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