111208_Idaho_110708[1]

WWAMI - Idaho

WWAMI is recognized internationally as a “benchmark program” for high quality, cost-effective, community-based medical education that is responsive to health professional workforce needs.

111208_Idaho_110708[2]

The WAMI Program:Founding Goals (1971)

1) Provide access for citizens of the Northwest to publicly supported medical education

2) Increase number of primary care physicians and address maldistribution of physicians

3) Create community-based medical education

4) Expand graduate medical education and continuing medical education

5) Avoid excessive capital costs and duplication of resources by using existing educational infrastructure

111208_Idaho_110708[3]

Community-based Clinical Clerkships

EducationalContinuum

UNIVERSITY OF WASHINGTONSCHOOL OF MEDICINE WAMI

Continuing Medical EducationMEDCONHealth Sciences Library

Retention Services

CommunityPractice

S c h o o l o fM e d i c i n e

PostgraduateCollegeK-12

3rd year1st year 2nd year

PedsPedsFamFam Ob/GOb/G

First Year SitesFirst Year SitesPreclinical Education

Focus on PrimaryCare

4th year

State-specific Admissions Committees

Clerkships

1975

111208_Idaho_110708[4]

PullmanMoscow

Boise

Pocatello

OB/GYN Clerkship Site

Pediatric Clerkship Site

WAMI First Year Sites

University of Idaho, MoscowWashington State University, Pullman

1975 UI/WAMI in Idaho

Ob/GOb/G

Ob/GOb/G

PedsPeds

PedsPeds

FamFam

FamFam

Family Medicine

111208_Idaho_110708[5]

WWAMI Center for Health Workforce Studies

AHECArea Health Education Centers

WWAMI Rural Health Research Center

Mini Medical School

Lifelong Practice SupportContinuing Medical EducationMEDCONHealth Sciences LibraryRural Telemedicine Network

NIH-NIDDK-Charles Drew High School Summer Research Program (OMCA)

Summer Medical Dental Education ProgramOMCA

State-Specific Admissions Committees

R/UOERural/Underserved Observation ExperienceAHEC Program Office

Fausto & DeLancey Middle School Program (NACOE)

AHECArea Health Education Centers

Native American Center of Excellence (OMCA)

K-12

Office of Multicultural Affairs (OMCA)

Higher Education

CHAPCommunity Health Advancement Program

SPARXStudent Providers Aspiring to Ruraland Underserved eXperiences

R/UOPRural/Underserved Opportunities Program

WRITEWWAMI Rural Integrated Training Experience

First Year SitesPreclinical Education

Clinical ClerkshipsRequired (3rd & 4th year)Community-Based

WWAMI Tracks

The College System4 year, integrated curriculum of fundamental clinical skills and professionalism

2008 WWAMI Educational ContinuumTargeting Primary Care from Grade School through Community Practice

Medical School Postgraduate

Residencies/Fellowships

Community Practice

A A

IntMd PsychFam

W

Peds

SpokaneIdahoAlaska

Montana

Peds

Psych

Surg

Fam

IntMd

Ob/G

EMd

CC

Neuro

Wyoming

111208_Idaho_110708[6]

Idaho WWAMI

3 of 4 medical school years can now be completed in Idaho through this distributive

model.

Year 1: Basic sciences & introduction to patient care at University of Idaho

Year 2: Organ-systems medical education and core clinical skills “Colleges” training in Seattle

Years 3 and 4: Clinical training in Idaho or other WWAMI states

111208_Idaho_110708[7]

2008 Idaho WWAMI

111208_Idaho_110708[8]Note: Alaska not to scale

WWAMI Program Site Map

Indicates presence of both Family Medicine Clerkship & Residency

Sandpoint

St. Maries

Moscow

Grangeville

Salmon

Driggs

Shoshone Blackfoot

Emmett

Nampa

Boise

Orofino

X

AMcCallW

HaileyW

Plummer

Bozeman

Ronan

Libby

Whitefish

Cut Bank

Havre

Helena

Dillon SheridanLivingston

Red Lodge

Columbus

Lewistown

Glasgow

Baker

Wolf Point

Miles City

Billings

ABelgrade

Butte

Kalispell

LaramieCheyenne

Newcastle

Sheridan

Torrington

Green River

Montpelier

FerndaleBellingham

Anacortes

DarringtonEverett

Shelton

Bremerton

Cathlamet

Vancouver

Toppenish

Wenatchee

Othello

Odessa

Ellensburg

Yakima

Grandview

TonasketOmak

Chewelah

OlympiaMadiganUS Army

Tacoma

Spokane

Pullman

X

A

Seattle*

Moses Lake

South Bend

Cle Elum

Colville

Colfax

White Salmon

Renton

Goldendale Pasco

A

Jackson

Buffalo

Afton

Lander

Saratoga

Ob/GRock Springs

Juneau

Kodiak Island

Metlakatla

Seward

Wasilla

Soldotna

Anchorage

DillinghamHomer

ABethel

W

Stevensville

W

Gillette

Cottonwood

Wrangell

09/05/08

W

W

Cody

Kemmerer

Coeur d’Alene

Klawock

White Sulphur Springs

Sundance

Malad City

Wheatland

Polson

Fort Benton

Walla Walla

Westport

Auburn

KettleFalls

Great Falls

Heart Butte

EurekaBonnersFerry

W

Kirkland

Redmond

Davenport

Unalaska

Unalakleet

Dayton

W

Leavenworth

Hamilton

La Conner

Idaho Falls

IntMdMontesano

Enumclaw

Rexburg

IntMdFam Ob/G

NeuroPeds

Psych

Fam

FamIntMd

FamIntMd

EMd

PsychSurgOb/GFam

Neuro

Neuro

Pocatello

PedsFam Fam

IntMd

IntMd

Fam

Ob/G

Fam

NeuroIntMdOb/G

Fam

FamIntMd

Ob/GPedsPsych

IntMd

Psych

Fam

Fam

IntMd

Ob/G

Ob/GOb/GFa m

Ob/GPeds

Ob/G

Fam

Peds

Fam

Neuro

Peds

CC

Neuro

Neuro

Neuro

Neuro

NeuroCC

CC

Surg

Neuro

Ob/G

X

Fam

Peds

Psych

Fam

Kent/DesMoinesIntMd

Ob/G

Fam

mFa

mFa

mFa

Fam

PsychSurg

Missoula

Ob/GIntMd

PsychSurg

A

Ob/G

Lewiston

Cascade

Weiser

IM

A

Post Falls

Caldwell

MaltaConrad

Big Timber

Lame DeerCrow Agency

Ennis

Hardin

Ketchikan

Eastsound

MarysvilleBrewster

Buckley

Chelan

Grand Coulee

X

NewportOkanogan

RitzvilleW

F

F

F

Twin Falls

Sun Valley

Fam

WWAMI track location

MammothHot Springs

F

F

F

F

IM

IM

Ps

Ps

IM

F

FF Shelby

F Big Sky

FBrowning

F

IM

IM

IM

IM

IM

F

IM

Pd

Ps

Ps

FairbanksOb/GSurg AIM Ps

Pd

Pd

IM

IM

FRupert

F

F

DowneyF

F

F

F

AmericanFalls

X

Fam

Powell

Fam

IntMdIM

Ob/GFam

Fam

NeuroPeds

IntMd

F

FF

F Nome

F Dutch Harbor

F

Cordova

Pt. Angeles

Neuro

Fa m

F

F

F

F

F

*Seattle

Surg

CCPedsPsychPsych

Ob/G

Fam

NeuroEMdIntMd

FamIntMd

FF

F

F

F

WWAMI Clinical Medical Education Office

F

F

F

Douglas

F

F

F

Rathdrum

F

F

F

F

F

FF

F

F

FStevenson

F

DavenportCheney

F

F

F

W

Ob/G

Ob/G

Peds(Multiple locations for each dept.)

F

Pd

Residency Programs

IntMd

Peds

Fam

Psych

SurgFam

IntMd

Ob/G

1st Year sites(University Phase)

Rural / Underserved Opportunities Program (R/UOP)

Area HealthEducation Center (AHEC)A

LEGEND

WWAMI Rural Integrated Training Experience (WRITE)W

EMd

CC Peds

WWAMI Rural Residency Rotations

F: Family Medicine IM: Internal Medicine Ob/G: Ob/GynecologyPd: Pediatrics Ps: Psychiatry

WWAMI Track location

Neuro

Fam Med

Internal Med

Ob/Gyn

Pediatrics

PsychiatryPsych

Ob/G

Chron Care

Emerg Med

Fam Med

Internal Med

Neurology

Ob/Gyn

Pediatrics

Psychiatry

Surgery

Req. Clerkship Sites

WWAMI Clinical Medical Education Office

CasperFamPsych

PsSurg

F

F

CCBellevue

IM

2008-09

F

FKotzebue

Barrow

North Pole

F Delta Junction

F

F

Prince of Wales Is.

F Petersburg

FF

HainesF

F Valdez

Sidney

Anaconda

DeerPark

Ilwaco

Mt. Vernon

Tacoma

WW

Lapwai

111208_Idaho_110708[9]

WWAMI Idaho Admissions E-2008

Idaho WWAMI

Total Non-

WWAMI Grand Total

Total Applied 138 1105 3094 4199 Interviewed 91 734 115 849 Accepted 20 195 21 216

111208_Idaho_110708[10]

Public vs. Private Medical EducationCost to the Student - 2008

WWAMI PUBLIC* PRIVATE* Student Tuition

Resident $17,425 $20,836 $38,180 Non-Resident $41,429 $40,126 $39,332

TOTAL STUDENT DEBT (at graduation) 2007 $104,919 $129,810 $156,804

*Mean Numbers

Costs of Educating a Medical Student

§ AAMC 1995 study reports an annual cost of educating a medical student between $95K and $136K in 2008 dollars; of this, instructional costs were $54K to $67K per year

§ LCME 2007 Financial and Medical School Questionnaires report theaverage state support of a public medical school student is $103K per year.

§ The funded cost per medical student in the Spokane WWAMI expansion is $71K

§ WWAMI Idaho costs of $63K per student include the additional costs related to a regional medical school, such as regional offices, faculty support and clerkships in Idaho.

§ 57% of appropriated funds for WWAMI in Idaho are spent in Idaho each year.

§ UWSOM’s first-year tuition and fees in FY 2009 are 81% of the average at public medical schools.

111208_Idaho [11]

2008 WWAMI Economic Impact StudyUI College of Business & Economics

§ Idaho WWAMI Education and Research Programs generate $17 million in sales; $8 million in wages; 195 jobs; and $500,000 in taxes annually§ Idaho WWAMI Practicing Physicians generate $275

million in sales; $156 million in wages; 2,064 jobs; and $2 million in taxes annually§ Idaho WWAMI generates over $5.00 of economic

contributions for every State dollar of funding received, compared to national medical school average of $2.30

111208_Idaho [12]

111208_Idaho_110708[13]

§ 50% of all Idaho WWAMI graduates have returned to practice medicine in Idaho

•U.S. medical schools average in-state return rate: 39%•Oregon 46%; Utah 42%; N Dakota 32%; S Dakota 41%

§ With additional non-Idaho WWAMI graduates who set up practice in Idaho, the State’s Return on Investment goes up to 75%

§ 48% of WWAMI graduates enter primary care•National average 38%

WWAMI Graduates Return to Idaho

111208_Idaho_110708[14]

WWAMI Graduates Practice Sites in Idaho

111208_Idaho_110708[15]

WWAMI = QualityAchieving Excellence in Medical Education

§ Full accreditation through the LCME:“The benchmark WWAMI Program provides students with a

unique opportunity for education and personal growth.”(LCME letter of accreditation, 2002)

• Consistent measurement of educational equivalency across distributed basic and clinical training sites

§ U.S. News & World Report:• #1 Primary Care Medical School (15 years)• #1 in Family Medicine & Rural Health (15 years)

111208_Idaho_110708[16]

§ Entering students (E-2008):

*(National Average)

§ Medical student board scores (USMLE) at or above national average§ AAMC Outstanding Community Service Award – 2002§ WWAMI Participation: Volunteer Faculty Rating n=4,800:

• High degree of satisfaction & support.................... 93%• Enhanced their patient care................................... 90%• Contributes to meeting professional goals............. 97%

§ Provision of ongoing faculty development for all preceptors § Students achieve residency match goals > 95% of time

WWAMI = QualityAchieving Excellence in Medical Education

MCAT Composite 31.0 (27.4)* GPA 3.66 (3.6)*

Resident Training (GME) is Different from Medical Student Education

Federal + State + Sponsoring Hosp.

Tuition + State or Private

Source of Financial Support

Multiple: Hosp., Med Sch, Univ.Medical SchoolSponsorship

Eligible During ResidencyNot Eligible as StudentState Licensure

ACGMELCMEAccreditationNRMP MatchAdmissions CommitteeAdmission

Receives Stipend/BenefitsPays TuitionLearner

Trainee/EmployeeStudentLearner Status

ResidentMedical Student

111208_Idaho_110708[18]

WWAMI GME in IdahoUW-Affiliated Programs

§ Family Medicine Residency*§ Boise – 10 residents/year§ Caldwell – 2 residents/year§ Magic Valley – 1 resident/year§ Pocatello – 6 residents/year

§ Family Medicine Residency Fellowships*§ Sports Medicine – 1 fellow/year§ HIV Primary Care – 1 fellow/year§ Rural – 1 fellow/year

*University of Washington Family Medicine Residency Network

111208_Idaho_110708[19]

Family Medicine Residency Network Outcomes

§ 101 Idaho graduates through 2004§Among all Network graduates:

• 65.4% practice in WWAMI• 24.1% practice in communities < 25,000• 16% practice in communities < 5,000• 34.5% practice in medically underserved communities

111208_Idaho_110708[20]

WWAMI GME in Idaho –UW School of Medicine Programs

§ Internal Medicine Residency Track§ Boise Track – Ten 2nd-year residents (R2)§ Preliminary Program – Six 1st year residents (R1)

§ Psychiatry: Idaho Track Psychiatry Residency § Two R1, Three R2 residents in Seattle§ Three residents per year (R3 & R4) in Idaho

§ Pediatric Residents§ Six R2 residents/year in Pocatello

§ Pulmonary Fellowship§ One per year pending ACGME action

111208_Idaho_110708[21]

Research

§ UI WWAMI faculty bring in $11 million dollars of NIH funding annually to Idaho (5 year average)§ UI WWAMI NIH research funding is already

greater than 14 U.S. Medical Schools (including U of North Dakota, Creighton U, and Florida State U.)§ Institute for Translational Health Science

initiated 2008 to serve WWAMI region.

111208_Idaho_110708[22]

WWAMI and University of IdahoProposal to the SBOE June 19, 2008

§ Expand class size for Idaho residents from 20 to 40 medical students/year;

§ Begin planning to establish a second-year medical education program in Idaho to create a four year WWAMI Idaho medical education program;

§ Expand existing statewide network of 3rd and 4th year community clinical training sites to accommodate class size increase;

§ Create a statewide GME approach to expand residency training in Idaho and build on existing collaborative efforts;

§ Build on existing collaborative efforts in biomedical research.

111208_Idaho_110708[23]

WWAMI = QualityThe 2nd Year Curriculum

§ 2nd year currently taught in Seattle for all WWAMI students. § Curriculum has 10 “organ systems” courses that integrate

basic sciences, research, and clinical care§ Each course has 10-40 faculty, integrating medical or surgical

specialists/sub-specialists with professors and researchers.§ Currently, 200+ faculty, and an Academic Health Center.§ 2nd year also includes: the Colleges (professional mentoring),

Pharmacology, Pathology, Epidemiology, ICM, Medicine-Health-Society, Genetics, and Nutrition courses§ What is required to offer the 2nd year in Idaho? Financial

support for increased university-based faculty, clinical faculty, and capacity for distance learning. Requires a feasibility studyto develop a design and plan.

111208_Idaho_110708[24]

WWAMI Idaho Expansion Proposal

Current Status20 ID students/class

Gradual Increase in

Class Size During Planning Using Current WWAMI model

Major Increase in Class Size WhenNew Idaho 4 Yr

Model is in Place

Stu

dent

s/C

lass

Planning phase for New Idaho Model:Planning Funded by UWSOM

Implementationof

New Idaho Model

111208_Idaho_110708[25]

GME Expansion in Idaho

§ In 2009, expand the WWAMI Regional Office in Boise in conjunction with the University of Idaho to allow for GME planning and development in Idaho (cost to be determined). Create an Idaho legislative proposal regarding this initiative.

§ Charge:

• Identify opportunities for additional GME in Idaho and build upon existing programs shared between UWSOM and State of Idaho

• Strengthen working relationships with hospitals, state agencies,organized medicine to prioritize workforce needs and planning ofadditional residency programs

• Create advisory group to oversee planning process

Questions/Comments?