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Major Teaching Sites
The Rural and Community Care (RCC) clinical clerkship will provide students insight into providing contextual care for populations in rural and semi-rural communities in Colorado. The site of practice is important to understand the differences in medical care and the specific challenges that occur in this population compared to urban and suburban primary care practices. We will recruit exemplary rural and semi-rural primary care practices especially those that by their geographic location or history conveys the importance of the provider to the fabric of their community.
We propose that the clinical training sites that will be used in the Rural and Community Care block will have to take into account both population and rural orientation. As mentioned above, with the urbanization of the United States and Colorado, previously rural practices have to some degree been swallowed up by encroaching urban sprawl. In other circumstances these would not be considered rural sites, yet history still connects these practices to a previous rural orientation. As this block is intimately connected to the Adult Ambulatory Care block, an important overall goal for both rotations is to expose students to some similar problems in both blocks but then have them compare and contrast the provision in care in different practice environments. To this end we propose that the following practice characteristics should be considered in clinical training site selection for the Rural and Community Care clerkship block:
- Practices that provide comprehensive care to a wide variety of genders, ages and problems that occur in their community.
- Practices demonstrate that they are a social, medical and economic resource to their community.
- Practices that are involved in caring for and interacting with a large number of their patients in a variety of settings in their community rather just in their offices. (Home, nursing home, schools etc.)
- Practices that draw many of their patients from rural/frontier communities.
- Practices whose patients, when hospitalized, are cared for by individuals in the practice and are hospitalized in smaller community or Colorado Critical Access rural hospitals.
- Practices whose referral patterns are directed to specialist care in smaller communities and hospitals rather than Metro Denver Hospitals.
- Practices that help students understand about the disparity/differences in local health care resources compared to what is available in metropolitan areas and the Academic Health Center.
Our expectation is that these more comprehensive practices with a more intimate relationship with their local population would provide excellent teaching both on the content of community based practice and the associated process of care. We also expected that these sites provided the students a new perspective on determinants of health in smaller communities by living in a new and in many cases smaller community than what they have experienced before.
Current Recruited Ambulatory Clinical Sites & Faculty: In the current Family Medicine clerkship (see Table A) all clinical instruction occurs in community ambulatory practices where community family physicians see community patients. The Department has created a network of approved rural clerkship sites that are distributed throughout Colorado. In 2006-07 the clerkship is using 68 community practice sites that include over 200 experienced generalist family physician preceptors with clinical appointments in the Department of Family Medicine. Of these, approximately 70% are rural and semi-rural, and about 50% of these are Governor designated Medically Underserved Areas, (MUAs) federally designated Health Professions Shortage Areas (HPSAs) or Community Health Centers. (CHCs) The balance of our sites serves a significant underserved population. In addition, 20 practices exist in counties with greater than 20% Hispanic populations. In academic Year 2006-07, approximately 50% of students completed their required Family Medicine clerkship in a designated MUA, CHC or HPSA. It is expected that in the upcoming Rural and Community Care clerkship an every greater proportion of rotations will occur in underserved communities since the rotation will be have a strictly rural focus.
The current community General Internal Medicine clinical faculty who will be recruited to serve as instructors are listed in Table B. These have been successfully utilized in the previous outpatient Internal Medicine component of the old curriculum. Partnering with the regional (Area Health Education Centers) AHECs we are actively recruiting additional General Internal Medicine sites to expand our roster.
Our current clinical faculty instructors are highly rated. During 2006-07 to date the Family Medicine clinical faculty at our training sites were rated at 4.7 (n=86) on a 5-point Likert scale. (1=Unsatisfactory, 4=Excellent, 5=Outstanding) Likewise current Internal Medicine clinical faculty in rural communities are highly rated. The majority of instructors who work with students have several years of teaching experience. All Department of Family Medicine instructors have the opportunity to take part in faculty development to enhance their teaching skills. Department faculty perform site visits, supply our instructors with teaching monographs and conducts teaching workshops during regional medical conferences such as the Colorado Academy of Family Physicians Scientific Conference. We have also just completed the first of five regional faculty development workshops planned for academic year 2006-07. Four additional workshops will be conducted in Grand Junction, Pueblo, Fort Collins and Denver in the next 6 months. Both Family Medicine and Internal Medicine clinical faculty have been invited to participate.
Equivalency of sites is monitored in the current Family Medicine clerkship through the use of New Innovations log of patient encounters. Evaluations of clinical faculty and clinic site characteristics such as patient demographics and diagnoses seen will be reviewed by the clerkship director and provided to each site. Those not meeting the quality standards of the program will be remediated or dropped. Since almost all community faculty in the new Rural and Community Care clerkship will be current instructors we expect the quality of the clinical teaching to be similarly outstanding.
What will be different in this respect in the upcoming Phase III?
The clinical training sites for “Rural and Community Care” will be in rural community practices, whether in those of family physicians or internists. Currently we use some urban-suburban Family Medicine sites in the Family Medicine clerkship to accommodate students with educational issues or significant personal issues where living away from home would pose a significant hardship on students. While these will not now be appropriate for a rural rotation, we anticipate that students that are identified by the Office of Student Affairs with significant personal or educational issues can be accommodated in communities, that while may involve some commuting on the part of students, would not necessarily involve living in the practice community. As these sites would be limited, we really would need the students to understand that this accommodation of their needs would be both something that we will work hard at to make happen, while at the same time a true last resort.
Placement Logistics
Students who are assigned to each 8-week block are contacted 6-8 weeks prior to their rotations to begin the process of matching students to sites. Rural and Community Care and Adult Ambulatory Care staff will then divide the group into 2 and begin assignments in each of the 4-week clerkships. Students will complete a personal profile that outlines some personal objectives for the clerkship and will submit this to our Rural and Community Care Program Coordinator along with a ranking of preference for available clerkship sites. Students can view some site characteristics and preceptor evaluations online or view hardcopy files in the DFM Student Affairs Office. Students are then matched as closely to their matches as possible and register with AHEC to begin the process of finding housing in those communities.
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Block Scheduling
Adult Ambulatory Care Course
Course Committee
Major Teaching Sites
Competencies
Integration
Formats for Learning
Assessment
Rural and Community Care Course
Course Committee
Major Teaching Sites
Competencies
Integration
Formats for Learning
Assessment
Core Signs and Symptoms
Core Clinical Issues
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