Building and Evaluating a Rural Community-based Immersion

Program

Vicki Weidenbacher-Hoper, MSW,1 Kelli Hill-Stover, BS2 Michael Glasser, PhD,1 Martin MacDowell, DrPH, MBA1, Dorene Ewell3, Aaron Jannings4

1 National Center for Rural Health Professions, University of Illinois at Rockford2 South Central Area Health Education Center, Rend Lake Community College, Ina, Illinois 3 SEIgrow, Harrisburg Medical Center, Harrisburg, Illinois4 Rural Medical Education (RMED) Program, University of Illinois at Rockford

Learning Objectives• Learn how to develop/maintain partnerships in rural

communities in order to develop and offer rural community-based immersion programs.

• Learn how to develop, implement and evaluate the various components of a rural 3-5 day interprofessional immersion education program. This will include insights from a RHE student and a RHE sponsoring hospital.

• Share success stories and unique challenges and offer session participants the opportunity to discuss and provide new ideas as well as practical information that will aid in developing new and improved rural immersion programs.

National Center for Rural Health Professions

• Located on the University of Illinois Regional Health Science campus in Rockford, IL. Part of a land-grant University – mission to serve the state.

• Established in 2003.

• The purpose of the National Center for Rural Health Professions (NCRHP) is to meet the health care needs of rural Illinois residents through collaborative projects involving multiple health professions and emphasize recruitment, retention and health care delivery initiatives that will positively impact the health and well being of both rural residents and their communities.

• NCRHP web site http://www.ncrhp.uic.edu/index.cfm.

Background • Immersion education comes from elementary and

secondary language acquisition programs developed in Canada in the 1960s (Zink et al., 2008).

• Adopted by health professions educators as a teaching strategy to help students develop greater cultural competency.

• Vary in purpose and length but common feature is an “eye-opening” experience for students.

Background cont.• Local community and health care workers become

educators (Zink et al., 2008).

• Rabinowitz’s work suggests that a curricular experience in a rural community is an important ingredient for increasing the numbers of rural primary care physicians (Zink et al., 2008).

• Literature lacking in regards to curricular components of this experience in medical education, especially in a rural setting (Zink et al., 2008).

Rural Health Experience (RHE)

What is the Rural Health Experience?• 3 to 5 day immersion program shadowing

health professionals and other community interactions in a rural area.

• Intended for college, graduate or professional level students in their 1st and 2nd years of a health professions program (medicine, nursing, pharmacy, public health, social work, dentistry, physical therapy and others).

Objectives of the Rural Health Experience (RHE)

• Learn about the social and health characteristics, needs, and resources of a specific rural community.

• Understand the roles and responsibilities of different healthcare providers in a rural community.

• Reflect on a future career as a healthcare provider in a rural community and potential interest in this location as a future career location.

RHE Components• Student meets with the hospital CEO and/or other leadership staff – ideally

has lunch/dinner.

• Hospital Tour.

• Emergency Medical Technician or Emergency Room shadowing experience.

• Shadowing at the local health department

• In addition to the above, two experiences shadowing professional level clinicians i.e. physician, pharmacist, physical therapist, social worker, public health. Shadowing of tech level positions i.e. x-ray tech, ultra sound tech, etc. not appropriate level for shadowing experience.

• Ideally, attendance at an interprofessional team meeting i.e. hospice, discharge planning, home health etc.

Establishing RHEs• Partnerships

– University, hospitals, communities• Funding

– Federal Grants – State Grants– Contracts , i.e. hospitals, civic organizations

• Timing of experience– Student schedules– Hospital schedules

• Availability of housing • Availability of a variety of supportive health professionals for

student(s) to shadow in the community

5 Day RHE SAMPLE SCHEDULE

Why Should a Student Complete an Interprofessional Rural Immersion

Program?• Defines areas of interest.• Exposure to a rural community, healthcare facilities,

and personnel.• Experience how the different health professions and

care settings interact to provide patient care.• Offered through a University – provides credibility

related to being an educational experience.

Student Feedback from the RHE• I’ve learned that rural healthcare professionals wear more hats than those that

work in larger locations. This is more exciting because they aren’t always doing the same thing over and over.” Student Participant 1

• “I felt I was really able to understand each specialty in the rural healthcare system and was able to witness how each department worked along with each other to treat patient needs. I also learned the benefits and some issues that rural healthcare providers face.” Student Participant 2

• “I think this experience has really shown me what to expect in rural healthcare. I have realized after this experience that even though it may not be the most luxurious job, I am passionate about helping others and I would enjoy helping those in the rural communities especially coming from one.” Student Participant 3

Why Should a Hospital Participate in a Rural Health Immersion Experience?

• Access to health professions students with rural interests who will be looking for employment after completion of their training. Provides an opportunity for the student to see themselves in a specific rural community.

• Opportunity for hospital staff to engage in teaching.

• Opportunity to highlight community.

• Contribute to the development of qualified and competent rural health professionals.

• Investment in the community – contributes to the overall good of the community.

Key Information for an Interested Hospital to Consider

• Are there key personnel (CEO, pharmacist, primary care physician) who are willing to participate? Do they like their job/profession and will they depict their profession in a positive light to the student(s)?

• Is there a person on site at the hospital to coordinate experience i.e. meet with providers both internal and external to coordinate student’s schedule, meet student, be available to both student and providers during the experience to coordinate/adjust student’s schedule.

• Are there enough clinical activities for the student(s) to observe during the experience? Is patient volume sufficient at each clinical area?

• Is there adequate housing and dining options for student(s) during stay?

Why Should Rural Academic Programs Offer a RHE?

• Acknowledgement that educating health professionals within a rural environment is an effective strategy for increasing health professional knowledge and experience of working or living in a rural environment (Whelan et al., 2008).

• Rural placements can provide enhanced access to day to day clinical practice learning opportunities, including clinical decision-making, a clearer experience of the social forces involved in meeting both individual and community health care needs and can enhance the recruitment and retention of rural doctors (Page & Birden, 2008).

• Students who observe or shadow in an urban hospital before beginning medical school are less likely to choose family medicine (Avery et al., 2012).

• A university can assist in screening students as related to rural intent. The selected RHE students need to have evidence of sincere interest in considering a rural career path so the RHE is of potential benefit to the rural community. It should not just be a “visit to the country”.

RHE Evaluation • Student pre/post tool – examples of questions

– I understand multiple health professions and effective ways they can work together.– I understand the needs of rural healthcare and know how to work with different

health related disciplines.– I can identify healthcare needs of rural populations (especially as compared to

urban).– I feel interdisciplinary education/training should be required for all health

professionals. • Hospital post survey – examples of questions

– Were the goals and objectives of the RHE made clear in your view?– What were the positive aspects of participating in the RHE for your hospital? Please

be specific. – What were the challenges for your hospital in being a participating site for the RHE?

Please be specific. – How was the quality of students you were able to choose from when selecting a

RHE student participant(s)? – What disciplines were you seeking to participate in the RHE at your hospital?

Community and Hospital CharacteristicsCommunity Population

(2012) Type of Hospital

Fairfield, IL Fairfield Memorial Hospital Federal HPSA Designation Area

5,087 Critical Access Hospital

272 employees

Harrisburg, IL Harrisburg Medical Center Federal HPSA Designation Area

9,034 72 beds - In-patient behavioral health service for both adults and geriatric adults.

509 employees

McLeansboro, IL Hamilton Memorial Hospital Federal HPSA Designation Area

2,850 Critical Access Hospital 150 employees

Olney, IL Richland Memorial Hospital Federal HPSA Designation Area

9,092 Not-for-profit - licensed at 134 beds

165 employees

Student Background CharacteristicsVariable N=13 %

GenderFemaleMale

94

7030

Health Professions ProgramMedicinePre-Med (undergrad) PharmacyDoctoral Level Undergraduate

44311

31312388

Location of RHE ExperienceHamilton Memorial HospitalFairfield Memorial HospitalRichland Memorial HospitalHarrisburg Medical Center

5332

38232315

Qualitative Analysis • Students completed a reflective paper.• Student reflective papers were analyzed using:– Atlas.ti Version 6.2.16 (ATLAS.ti Scientific Software

Development GmbH, Berlin).• Papers were read and coded for comments

and passages reflective of RHE learning objectives.

Theme Frequencies and Examples from NarrativesTheme # and % of

QuotationsQuote illustrating experience relating

to code

Health characteristics, needs and resources

120 (40.9%) In my three short days, I saw a wide variety of services offered to the residents of Hamilton County.

There were a few primary care doctors on staff who worked with nurse practitioners in both the clinic and the ER. Specialists would visit periodically, often once a week, or patients in serious condition would have to be transferred to the closest large hospital…

Social characteristics, needs and resources

36 (12.3%) Without support from the hospital, the community would not enjoy the exceptional care that is provided and without the community, the hospital wouldn’t be able to exist.

Theme # of Quotations Quote illustrating experience relating to code

Roles and responsibilities of different health care providers

109 (37.2%) I was able to observe how a PT, PTA, OT and ST work together for the better care of their patients.

I learned about other services that public health provides including medical cards, smoking and tobacco hotlines and vaccinations.

Reflect on future career as a healthcare provider

19 (6.5%) It just reinforced my desire to settle in a rural setting.

This experience and time spent with Dr. Absolutely boosted by interest in family medicine as a future profession in medicine.

Reflect on the potential interest of this location as a future career site

9 (3.1%) I would tell others who asked about my trip in the following days that the people in McLeansboro “said all of the magic words”.

Theme Frequencies and Examples from Narratives

Share success stories and challenges

References1) Zink T, Halaas G, Finstad D, Brooks K. “The rural physician associate

program: the value of immersion learning for third-year medical students”. Journal of Rural Health 2008;24(4)353-59.

2) Avery D, Wheat J, Leeper J, McKnight J, Ballard B, Chen J. “Admission factors predicting family medicine specialty choice: A literature review and exploratory study among students in the rural medical scholars program”. Journal of Rural Health 2012;28(2)128-136.

3) Whelan J, Spencer J and Rooney K. “A ‘RIPPER’ Project: Advancing rural interprofessional health education at the University of Tasmania”. Rural and Remote Health 2008;8 1-9.

4) Page S, Birden H. “Twelve tips on rural medical placements: What has worked to make them successful”. Rural and Remote Health 2008;30(6)592-596.