CREATING AND IMPLEMENTING A NEW RURAL / UNDERSERVED MEDICAL STUDENT TRAINING TRACKTRUST AT THE UNIVERSITY OF WASHINGTON

TRUST: Targeted Rural UnderServed Track

Introduction TRUST Admissions TRUST Year 1 TRUST Year 2 TRUST Years 3 & 4 Challenges Discussion

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The WWAMI Program 1971-2009

66%

61% 70%

59%

17%

Rural/Underserved Programs4

R/UOP: 1988 WRITE: 1996 Underserved Pathway: 2006 Rural required third-year clerkships

(Family Medicine, Internal Medicine, OB/GYN) Rural clinical electives

TRUST Continuum5

TRUST Admissions: A Separate Process

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Where have you lived/worked from birth until

present? How do you imagine your personal and professional lives intersecting ten years

from now? What obstacles have you overcome in

your life to get to the point of applying for medical

school? Why have you applied to participate in

the TRUST program?

Pre-Matriculation Experience7

Grand Coulee, Washington

Pre-Matriculation Experience

2 weeks before starting 1st year

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Hospital First observation of a birth First mentor experience

created

EMS Public Health Shadowing

TRUST: The Students’ First Year Experience

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TRUST rural health class addressing: Rural social life Scope of practice Benefits/pitfalls Economics

Continuity with the Pre-Mat Site10

Hands on experience with visits

to Pre-mat site Growth in skills becomes

evident to student and preceptor Mentorship continues Continuity of care

manifests

Journal Club11

Focus on health policy discussions High student interest evident from lively

discussions Open to other interested students

R/UOP12

Month long immersion clinical experience Approx 120 of 216 students will participate in Summer 2010 Most students complete a community-oriented scholarly project Highly rated

The Students’ Second Year Experience in Seattle: Building TRUST Scholar Cohesion

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All TRUST students are together in Seattle for their

second year where they: Continue participation in the

Underserved Pathway Participate in the Rural Health Class Continue and build relationship with

School of Medicine college mentor

Underserved Pathway Diagram

Pre-Clinical Electives, Selectives, RUOP, Preceptorships in underserved sites

ClinicalBlock Rotations, Core Clerkships, Electives in underserved sites

Web Module

Service Learning – CHAP, SITC, Volunteer activities

Mentorship – Quarterly contacts with mentors, faculty/staff support

Web Module

Web Module

Web Module

Independent Investigative Inquiry

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Year I Year II Year III

Year IV

Underserved Pathway Core Curriculum (web-based)15

Teaches fund of knowledge in underserved

medicine 12 web-based modules with interactive

elements Pathway students complete two modules

per year In person/video conferencing sessions to

build community with mentor and others

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UP Provides Core Support for TRUST Scholars

Pathway as curricular base Pre-matriculation Mentor’s role New courses (rural health) Community building and support Journal Club across years “Face to face” module completion Social gatherings

Mentorship: TRUST Scholars Have Many Opportunities17

Pre-matriculation site mentor Regional Dean - home state mentor School of Medicine College mentor with underserved service background Underserved Pathway faculty

Mentorship Purposes18

To establish a long-term mentoring relationship

between student and healthcare provider working

in an underserved setting To nurture the student’s career goals To provide career and educational

counseling To introduce students to working in an

underserved setting

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TRUST: The Students’ Third Year Experience 15 WRITE (WWAMI Rural Integrated

Training Experience) sites across the region 20 weeks of integrated training Immersion experience - Significant

clinical responsibilities Significant outcomes

Two thirds of students choose primary care

One third of students choose rural practice

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WRITE Sites in 5 WWAMI States

Note: Alaska not to scale

WSandpoint

Libby

McCall

Hailey

Powell

Wasilla

Ellensburg

WLewistown

Grand Coulee

Juneau

Boise

Anchorage

Cheyenne

Spokane

Lander

WRITE SiteWWAMI Regional Office

W

W

W

W

Whitefish

WPort Angeles

WMoses Lake

Chelan

Helena

W

W

W

W

W

W

W

W

WW* Port

Townsend

* Ferndale

W

W * Shelton

Newport W

Washington

Alaska

Idaho

Montana

Wyoming

ShelbyW

W

WW

Miles CityDillon

Butte

* WRITE Site pending approval

W

2121

TRUST in Washington

Ellensburg

Grand Coulee

Spokane

W

Port Angeles

Moses Lake

Chelan

W

W* Port Townsend

* FerndaleW

W * Shelton

Newport

Washington

WRITE Site

WWAMI Regional Office

W

* WRITE Sites pending approval

W

W W

W

W

TRUST in Montana22

LibbyW

Lewistown

W

WWhitefish

HelenaW

MontanaShelby

W

W

WW

Miles CityDillon

Butte

WRITE/TRUST SiteWWAMI Regional Office

W

TRUST:The Students’ Fourth Year Experience23

Work on career development

Participate in sub-internships

Establish links with regional

residency programs Explore integrated

residency

Challenges24

Funding Program administration costs Student scholarships and/or loan

repayment Student travel costs Program evaluation

Faculty Development Regional challenges - students across

four years, faculty across four states

Challenges

Pipeline starting with K-12 Connections with communities including

training site support Balance of rural and urban opportunities Engaging other medical specialties Linkages with regional residency

programs

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