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From Cornfields to Classrooms to Collaborations
How Our Medical School Can Partner With Your Rural Community
Emily Onello, M.D., Sarah Beehler, Ph.D. & Jim Boulger, Ph.D.
University of Minnesota Medical School, Duluth Campus
The University of Minnesota Medical School – Duluth Campus
Established by Legislature in 1969, opened in 1972
1834 Graduates (as of May 11, 2014)
Original mission set by legislature: Train and provide physicians for rural Minnesota who practice Family Medicine
Faculty added mission: Train Native American physicians and others who will serve that underserved population
Internationally recognized for our success in mission attainment –in Minnesota, not so much
The University of Minnesota Medical School – Duluth Campus
The Duluth campus was separate from the Twin Cities campus until 2003, with different financial support streams, curriculum, admissions procedures, etc. At the time of the merger, assurances were made that the mission of the Duluth school/campus would be maintained.
While the school is located on the Duluth campus, the administrative chain is to the Medical School Dean and Vice-President for Health Sciences in the Twin Cities.
The University of Minnesota Medical School is one of only two US Medical Schools which rank in the top quartile for NIH research funding and in meeting the nation’s social mission in primary care.
Key Success Factors
Admissions Processes and Mission Dedication
Family Medicine Preceptorship and Rural Health Scholars Programs
The people, culture and environment of the school are strongly and historically supportive of our missions.)
Summer Internship in Medicine
Community service projects
Family Medicine Interest Group
University of Minnesota Medical School Funding Sources
Duluth Campus Medical School budget is approximately 1% of this total.
Rural Results
What have been the benefits to rural Minnesota? Have the aspirations of the rural Minnesotans and our legislature more than forty years ago – to train family physicians for rural Minnesota and for Native American Populations – been satisfactorily met?
Key Successes
While only 5% of Minnesota physicians practice in rural areas, 39% of the graduates of the Duluth campus practice in communities fewer than 20,000 population (Brooks, et. al.).
Nationally, about 81/2 % of United States medical school graduates select Family Medicine; since the first class in Duluth, 47.3% have selected Family Medicine – almost six times the national average.
The campus at Duluth has been extremely successful in training more than one hundred Native American physicians – second only to the University of Oklahoma (which is much larger).
34.5
%
50.9
%
30.2
%
45.0
%
39.3
%
39.2
%
8.4
%
10.0
%
13.3
%
9.2
%
11.2
%
8.2
%
7.4
%
8.4
%
8.5
%
8.3
%
8.5
%
8.2
%
0%
10%
20%
30%
40%
50%
60%
2010 2011 2012 2013 2014 5 Year Mean
Pro
port
ion O
f G
roup
Graduating Year
Proportion Of Senior Students Selecting Family Practice In NRMP Match
UMD
UMTC
National
Non-Metro Locations of Duluth Practicing
Graduates (N = 456)
Family Medicine70%
Internal Medicine
6%
Ob/Gyn4%
Pediatrics4%
Surgery4%
Orthopedics2%
Emergency Medicine2%
Psychiatry2%
Radiology1%
Pathology1%
Anesthesiology1%
Dermatology1%
Hospice1%
Med-Peds1%
Ophthalmology<1%
Gastroenterology<1% Occupational Med
<1%
Specialty Choices of Duluth Practicing Graduates In Non-Metro Minnesota (N = 456)
What’s “tried and true” in Duluth?Longstanding collaborations!
• Consistent exposure to Family Medicine during training
• Multiple opportunities to experience rural healthcare in your communities
What’s “tried and true” in Duluth?
First year medical school course entitled Introduction to Rural Family Medicine
• begins the first week of medical school
• daylong rural community visit
• includes Agricultural Medicine lecture by practicing rural Family Physician
What’s “tried and true” in Duluth?
Our students live with the doctor during the rural preceptorship weeks and experience what life as a family doctor is like in that community
• Over the past 40 years, we estimate that our ruralFamily Medicine colleagues have donated over 4. 5 million hours to this program.
• If we had to pay these physicians $50 per hour, this would be a program cost of approximately $225 million.
What’s “tried and true” in Duluth?
What else is happening?
Since 2003, summer opportunity for students to experience rural healthcare settings;
“Summers In Medicine” program (SIM)
What’s new? Curricular innovations
What’s new? The “rural laptop preceptors”
Rural “lap top” preceptors
• Funded by Health Resource Service Administration grant (D56HP20690)
• 6 rural Family Physicians “meet” via laptop with smaller groups of medical students
• Initiated January 2014 and ongoing
• Opportunity for students to hear about the joy, challenge and unique qualities of rural medical practice
MartinFaribaultJackson
FillmoreHoustonMower
FreebornNoblesRock
Watonwan WinonaCottonwood OlmstedWaseca Dodge
Steele
Murray
PipestoneBlue
Earth
Wabasha
Nicollet
Brown
RiceLe SueurLyonLincoln Redwood Goodhue
SibleyScott
RenvilleDakotaYellow Medicine
CarverMcLeod
RamseyChippewa HennepinLac qui
Parle
WashingtonMeekerSwift Kandiyohi
Anoka
Wright
SherburneBig Stone
ChisagoIsan
tiPopeStevens Stearns
BentonTraverse
DouglasGrant Kanabec
Mille
LacsMorrison
ToddPine
WilkinOtter Tail
CarltonCrow
Wing
WadenaAitkin
Clay Becker
Hubbard
Cass
NormanMahnomen
Itasca
Red Lake
Clearwater
Pennington
Polk Lake
CookBeltrami
Marshall
Saint Louis
Koochiching
RoseauKittson
Lake of the
Woods
Duluth
Warroad
Decorah
Glenwood
Staples Moose Lake Kathy Brandli, MD
Dave Heine, MD
DebErickson, MD
Julie Benson, MD
“Laptop” Preceptors
MartinFaribaultJackson
FillmoreHoustonMower
FreebornNoblesRock
Watonwan WinonaCottonwood OlmstedWaseca Dodge
Steele
Murray
PipestoneBlue
Earth
Wabasha
Nicollet
Brown
RiceLe SueurLyonLincoln Redwood Goodhue
SibleyScott
RenvilleDakotaYellow Medicine
CarverMcLeod
RamseyChippewa HennepinLac qui
Parle
WashingtonMeekerSwift Kandiyohi
Anoka
Wright
SherburneBig Stone
ChisagoIsan
tiPopeStevens Stearns
BentonTraverse
DouglasGrant Kanabec
Mille
LacsMorrison
ToddPine
WilkinOtter Tail
CarltonCrow
Wing
WadenaAitkin
Clay Becker
Hubbard
Cass
NormanMahnomen
Itasca
Red Lake
Clearwater
Pennington
Polk Lake
CookBeltrami
Marshall
Saint Louis
Koochiching
RoseauKittson
Lake of the
Woods
Duluth
Redwood Falls
Preceptor: Dr. Alan Olson
Dr. Alan Olson
Redwood Falls, MN
June 24th, 2014
What’s new in the student rural experience?
• Lengthening the longitudinal rural experience
• Expanding topics to include:
• community service project
• community health assessments
• rural class research project
• Lengthening the longitudinal rural experience
• Expanding topics to include:
• community service project
• community health assessments
• rural class research project
What’s new in the student rural experience?
All students are required to complete a service project during their time in the community. Many choose to serve as guest presenters in community sixth grades during “Brain Awareness” week.
To date, more than 480 medical students have presented classroom sessions to more than 12,000 small community grade school pupils.
Additionally, many students also complete other types of community service projects.
Community Service Projects
• Lengthening the longitudinal rural experience
• Expanding topics to include:
• community service project
• community health assessments
• rural class research project
What’s new in the student rural experience?
Data on community health assessment from student 2014 survey…
“At this point in my medical training, I can explain what sorts of Community Health Assessments the ACA expects of hospitals and health systems in the future”
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
1 2 3
Agree Disagree Strongly disagree
• Lengthening the longitudinal rural experience
• Expanding topics to include:
• community service project
• community health assessments
• rural class research project
What’s new in the student rural experience?
Class Research Project
Goals:
1. Enhance student research experience and skill
2. Utilize our extensive network of Family Physicians
3. Collaborate with rural communities to explore topics of mutual interest
Advancing the rural health research mission
The mission of the University of Minnesota Medical School, Duluth campus is to be a leader in educating physicians dedicated to family medicine, to serve the health care needs of rural Minnesota and American Indian communities, and discover and disseminate knowledge through research.
1. Infrastructure to support partnerships
2. Partnerships to understand & improve rural health
3. Conducting partnered research
Why conduct partnered research?
• Ethical/moral stance – it’s the right/nice thing to do• “Nothing about us without us”• Empowering individuals, organizations, & communities• Decreasing disparities & achieving health equity
• Scientific stance – it produces the best data/outcomes• Asking meaningful questions, collecting actionable data• Capitalizing on diversity of perspective/approach• Learning from effective, local solutions• Developing sustainable knowledge, processes, interventions
• Difficult, complex, political work AND productive, rewarding, enduring!!
Partnering For Rural Health
• Duluth Campus• Center for Rural Mental Health Studies
• Duluth Medical Research Institute (DMRI)
• Research for Indigenous Community Health (RICH) Center
• Student training experiences (RMSP, SIM, etc.)
• Twin Cities Campus• Clinical and Translational Sciences Institute (CTSI)
• Rural Health Research Center (RHRC)
Infrastructure to Support Rural Research Partnerships
Center for Rural Mental Health Studies• Carlton County Public Health and Human Services• Human Development Center• Crisis Connection (Minneapolis)• Minnesota Department of Human Services• Northland Medical Clinic (Bigfork)• Scenic Rivers Health Care Center (Cook)• Cook Hospital (Cook)
Individual Faculty Members• Bois Forte (MN) and Lac Courte Oreilles (WI)
Partnering For Rural Health Research
• Many successful, ongoing research partnerships
• Example 1 – Surveys of Local and Rural Preceptors
• Physician/clinic characteristics
• Patient unmet social needs
• Physician research interests
• Learning & adapting as we go
• Future possibilities:
• Student research elective
• Cross-state research collaborations
• Practice-based research network
Partnered Research
• Physician/clinic characteristics• 51 preceptors (26 rural; 28 female; 1998 median graduation year)
• Majority (67%) are employees with no ownership
• Average 73 patients/week
• Unmet social needs• 28% of each visit spent on unmet social needs
• Majority (92%) felt unmet social needs interfered with providing quality care
• Majority (67%) somewhat confident addressing unmet social needs
Partnered Research – Preliminary Data
Number of Preceptors Expressing Interest (N = 51)
Selecting topics/issues for research* 9 (17.6%)Writing grants* 2 (3.9%)Designing studies 0Collecting data* 15 (29.4%)Participating in surveys, interviews, or focus groups 25 (49%)Reviewing and interpreting results 4 (7.8%)Writing up results for presentation and/or publication 0Presenting results at conferences* 2 (3.9%)Receiving final reports, publications, and/or presentations 12 (23.5%)
Example 2 – MN Veterans Coming Home Study (funded by UMN CTSI): Survey of returning veterans & spouses at 2014 Minnesota State Fair
• Neighborhood/community satisfaction• Social integration • Social support• Relationship satisfaction• Reintegration/social functioning• Health care access/use• Focus on rural – urban variation
Project team includes members from 148 FW Air Guard, MAC-V, Minneapolis VA, Med School Duluth
Future possibilities:• Follow-up interviews• Outreach at rural county fairs (“road show”)• NIH/DoD grant to study rural reintegration of veterans and families
Partnered Research
In conclusion….
We need you!
And we hope we’ve convinced you that you need us, too!
Thank you!
For more information on training or research partnerships with the University of Minnesota Medical School in Duluth,
please contact:
Emily Onello, [email protected]
218.726.7820
Sarah Beehler, [email protected]
218.726.7016
James Boulger, [email protected]
218.726.8895
References
Brooks KD; Cieslak JE; Radcliffe PM; Sjogren K. Minnesota Medicine; 91(5): 40-4, 2008 May.
Mullen F, Chen, C, Petterson, S, Kolsky,G and Spagnola, M. The Social Mission of Medical Education. Annals of Internal Medicine. 2010;152(12):804 - 811.
Spike C; Hildebrandt M. Community Health Needs Assessment: Planning and Collaboration Kickstart the Journey. Minnesota Physician. 2013;27(8):24-25.
Students involved in Family Medicine research:
Some examples…
• Trends in Obstetrical Care in Rural Minnesota: Prevalence of Surgery Due To Incontinence Following Vaginal and Cesarean Section Delivery (2009)
• Rural Family Medicine Physicians’ Impressions of Rural Practice and their Perceptions of the Future of Rural Medicine: A Qualitative Study (2009)
• Evaluation of Cultural Competency Curricula in U.S. Medical Schools (2010)
• Services provided to Spanish-speaking Latinos in Minnesota Hospitals and their cost. (2010)
• Physician Acknowledgment of Obesity and Overweight in a Health Maintenance Exam (2011)
• Barriers to colorectal cancer screening in rural family practices. (2011)
• Current State of Care Provided to Sexual Assault Survivors in Rural Minnesota Emergency Departments Management and Antibiotic Resistance in Urinary Tract Infections (2011)
• The Skinny on Fat: Weight Loss Interventions in the Primary Care Setting (2012)
• Searching For A Relationship Between Dysfunctional Families And Symptom Burden In A Hospice Care Setting (2012).
• A critical Evaluation of iPad Applications Supporting Medical Student Learning (2012)
• Cookin’ Up Change: Community-Based Disease Prevention (ongoing)