projects • Service Learning • Community Based Participatory Research • Inter-professional, Interdisciplinary • Health Careers Education • Population Based - School aged, Senior Citizens • Occupationally based - Farming, logging, mining, etc. • Recreationally based- Hunting, fishing, hiking, camping, etc.

21. Immersion in Rural life and practice • Typical life outside of practice • recreational things to do • good/desirable lifestyle • raising a family in rural community • Support – • Professional • Personal and family • Practice options in a rural community • Financial perspectives – incomes, expenses • Exposure to various practice styles – CHC, RHC, Private, etc.

22. Develop community sites and foster Partnership • Partner with • Rural physicians individually and their organizations • Rural clinical service facilities: family practice centers, CHC’s, RHC’s, Health Departments, long term care, rural hospitals • Specialists serving the rural communities

23. Develop community sites and foster Partnership • Exemplary clinical practice • Private practice – solo and group • CHC • RHC • Health Department • Hospital • Extended, long term care • Hospice

24. Technology: optimize Tele-health experiences • Patient care - team care • Electronic Medical Records – Regional Health Information sharing (RHIOs) • Tele-medicine clinics • Information Access – evidenced based care • WEB based data bases, libraries • Continuing education • Promote students/residents as teachers to “give back” to rural health care providers

25. RURAL PROGRAM DEVELOPMENTA Quality Improvement Process Institute for Healthcare Improvement

26. Developing Rural Competence • Competence is a habit • Health care is a cooperative art; performance occurs in relationships; competence in relationships • Competence is developed along a continuum • Knowing the rules is not enough; values are important Adapted from “Residency Training and Systems Based Practice” (2004) David C. Leach, MD, Exec Director ACGME

27. Principles for Rural Success • recruiting rural students into the health professions • giving admissions preferences for rural students • implementing rural training tracks  • training in rural communities • preferences for rural primary care

28. Rural training best practices • In Rural • By Rural • About Rural • For Rural • With Partnership

29. If you want a Rural Health Workforce, you need to provide Medical Students and other Health Professional Students with Rural Experiences……. You Can’t Fall in Love with Something You Never Experience!