PROGRAM ANNOUNCEMENT
The Minifellowship in Rural Family Medicine is now beginning its fourth year. Its mission is to assist family practice faculty and program directors who are involved in rural medical education.
Schedule: The introductory session of the Minifellowship will be held in three different locations. Prospective candidates should make plans to attend selected Family Practice or Rural Conferences such as RAP, the Family Practice Program Directors June meeting or the NRHA or STFM Annual Meetings in April or May. A special introductory session can be set up by request (to be held in Omaha). Minifellows will attend one of these introductory session, then a three day session in Omaha, and then a final session next year at a rural health or family practice conference.
Curriculum: Rural minifellows will develop a rural health education program involving medical students or residents such as a preceptorship, a rural training track, or a rural health center. Minifellows review and discuss relevant rural medical education literature and programs. Minifellows will attend discussions by experienced rural faculty. Faculty for the minifellowship will assist the minifellows with career and project development.
Track record: Past minifellows and their projects include Joe Florence and the Hazard KY Rural Training Track, Joe Ferguson and the Rural Training Tracks at the North Colorado FP program, Whit Oliver and the rural rotations at Tallahassee FL, Jim Buechler and the rural training track at Terre Haute, IN, Barb Doty and the residency program in Anchorage Alaska, Tom McWilliams and the rural sites at Kirksville College of Osteopathic Medicine, Judy Monroe and the rural training site for the State of Indiana. Paul James at Buffalo, Jeff Warren at Memphis and Mark Penn at Akron Ohio have attended and developed rural sites and/or curricula.
Significance: The minifellowship is the only faculty development program focused on giving vital information, support, networking, and encouragement to faculty who are developing rural programs. Health care reform may impact on primary care, but this is no guarantee that primary care physicians will train or retrain for rural locations. The development of rural faculty and rural programs is an important component of preparing physicians for rural practice.
Logistics: Minifellows need the support of their program director or chairman. They will need transportation, registration, and lodging for the above locations. Materials, coordination, and consultation are provided.
To Apply to the updated version: Contact Bob Bowman at (402)-559-8873 day, rcbowman@atsu.edu
THE FIRST MINIFELLOWSHIP SESSION at the Governor's Conference on Rural Health in North Carolina gave the ETSU-based minifellows a chance to escape beepers and interact with a significant group of rural health experts. Sessions on reimbursement, rural hospitals, rural community development, AHEC, and COPC highlighted the conference. Special sessions with Harvey Estes and Eva Salber gave minifellows (and faculty) a chance to relieve the exceptional experiences and careers of two pioneer rural academicians.
THE SECOND MINIFELLOWSHIP also invaded North Carolina to visit Greenville for the STFM Regional conference at East Carolina University's Department of Family Medicine. This conference also hosted the Public Health Service Advocacy Program, giving the entire conference a rural flavor. Rural topics included agrimedicine, rural medical education, and rural sites developed by students. Robert Walker from Marshall University and Don Weaver, Director of the National Health Service Corps, addressed the minifellows in special sessions.
THE NEXT SESSION found the minifellows in Washington DC at the National Advisory Board meeting of the Office of Rural Health Policy. Highlights of these sessions included presentations on Medicaid, Rural Health Clinics, and financing of graduate medical education. Minifellows also visited their senators and representatives and health policy experts. Minifellows also attended the legislative action sessions of the National Rural Health Assoc.
SESSIONS IN JOHNSON CITY examined the role of the hospital in rural health, rural medical education, the current rural research efforts at ETSU and new directions for the rural programs. Part of this latter session included nursing and allied health faculty. This gave all the rural faculty in all 3 health divisions at ETSU a chance to interact and network.
A FINAL SESSION held at the National Rural Health Association Meeting in May in Seattle examined a number of topics. Rural hospitals, management, leadership, rural economies, rural sociology, Rural Health Clinics, and more. Special sessions were scheduled with leaders in rural health.
MINIFELLOW PROJECTS for this year include developing the Mountain City site and curriculum, a project to examine the role of physician relationships in rural hospital closure, and defining the rural faculty member.
EVALUATIONS The first minifellowship year revealed that the program accomplished its objectives of training the rural faculty for future programs. Improvements in the rural rotations were noted and the rotations became mandatory. Minifellows were recruited at several of the sessions. The minifellow sessions away from the Tri-Cities seemed to be more beneficial as duties were less of a problem. New faculty received much support.
PROBLEMS NOTED This was the first year of a one-of-a-kind program. The definitions of rural, minifellow, family practice, primary care, and rural curriculum were a key focus and will continue to be. The use of minifellows in their first year was a problem as these faculty were learning the system. Two of the faculty were involved in residency programs without a rural project. Two other faculty were developing a site, but the controversy and other problems at this site disrupted site development, although it was educational.
LESSONS LEARNED Future minifellows must be experienced faculty with a rural project and rural health career emphasis. The project can be early or fairly established, in fact a mix of various projects would be desirable. The goal of using part-time faculty was not recognized. Even the minimal time commitment did not allow for part-time faculty participation. The role of part timers was to provide the rural experience if the full time faculty did not have rural experience. As it was, the rural experience came from minifellows who were faculty with rural experience. This would not preclude a devoted part time teacher but in all likelihood, the participation of part time faculty minifellows would be intermittent without some formal agreements. One or two day workshops every six months or on-site visits may be better ways to teach part-time faculty.
Summary of the 1991-92 Minifellowship
as of September 1991
The minifellowship needs for the 1991-92 session were minifellow recruits with rural projects and rural career emphasis, more rural curricular structure, and more use of consultants. Eight candidates applied and six with residency focus were chosen. More structure was added by emphasizing the projects and rural curricula development with the projects. The developers understood much more about rural curriculum this year. Consultants were added for the first and subsequent sessions and they were given more time to prepare for the sessions. The minifellowship was much farther along than this time last year.
The 1991-92 session began with Rural Medical Education in Johnson City in August. This session focused on rural medical education models, financing of medical education, and rural curricula. Tom Rosenthal of SUNY in Buffalo and Bruce Behringer were consultants for this session. Minifellows presented their projects and received individual and group consultation at sessions at the Sheraton Plaza:
Joe Ferguson attended for Marc Ringel who was preparing four site applications (for Greeley, CO) for two rural and two urban training sites. Evaluation and faculty development were noted to be key areas of need. Joe contributed a sense of vision and commitment, and the experience of a program director.
Joe Florence presented his design for a rural residency in Hazard, KY that will begin on July 1, 1992. His needs were faculty, residents, policies, and job descriptions. Joe contribute to the overall rurality of the program. He added a great degree of cultural sensitivity. He also helped to keep the sessions focused on practical needs.
Paul James is improving rural rotations and developing a central rural focus for his department. His needs involved examination of faculty and personal commitment, leadership, management, and negotiation skills. One of the other minifellows gave him a copy of "Getting to Yes" regarding negotiation skills, illustrating the importance of networking and use of current minifellows as faculty. Paul has a talent for questioning and made sure that what was presented was clear and relevant. He received much support for his rural efforts while in Johnson City.
Whit Oliver is expanding the rural rotations in the rural areas around Tallahassee, Florida. He hopes to eventually develop a rural training track based on outreach and other grants. He needs faculty support, information to develop a rationale for rural programs, and a means of integrating the rural programs with the various interests of a diverse faculty. He will eventually need funding support from several sources. He received information, advice on faculty integration, and support from the other minifellows.
Jeff Warren is developing a rural site and working toward a Certificate of Added Qualification (1 year fellowship) in rural emergency medicine. His needs were learning rural, procedural, leadership, and management issues. He contributed many questions, assistance with departmental support issues, and helped other minifellows with their needs.
Alex Augoustides attended in his role as a fellow.
THE SESSIONS OVERVIEWED rural health policy and rural medical education programs. Tom Rosenthal added his expertise at state legislative issues (he is a line item on the NY budget) and rural program development (at least 4 sites). Bruce Behringer added regional and national perspective about Community Health Centers and the National Health Service Corps. Rubye Beck described needs assessments and community evaluations. Dan Brown from communications discussed the use of videotapes. He reviewed the WCYB tape, the Nebraska Coming to the Country Tape and assisted in planning for future educational uses of these and other tapes. His presentation was exceptional, utilizing the resources in the room, the videotapes, and group discussion. Bruce Bennard added his expertise in curriculum development. Bruce attended most of the sessions. Mike Floyd talked about rural Balint and assisted with the support of several minifellows.
The accommodations were great, the breakfasts were slow, and the assistance of the staff in preparation of many handouts and packets was superb.
Second Session - The minifellows traveled to Chicago for the AMA Conference on Rural Health. The minifellows received instructions on impacting on meetings and hearings and utilized this conference to practice testifying and preparing handouts and statements. The conference covered most of the Ambulatory Issues in rural health from reimbursement to rural modes of practice to other practitioner issues to organization leadership and the building of coalitions. The conferees agreed on the need to work on medical education from without (funding and health policy) as well as from within (rural programs and curricula). National leaders in rural health were speakers.
Minifellows attended special sessions with Kevin Fickenscher (former NRHA president, rural researcher, established Rural Caucus in Congress), Wayne Myers (Center for Rural Health at KY and WAMI Developer), Harvey Estes (Chairman of Family and Community Medicine at Duke and developer of community oriented programs), Bob Maudlin (developer of Rural Training Track at Spokane), and Mike Sitorious (Chairman of Family Medicine at Nebraska). The focus was organizing programs, leading elements of change, developing support from various sources, current program models, future leadership needs, and many opportunities for individual help for minifellows and their programs.
In addition three potential minifellows were added. Mike Sitorious plans to attend future sessions and plans to send faculty next year. Judy Monroe and Roy Bontrager also attended the minifellow sessions. Their interests are in the predoctoral area. Dr. Bowman had an opportunity to network with rural program directors in Nebraska, Kansas, and Illinois.
Minifellows, special guests, and faculty prepared for special rural focus sessions at the RAP Conference in Kansas City and the STFM Annual in St. Louis. Planning continued for next years minifellowship with the first session set for the AAFP Student Resident Meeting in Kansas City, a group presentation of the basics of rural curricula, as well as a proposal for a national program for rural faculty development (submitted to NRHA to Ted Kennedy's health advisor).
The November session returns to Johnson City for a discussion of Rural Curriculum, Evaluation, Hospitals, and Economies.
The next session moves to Kansas City for the RAP conference and presentation of a special rural track to current and developing programs. It is also a chance to recruit minifellows and emphasize rural faculty development as a priority.
The final session in Washington DC at the National Rural Health Association in May will fill out the schedule.
Applications for the 1992-93 sessions can be obtained from Linda Nwosu, Rural Programs Coordinator, ETSU Department of Family Medicine Box 21,130 A Johnson City, TN 37614, or call 615-929-6396 or 615-929-7803 (after hours).
The enclosed material about the ETSU Minifellowship in Rural Medicine describes a model rural faculty development program. It is the only rural faculty development program in the nation. There are several essential elements of the program:
I. Understanding of rural health
II. Assistance in the development of rural curricula
III. Assistance in the development of rural programs and sites
IV. Leadership and management skills
V. Development of rural teaching and precepting skills
VI. Support systems for rural practice
VII. Networking between rural faculty in different programs or states
Rural faculty must know rural health on the local, state, and national level. They must understand rural health policy, reimbursement, modes of practice, rural facilities, and rural economies.
Rural faculty must be able to take rural doctors and communities and build rural experiences that will influence students to choose rural practice. Minifellows are chosen on the basis of their rural projects and programs. Learning is vastly improved if it involves the learner. It is better yet if the material is quickly and easily applied to what the learner is doing. A major focus of the minifellowship is consultation, discussion, and didactics connected with the development of the rural sites or programs.
Rural faculty must know how to work within institutions and legislatures to effect change. They must manage their own time effectively, especially if they want to span the range from practice to teaching to research or administration.
Rural faculty must know how to illustrate the rural difference. The goal of any faculty development program is to prepare students and residents for rural practice. This preparation involves clinical techniques, behavioral training, and recognition of the effect of culture or community on health.
Rural practitioners must also develop a means of support from peers, neighbors, consultants, family or others to continue to meet the needs of patients, family, and community. Through their efforts, rural faculty can support current and future rural practitioners, reduce their isolation, improve their practice management, and improve the quality of their care.
Networking is important to the improvement of current rural programs, the adaptation of current ones, and the development of new ones. Minifellows interact with the fathers of rural programs and rural medical education. They learn the tough aspects of negotiation and curriculum change. They get a boost up on their mentors shoulders so that they can reach ahead and improve the future of rural health.