family medicine residency program · oregon first: family medicine integrated rural student...
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Family Medicine Residency Program
Celebrating Complexity in the Emerging Diversity of Rural Medical Education
RRT Collaborative Annual MeetingSpokane, Washington
April 11-13, 2018
Oregon FIRSTFamily Medicine Integrated Rural
Student Training
Speakers
• Dwight W. Smith MD – Director, Oregon FIRST
• Kristi Coleman MD– Co-Director, Oregon FIRST– Associate Director for Medical Student
Education– Education Director for Campus for Rural
Health
Rural Residency’s Recruitment Goals
• Fill in the match.• Get good quality residents.• Get residents that are ready for rigors
of a rural residency.• Get residents that fulfill your mission.
OREGON FIRST:FAMILY MEDICINE INTEGRATED RURAL
STUDENT TRAINING¡ Brief Residency Background
¡ The Oregon FIRST goals¡ An individualized 4th year medical school curriculum
¡ Increased residency readiness
¡ Healthcare workforce needs for Oregon
Cascades East Family Medicine Residency Program
¡ Established in 1994
¡ Sky Lakes Medical Center in Klamath Falls, OR
¡ One of the most rural and remote based 3 year
training programs in the nation
Residency Training Outcomes¡ Approximately 50% of our grads stay in
Oregon after graduation
¡ 60% practice in communities with
populations of 25,000 or less
¡ 63% are in Health Professional Shortage
Areas
Cascades East Family Medicine¡ 8 residents per class, total of 24 residents
¡ Family Medicine Center
¡ Patient-Centered Primary Care Medical Home¡ Tier 4 Certification Status
¡ Team-based care
¡ 12+ FTE Faculty – Department of Family Medicine¡ Inter-professional Approach
OREGON FIRST:FAMILY MEDICINE INTEGRATEDRURAL STUDENT TRAINING
¡ Student Selection¡ One to Two students per year
¡ Pre-identified interest in rural Family Medicine Training
¡ Prefer students from OHSU’s Rural Scholars Program
¡ They will spend their Fourth Year of medical school at
Cascades East Family Medicine Residency in Klamath Falls
¡ Started in AY 2014-2015
¡ 1st graduates this June
Oregon FIRST Selection¡ Selection occurs in the mid-point of the third year
¡ Personal Statement of Interest
¡ USMLE, Transcript, 2 Letters of Recommendation
¡ Course evaluation summary from OHSU Dean's office
¡ Expectation: match with our residency
¡ Consider applying for an NRMP Waiver/LCME approval for
integrated track, we did not apply.
Oregon FIRST Highlights¡ Increase residency readiness for OHSU students
going into rural Family Medicine
¡ Allow students to individualize their learning plan
around rural primary care
¡ Decreased cost to students
¡ Interviewing travel costs ($10,000)
¡ Tuition waiver or loan forgiveness with service
requirement
Fourth Year Curriculum¡ Sequential rotations in core specialties and care delivery sites
¡ Combined with longitudinal experiences with
¡ Chronic disease management
¡ Population-based health
¡ Own Panel of continuity patients
¡ Setting of a Learner-Centered Medical Home within a PCMH
¡ Daily dedicated learning time with noon conference series
¡ Monthly procedure simulation workshops
¡ Wilderness Medicine curriculum
¡ Mentor junior medical students and rural programs
Summer August September October November December January February March April May June
1 2 3 4 5 6 7 8 9 10 114 weeks 4 weeks 4 weeks 4 weeks 4 weeks 4 weeks 4 weeks 4 weeks 2 week 4 weeks 4 weeks
Bloc
k
TWO-WEEK ELECTI
VE
Fall Break 9/22-9/26
Summ
er Break 6/23-6/27
Spring Break 3/24-3/27
Oregon FIRST/Cascades East Fourth Year Medical Student Curriculum
ELECTIVEELECTIVEELECTIVE
Elective/Selective Choices
Transition to Residency - Portland 1 week
Oregon FIRST Rural Continuity 1
GRADUATIO
N W
EEK 6/1-6/5
Family Med Inpt
SUB-I
Long
itudi
nal
Cu
rric
ulum
Outpatient Family Medicine
Pulmonology
DermatologyAnesthesiaPodiatryRadiology
ELECTIVE
Winter Break 12/22-1/2
CardiologyGastroenterologyEmergency Medicine
ENT
TABLE KEY
Noon lecture series, procedure workshopsWilderness Medicine Track - lectures, conference and AWLS
Rural/Frontier Family MedicineOB
Palliative CareGeriatrics
BLUE FILL = OHSU Requirements in Portland
Wellness/ Preventative Care
Procedures
OHSU Inter-cessions
Orientation and Family
Med Inpt
YELLOW FILL = INPATIENT Selective
GREEN FILL = ELECTIVE
Oregon FIRST Rural Continuity 4Oregon FIRST Rural Continuity 3Oregon FIRST Rural Continuity 2
OHSU Inter-cessions
ELECTIVE
Family Medicine Clinic - 1 half day per weekScholarly Project - Deep Dives - longitudinal population research on own patient panel -1 half day per week
OB SELECTIVE
Residency Considerations
¡ Faculty Oversight
¡ Engaged and experienced teaching faculty
¡ Two faculty with protected time for mentoring and training
Financial Considerations¡ Cost savings to student
¡ Faculty teaching time and program administration
¡ Precepting time
¡ Equipment, supplies, space
¡ Tuition
Outcomes for First 4 Years
• 1st Oregon FIRST student class graduating from residency in May.
• Placement in: – Oakridge, pop 3000– Gold Beach, pop 2200– Anticipate 3rd Graduate will stay in Klamath
Falls, pop 20,000
• Successful residents
Challenges/Lessons Learned
• NRMP/LCME waiver• ? Quality of applicant's• Is 4 years too long? Burnout?• Decision made in 3rd year, will there be students
that change their mind?• How to best assess the quality of applicants with
less accessible info (No MSPE).• Coordinating UME and GME rotation timelines
and requirements
OREGON FIRST:FAMILY MEDICINE INTEGRATEDRURAL STUDENT TRAINING• Individualized Learning• Increased Residency Readiness• Decreased Cost to Students• Improved Healthcare
Workforce for Oregon
Questions?