Design and Dissemination Studio – August 19, 2020

Researching Pathways and Gateways to Rural Practice

The Rural Health Professions Education Research Design and Dissemination Studio (DDS) is a community-engaged studio in rural primary care health professions education research. During the August DDS participants will work together in a facilitated discussion to assist rural research presenters in strengthening their research through participant feedback and sub-group discussion.

Davis Patterson

Davis Patterson, PhD

Davis Patterson, PhD, is a sociologist and Research Associate Professor in the University of Washington (UW) Department of Family Medicine in Seattle, Washington. He is Director of the Collaborative for Rural Primary care Research, Education, and Practice (Rural PREP), Deputy Director of the WWAMI Rural Health Research Center, and an investigator in the UW Center for Health Workforce Studies. His research seeks to inform policy and improve rural and underserved populations’ access to healthcare, with a particular focus on the health workforce. His current research includes studies examining educational pathways, from K-16 through health professional schools, to produce rural health care practitioners, rural emergency medical services, and factors affecting provision of home health services to rural patients. He is a member of the International Health Workforce Collaborative and Chair of AcademyHealth’s Health Workforce Interest Group. He is a returned Peace Corps Volunteer (Belize), an avid traveler, and fluent in Spanish.

Recruitment to Rural Residency Programs: Match Rates and Best Practices

A proposed study

Rural residency programs, where residents spend >50% of their time training in a rural location,1 struggle to recruit residents, just as rural communities struggle to attract physicians and perhaps for many of the same reasons. Students, the faculty who advise them, and accrediting agencies unfortunately may view publicly available match rates in the NRMP not only as a marker of program desirability, but also program outcomes. No comprehensive or longitudinal studies of NRMP match rates and their correlation with program outcomes have been conducted in the past two decades. This study will: (1) document patterns in NRMP match rates for rural residency programs for a 25-year period from 1996 through 2020; (2) compare these rates with program outcomes, such as performance on board exams and yield to rural practice, for a three-year period from 2013 to 2015; (3) explore strategies for success in the match that could be shared more widely. To explore the last objective, we propose to conduct semi-structured interviews with residency coordinators from 20 programs to explore strategies for success in the match that could be shared more widely and deepen our understanding of the quantitative results.

Research questions relevant to this studio:

  1. Of rural programs with consistently high or improving match rates, what strategies have been successful?
  2. How do rural programs achieve success in the SOAP when necessary?

Julie Phillips, MD, MPH

Dr. Phillips is a Professor of Family Medicine and the Assistant Dean for Student Career and Professional Development at Michigan State University College of Human Medicine. Dr. Phillips received her medical degree and a Masters of Public Health from the University of Michigan, and completed her residency training in Family Medicine at the same institution. Dr. Phillips’ professional interests include student, resident, and faculty professional development; social mission-driven medical education; narrative medicine; and development of the primary care physician workforce. She is a core faculty member at the Sparrow-MSU Family Medicine Residency Program in Lansing, where she practices full-spectrum Family Medicine, leads the Community Medicine curriculum, and serves as the program’s Research Director. She also serves as an Assistant Editor for Family Medicine and as an Associate Editor for PRIMER. When she is not working, Dr. Phillips enjoys parenting, reading and writing poetry, biking, knitting, swimming, cooking, participating in her local church, and spending time with her family and friends.

Andrea Wendling, MD, FAAFP

Dr. Wendling is a Professor of Family Medicine and the Director of the Rural Medicine Curriculum for Michigan State University College of Human Medicine (MSU-CHM). In that role, she oversees the Leadership in Rural Medicine Certificate program, the Rural Community Health Program, and the Rural Premedical Internship Program. She practices as a family physician in Northern Michigan, where she works for Charlevoix Hospital and cares for patients at the Boyne Area Medical Center.

Dr. Wendling grew up on a Centennial Farm in Emmett, Michigan, where her family raised beef cattle and Christmas trees. She attended the University of Michigan for undergraduate studies and medical school, and completed her residency at the Grand Rapids Family Medicine Residency Program. When not at work, Dr. Wendling loves vacationing and spending time with her husband and four children. They enjoy traveling the world, playing bluegrass music, camping, and skiing and snowmobiling around Northern Michigan.

Which Medical Schools Most Successfully Attract Rural Students and Cultivate Interest in Rural Practice?

A study in progress

Although 19% of the U.S. population lives in a rural community, only 10% of the US physician workforce is rural, and only 5% of new residency graduates are choosing rural practice. Rural populations, on average, are also older, have a higher chronic disease burden, and have lower incomes. Recruiting and admitting students from rural backgrounds to attend medical schools is one of the most effective ways to develop the rural physician workforce. However, rural medical students are underrepresented: only 4% of matriculations nationally are of rural origin, and the proportion of rural medical students has declined substantially over the last 30 years. Rural medical students may face systemic challenges in the admissions process. Despite these challenges, some institutions successfully recruit a large proportion of rural students and cultivate interest in rural practice. The purpose of this study is to quantitatively examine which medical schools are most successful in admitting rural students, as measured by AAMC data sources, and examine the characteristics of those institutions with the most success. A secondary purpose is to examine which institutions are most successful in maintaining students’ interest in rural practice over time.

Research questions relevant to this studio:

  1. How does rural student representation vary among medical schools?
  2. How does student interest in rural practice change between beginning and ending medical school, and how does this vary among institutions?
  3. What are the characteristics of medical schools that are most successful in admitting rural students and in sustaining student interest in rural practice over time?

Your Pre-assignments – Spend time exploring the following

Read two articles on the match process

Read an article about rural students’ admission to medical school. Listen to a podcast that describes academic obstacles in rural communities.

  • Shipman S, Wendling A, Jones K, Kovar-Gough I, Orlowski J, Phillips J. The Decline in Rural Medical Students: A Growing Gap in Geographic Diversity Threatens The Rural Physician Workforce. Health Affairs 2019; 38(12): 2011-2018.
  • Terhune J. “Beyond a One Room Schoolhouse.” This Rural Mission. Michigan State University College of Human Medicine. January 14, 2020. Available at: https://msururalhealth.chm.msu.edu/podcast/index.html

Read an article that examines admissions policies of U.S. allopathic and osteopathic medical schools that target applicants likely to enter rural practice.

For those who wish to explore further, either before or following the webinar:

  • Wendling A, Phillips J, Jones K, Kovar-Gough I, Shipman S. Defining Rural: The Predictive Value of Medical School Applicants’ Rural Characteristics on Intent to Practice in a Rural Community. Academic Medicine. Acad Med. 2019;94: S14–S20.
  • Bell E, Zimitat C, Merrick J, eds. (2011). Rural Medical Education: Practical Strategies. Hauppauge, New York: Nova Science.

For a review of the DDS process: https://ruralprep.org/research-scholarship/research-design-dissemination-studios/


Objectives of the Studio

  1. Strengthen research proposals
  2. Increase the relevance of the research to a community of practice
  3. Improve recruitment and retention of research participants
  4. Build a cadre of research-engaged stakeholders
  5. Make research more community centered, culturally relevant, and accessible to potential research participants

For further description of the process, including a video, visit our website.

DDS Session Outline

1:00 PM EDT

Introductions and overview R Longenecker

1:15

Research presentation on “Recruitment to Rural Residency Programs: Match Rates and Best Practices”  (10-12 min.) with a question(s) for the group

  • Clarifying questions (5 min.)
  • Group discussion based on series of prompts (15 min. in Zoom breakouts with assigned facilitator; 15 min. report out)
  • Researcher response (5 min.)
Presenter

D Patterson

Facilitators:
R Longenecker
D Schmitz
D Evans
S Pollock
D Aldrich

2:20

Research presentation on “Which Medical Schools Most Successfully Attract Rural Students and Cultivate Interest in Rural Practice?”  (10-12 min.) with a question(s) for the group

  • Clarifying questions (5 min.)
  • Group discussion based on series of prompts (15 min. in Zoom breakouts; 15 min. report out)
  • Researcher response (5 min.)
Presenters

J Phillips, A Wendling

Facilitators:
R Longenecker
D Patterson
D Schmitz
D Evans
S Pollock
D Aldrich

3:15-3:30

Evaluation and reflection, group questions and feedback R Longenecker, D Patterson, D Schmitz

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