Questions in Rural Medical Education

Preparation for the RME Conference in May

Work Groups Proposed for RME Conference

Pipeline Issues

Admissions and the Early Years

  1. Pipeline issues - getting the right students into medical schools
  2. Which is most important, selection of the right candidates or having the right training curriculum?
  3. Can medical schools admit the most intellectual candidates and expect these to choose rural and underserved locations?
  4. In the most successful rural programs, small college advisors play a key role in helping to admit the right students into medical schools. What is the level of involvement of small college advisors across the nation? How are they involved effectively? Are there situations where their involvement is not appropriate?
  5. Is there a relationship between the deterioration of small college pre-professional training and the lack of young professionals going to rural areas?
  6. Should service-learning programs be used to screen medical school candidates for actual service motivation?
  7. Given the increasing needs for culturally competent graduates and increasing needs in underserved areas, why don’t medical schools require communication skills and non-English language proficiency?
  8. How do medical schools modify admissions to prefer candidates that tend to choose underserved areas and not appear to discriminate against certain minorities?

Medical School

  1. Should students that fail to demonstrate service ethic and communication skills be continued in medical school?
  2. What is the role of student organizations in supporting students with service career plans?
  3. What is the ideal rural medical education curricula?
  4. What constitutes and effective infrastructure for rural medical education?

Graduate Medical Education Issues

  1. Does the current method of financing GME facilitate rural training, both numbers and quality? 
  2. Funding of RTT programs? 
  3. Sole Community Provider status of rural hospitals and funding of graduate training
  4. Role of the rural hospital in funding and cost sharing 
  5. RTTs and residency caps
  6. What are the issues with osteopathic GME? 
  7. The blend of osteopathic medical school selections and primary care emphasis and allopathic rural graduate programs seems to be ideal for graduating more and better rural physicians. Why is this a rare occurrence? 
  8. Rural training tracks have proved themselves to be able to graduate residents into rural practice. What are the barriers to more rural training tracks? Enough rural interested graduates, accreditation, extra costs, family practice program and department barriers. 
  9. Can programs that train rural physicians continue to depend on allopathic medical school admissions policies?
  10. Accelerated rural programs hold great promise for graduating rural physicians for the smallest towns, but there is only one such program. Why has this program been so effective in locating physicians in the smallest towns? How can trainees leave urban areas after 7 years of the urban lifestyle? What can be done to encourage more accelerated rural and underserved programs? What barriers exist such as accreditation, the moratorium on accelerated programs, etc.?
  11. Optimal configuration of the three years between core and rtt 
  12. program facility and RRC considerations/ waivers
  13. Integration of distance learning modalities at rural training sites
  14. Recruitment to RTTS
  15. 'Selling' the RTT model to medical students
  16. Finding the right students for RTTs
  17. Recruitment costs for RTTs
  18. Centralized search process so students can find rural programs, updated regularly by programs so it is accurate

Role and Responsibilities of Medical Schools

  1. At the premedical levels
  2. Regarding workforce in underserved areas
  3. Regarding curricula that is rural-friendly
  4. Regarding infrastucture issues - faculty and departments and programs that meet rural needs
  5. Little investment in needs of local, state, regional, other than as economic role through research
  6. How can medical education effectively work to meet the incredible needs of rural areas with high poverty, large numbers of minority populations, low education, and difficult economic factors? (Southeast, border, natives)

Rural Faculty and Faculty Development Issues

  1. Productivity support for rural faculty
  2. Curriculum development and support for rural hospital faculty

National Leadership Issues

Financing of medical education

  1. The current role of the National Institutes of Health funding is to push medical education into more research and more intellectual choices of medical students. How do we change medical school incentives to align them with the country’s needs for physicians who serve, especially in underserved areas?
  2. Do we need specific financing for medical education to balance out the NIH incentives
  3. Do medical schools need additional bureaucratic hoops to jump through to insure that they keep service to the underserved as a top priority?
  4. How can allopathic and osteopathic entities work together better?

Medical schools and medical leadership have basically thrown in the towel regarding maldistribution. Medical leaders blame the poor rural economy instead of accepting responsibility for poor leadership in education at the state and national level. Also, medical schools have clearly prioritized research and funding and profit-making ventures at the expense of service and education. Most medical school campuses are also not appropriate learning environments for those interested in primary care. It seems that a new type of medical school is needed – one with only primary care graduates.

  1. Specific preparation for primary care as medicine has become so specialized.
  2. Medical schools have failed to address maldistribution.
  3. Medical schools would rather have newer medical schools shoulder the primary care burden rather than investing in it (Kentucky, Florida, newer osteopathic schools, West Virginia).
  4. Newer medical schools have a better track record of addressing maldistribution – studies indicate that selections, curriculum, and training environment are important factors for the graduation of doctors that will serve rural and minority populations

Licensure Issues

  1. Need for new methods to embrace new technologies - telemedicine, state border issues
  2. Need to address redundant administrative burdens and credentialling
  3. Can build in national requirements, such as for service
  4. Need to allow trainees more latitude in performing services under the supervision of practitioners without risking billing fraud. Need a category of learner that can will allow the provision of services in exchange for the cost of supervision.
  5. Need to establish criteria for independent primary care practitioners of all types, not just medical or nurse practitioner, etc.

Rural Workforce Research

  1. Gender and rural location and retention
  2. Contribution of trainees to delivery of workforce
  3. Service learning contributions
  4. Can temporary physicians fill the gap in workforce or do we need rural background graduates who are more likely to go and stay? Considerations in training fewer students, less likely production of too many physicians overall, more likely to have less turnover in critical rural shortage areas, more productive in community roles when staying longer, etc.

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