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Montana TRUST Targeted Rural Underserved Track
Jay S. Erickson M.D. Assistant Dean Montana WWAMI
W W A M I
Develop specific rural medical education programs
• “Medical educators and policy makers can have the greatest impact on the supply and retention of rural primary care physicians by developing programs to increase the number of medical school matriculates with background and career plans that make them most likely to pursue these career goals.”
Howard K. Rabinowitz, MD, et al., Journal of the American Medical Association, 2001
Rural/Underserved Communities
TRUST takes students from
rural/underserved communities, nurtures connections and returns
physicians to practice.
Summary of Montana TRUST
The overall goal of the TRUST Program is to increase the number of Montana WWAMI students choosing primary care or other needed specialties and then returning those practitioners to the rural and underserved areas within the state of Montana.
Admissions
Student admitted to UWSoM via separate process
Components of Montana TRUST
1. Admissions + Admit 33% 10/30 TRUST students to first
year class + Selected by the University of Washington
School of Medicine Admissions Committee ( 4 members are Montana physicians)
Components of Montana TRUST
1. Admissions
Suggested Guidelines: + rural and/or disadvantaged background + prior career experience in health related work + significant volunteer experience in rural or
underserved medical settings + strong commitment to service + Montana rural high school graduate and + graduate of a Montana public college/university.
First Summer Experience
Continuity Community orientation
Components of Montana TRUST
2. First Summer Experience + Trust students are matched with a physician
mentor in a rural community, or in clinic which serves underserved populations (FQCHC)
+ Prior to matriculating in medical school the students spend 2 weeks observing the rural or underserved physician and exploring the health community of the rural or underserved location.
Year 1
Student Continuity Community visits
Underserved Pathway Rural Health Course I
Components of Montana TRUST
3. First Year of Medical School; TRUST Student Pathway
The TRUST students: +enroll in the University of Washington School of
Medicine Underserved Pathway + be assigned a College mentor with significant rural or
underserved background + spend 2 weekends with their previously assigned rural
or underserved physician mentor. + participate in rural health elective at MSU ( Med 560) + journal club + Osler’s evenings + encouraged to attend a national, regional or state rural
health conference/meeting
Summer Between Years 1 & 2
Continuity Community (6 weeks):
RUOP TRUST Continuity Community
Project
Components of Montana TRUST
4. Post-First Year Rural/Underserved Opportunity Program
+The TRUST students participate in the Rural/Underserved Opportunity Program (R/UOP) of the UWSOM.
+This is a one month assignment in a rural or underserved community under the supervision of their previous physician mentor and takes place during the summer following completion of their first year of medical school (During this time students complete a community research project iii).
Year 2
Continuity Community linkages Underserved Pathway Rural Health Course 2
Components of Montana TRUST
5. Second Year of Medical School at the University of Washington School of Medicine
The TRUST students will: + participate in Underserved Pathway activities + participate in weekly College mentor teaching
sessions + rural health elective at UWSOM + journal club +encouraged to attend a national, regional or
state rural health conference/meeting
Year 3
Underserved Pathway Continuity Community: WRITE (20
weeks) TRUST Continuity Practice Project
Components of Montana TRUST
6. Third Year of Medical School at Montana Clinical Sites
TRUST students will: + be assigned to the WWAMI Rural/
Underserved Integrated Training Experience (WRITE) in Libby, Lewistown, Dillon, Miles City, Shelby, Butte or Helena Montana for five months
+ encouraged to attend a national, regional or state rural health conference/meeting
30 WRITE Sites in 5 WWAMI States
Note: Alaska not to scale
W Sandpoint Libby
McCall
Hailey
Powell
Wasilla
Ellensburg W Lewistown
Grand Coulee
Juneau
Boise
Anchorage Cheyenne
Spokane
Lander
WRITE Site WWAMI Regional Officecgional
Office
W
W
W
W
Whitefish W
W Moses
Lake
Chelan
Helena
W
W
W
W
W
W
W
W
W
Washington
Alaska Wyoming
Montana
Idaho
W
W
W W
W
W
W W
W
W
W
W
Newport Shelby
Miles City
Dillon
Butte
Kodiak
Douglas W
W
W
W
W Port Angeles
Shelton
Lynden/Birch Bay
Ferndale
Port Townsend
Pullman
W
W
W W
Juneau SEARHC
Nampa Jerome
Year 4
Underserved Pathway Continuity Community linkages
Rural clinical electives Residency linkages
Components of Montana TRUST
7. Fourth Year of Medical School at Montana Clinical Sites
TRUST students will: + spend a significant portion of their fourth year
doing clinical rotations in Montana - and - will be assigned to a do a rural clerkship if Track student
+guidance on career and residency planning. + encouraged to attend a national, regional, or
state conference/meeting on rural health
Residency (Including Rural Training
Tracks)
TRUST graduates match into rural/underserved residency
programs
Components of Montana TRUST
8. Students will be encouraged to: Choose a primary care residency program,
or a residency program in selected specialties that complement rural or underserved practices( Family Medicine, Internal Medicine, Pediatrics, Surgery Psychiatry, OB/GYN, Ortho)
Rural/Underserved Communities
TRUST takes students from
rural/underserved communities, nurtures connections and returns
physicians to practice.
Components of Montana TRUST
9. Upon completion of their residency training:
The TRUST students will be encouraged to select a rural practice site in the state, or to practice in a Federally Qualified Community Health Center within Montana. Physicians choosing these underserved locations will have access of up to $100,000 of loan repayment through the Montana Rural Physician Incentive Program (MRPIP).
Rural outcomes from special tracks (1600 + graduates over 30 years)
Rabinowitz HK. Acad Med. 2008; 83:235–243.
Per Cent practicing in small towns
79
6250
76
26
92
6468
47
68
53
0102030405060708090
100
RPAP Duluth UPP PSAP NY RMED Average
% 50,000>25,000>
Future health care system needs to be foundational in primary care
• “…we know from various types of evidence that the more and the better primary care you have, the better are the health indicators in the area or in the country. In this country, states with higher primary-care-physician-to-population ratios have overall better health, however you measure the health. And the impact on costs is equally striking. The more primary care we give relative to specialty care, the lower the costs.”
Barbara Starfield, MD, Professor of Health Policy and Management, Johns Hopkins University
Success in meeting rural physician workforce needs
• Specific rural focused programs that: 1. Select the right students 2. Provide the necessary rural educational
components 3. Rural exposure and mentorships 4. Close contact and advising 5. Links with residency programs 6. Programs to assist with return to the
state
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