TheStatesman: Medical students go rural

Originally posted to The Statesman on Feb. 6, 2014

By Kellen Albrecht

Two weeks ago, the University of Minnesota Duluth first-year medical students started the Rural Medical Scholars Program (RMSP). RMSP began as an offshoot of another rural family practice program called the Rural Physician Associate Program (RPAP). RPAP is constituted by a 9-12 month longitudinal community experience during the third year of medical school.

Part of what spawned these programs was the feedback from rural physicians that more rural, family practice doctors were needed. It was imperative to begin a ladder of experiences even earlier in the medical school curriculum to provide additional understanding of a rural opportunity.

RMSP was created to address that issue.

“The experiential material has been the hallmark of this school since its creation,” said Dr. Jim Boulger, associate director of RMSP. “RPAP and RMSP provided a unique break to allow students to achieve a more reality-based experience.”

As a part of RMSP this year, first-year medical students traveled out to a variety of rural communities such as Warroad, Pipestone, Deer River, Staples and New Ulm, while others traveled to rural communities in Wisconsin and Iowa. Students are welcomed by a local physician who serves as their preceptor.

“The best part of RMSP is getting hands-on experience,” said second-year student Abby Sauer. “The physicians we work with are great teachers and love to get us integrated into their patients’ care. I’ve had the opportunity to work on taking histories and physicals, follow a variety of specialists, and perform a few minor procedures.”

RMSP has proven to be wildly successful with students in what they are able to learn both in and out of the clinic.

“Students’ rating of the programs (RMSP and RPAP) are amongst the highest in the entire school,” said Dr. Boulger.

“The RMSP experience encourages a community focus which I feel is necessary to become a primary care physician,” said second-year student Nate Guimont. “Health is often extended beyond the individual patient in an exam room and is, in part, a product of the context which the patient finds themselves in.”

RMSP has proven to be beneficial for students. However, it all depends on the physician being willing to take on a student. Often, preceptors are not only welcoming students into their community, but also into their home.

“We have noticed that preceptors enjoy the experience of teaching and taking students into their home to show them what rural family practice is all about,” said Dr. Boulger. “It allows them a continuing educational opportunity to teach and learn to keep them fresh on their own medical education.”

“I want to give back,” said Dr. Ann Seagren. “I was a student, and I know how important teaching and learning is. I believe in the Duluth mission and want to promote students to go into primary care. It is great exposure for our hospitals and helps us to show what we have to offer in rural communities.”

Not only do preceptors enjoy the opportunity to host students, the hospital administration and community also enjoy the chance to help educate students.

“Hospitals like having students, as it allows them to see rural practice and shines light on the high quality of medical education and practice available in Minnesota statewide,” said Dr. Boulger

As the RMSP experience expands, data will show how effective the RMSP program is in preparing students for national board exams, clerkships, and in pipelining students to rural communities. To date, the medical school has seen very high rates of success regarding the RPAP program in terms of preparation for boards after year two, during the third and fourth year of clerkship, and in producing rural doctors when compared to national averages.

“Data on national boards has been entirely positive. We find that our students do equally as well on national tests and in clerkships as their cohorts in the Twin Cities,” said Dr. Boulger.

“I have noticed in the third-year clerkships that there is a certain calmness and confidence about the Duluth students from their experiences,” said Dr. Emily Onello, another associate director of RMSP.

The most telling data has been the success seen by the medical school in terms of the direction students choose for their career.

“The national average for those going into rural care of any type is four percent,” said Dr. Boulger. “In Duluth, that number is 44 percent. In terms of those practicing family medicine, the national average is eight percent, while in Duluth it is 48 percent.”

The direction RMSP will go in the future remains to be seen, as expansion of the program may not happen in awhile.

“As more sites grow and evolve, preceptors are being pressured into more and more teaching experiences, making it hard to provide our medical students with the best educational environment they can receive,” said Dr. Boulger.

Despite limited researchers, faculty remain positive about the future of RMSP.

“I think the model of RMSP is one that works,” said Dr. Onello. “New pieces have been and will be incorporated to provide extra, different learning experiences. In the future, the challenge will arise in seeing how the new health systems affect not only physician practice, but student education.”

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