Family Medicine Clerkship

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Rural Care

OVERVIEW

Rural America faces unique health problems and challenges. Although almost 20% of Americans live in rural settings, less than 10% of physicians practice in these communities. Reduced health care access and maldistribution of providers contribute to making disparities common. Social issues such as poverty and lack of health insurance have a significant negative impact on the health of rural communities as well. Because family physicians provide most of the health care delivered in rural America, there is concern about creating and maintaining a pipeline of students who will practice in rural settings. The following resources provide examples of possible objectives for clerkships and/or objectives along with resources for faculty developing rural-focused curricula.

TOPIC LEARNING GOALS AND OBJECTIVES

  (Organized by ACGME Competencies)

Patient Care

GOAL: Students will understand the implication of living in a rural setting on the health and illness of patients and families.

OBJECTIVES: Students will be able to:

• Participate in a family medicine clinical experience while living in a rural community setting.
• Describe the impact of rural living on the health/illness of patients.

GOAL: Students will deliver appropriate and responsive healthcare to patients and families living in rural communities.

OBJECTIVES: Students will be able to:

• Demonstrate awareness of health care resources and limitations in a rural community.

Medical Knowledge

GOAL: Students will gain knowledge about common medical issues in rural communities.

OBJECTIVES: Students will be able to:

• Demonstrate knowledge of common health problems in a rural population.
• Develop strategies to address one health issue in a rural community.

GOAL: Students will recognize disparities in health outcomes related to living in a rural community.

OBJECTIVES: Students will be able to:

• Describe differences in access to health care and health outcomes that exist related to living in a rural setting.

Practice-Based Learning and Improvement

GOAL: Demonstrate ability to analyze health data and population demographics for a rural community.

OBJECTIVES: Students will be able to:

• Explain the impact of the current health care system on access to health care services for rural populations.

Interpersonal and Communication Skills

GOAL: Students will become skilled in communicating effectively with patients and families in rural settings.

OBJECTIVES:   Students will be able to:

• Demonstrate the ability to communicate effectively with patients and/or families from rural communities regarding their health concerns.

Professionalism

GOAL: Students will recognize and address their own limitations and learning needs related to understanding health care needs in a rural setting.

OBJECTIVES: Students will be able to:

• Analyze their own behavior to identify gaps in knowledge and develop plan to address them.

Systems-Based Practice

GOAL: Students will increase their knowledge about the importance of collaboration and community resources, which improve care of patients and families in rural communities and decrease health outcome disparities.

OBJECTIVES: Students will be able to:

• Identify and analyze resources in a rural community that support positive health outcomes for patients and families.
• Collaborative with other disciplines and/or community agencies to develop and implement a plan of care for patients.

EDUCATIONAL METHODS

Teaching Strategies

• STFM Rural Interest Group lectures:
  http://www.ruralfamilymedicine.org/educationalstrategies/lectures.htm

Clinical Experience

• Required FM or ambulatory clerkships in rural communities

Electives

• Summer preceptorships between first and second year of medical school
• Fourth year electives in rural communities

EDUCATIONAL RESOURCES

Curricula

• The National Center for Rural Health Professions
  http://www.ncrhp.uic.edu/
• Rural Medical Scholars Program, University of Alabama SOM, Dr. John Wheat:
  http://bama.ua.edu/~ruralmed/RuralMedicalScholars.html
• National Rural Health Association Curricular Resources:
  http://www.ruralfamilymedicine.org/
• Clinical Topics in Rural Health STFM Rural Health Interest Group:
  http://www.ruralfamilymedicine.org/clinicaltopics/clinicalol.htm

Published Material

• Rural/Urban Differences Bibliography, Journal of Rural Health:
  http://www.nrharural.org/search/subj/Rural.html
• Community-driven medical education, Robert Bowman:
  http://www.unmc.edu/Community/ruralmeded/community_driven_article.htm
• Caring for the Country: Family Doctors in Small Rural Towns
  Rabinowitz, Howard K.
  2004, XII, 262 p., Softcover
  ISBN: 0-387-20978-6
  http://www.springeronline.com/

Web Sites

• STFM Group on Rural Health:
  http://www.ruralfamilymedicine.org/
• HRSA Rural Health Policy:
  http://www.ruralhealth.hrsa.gov/
• National Rural Health Association:
  http://www.nrharural.org/
• Rural Medical Educators Group of the NRHA:
  http://www.unmc.edu/Community/ruralmeded/
• AAFP Rural Health Exchange:
  http://www.aafp.org/rural.xml
• Rural Healthy People 2010:
  http://www.srph.tamhsc.edu/centers/rhp2010/

Contact People

• Robert C. Bowman, M.D., Rural Medical Educators Group of the National Rural Health Association UNMC Department of Family Medicine Director of Rural Health Education and Research
  http://www.ruralmedicaleducation.org

ASSESSMENT STRATEGIES

Patient Cases

• National Rural Health Educators Case Database
  http://www.ruralfamilymedicine.org/educationalstrategies/complistcases.htm

Lead Author: Ann O'Brien-Gonzales, PhD
Clerkship/Post-Clerkship Workgroup members: Ann O'Brien-Gonzales, PhD (Chair), Alexander Chessman, MD (EC Liaison), Caryl Heaton, DO, Janice Nevin, MD, MPH, Lauren Oshman, MD, Deborah McPherson, MD, Mark. E Quirk, EdD, David Schneider, MD, MSPH, William B. Shore, MD, Richard Usatine, MD

Family Medicine Curriculum Resource (FMCR) Project HRSA Contract 240-00-0107.

For questions or comments, please contact Webmaster or Ardis Davis

This page last updated October 17, 2005