Meeting Rural Community Needs:
The Community Health Project in Rural Medical Education
and
The Value of Public Health in the PreMedical Education of
Future Rural Physicians
Taihung Duong, PhD
Robin Danek, MPH
Priya Abhyankar
Indiana University School of Medicine – Terre Haute
Indiana State University
Physician Workforce in
Indiana (2010)
Active Physicians per 100,000 Population
• Active Patient Care Physicians:
194.5/100,000 (34th/50 states)
National Median: 215.1
Massachussetts: 314.8/100,000
(1st/50)
• Active Patient Care Primary Care
Physicians: 71.2/100,000 (36th/50
states)
National Median: 80.4
Vermont: 111.5/100,000 (1st/50)
• Active Physicians By Selected
Age Groups
Under Age 40: 16.5%
Age 60 or older: 23.4%
Active Primary Care Physicians per 100,000 Population
Physician Access
in Indiana
The darkest shading indicates
the best access and the lightest
colors indicate poor access.
Indiana State University/ Indiana University School of Medicine – Terre Haute
Rural Health Initiative B/MD program
• Established in 1997
• Recruit high school students from rural areas of Indiana
• High school GPA 3.5 minimum
• SAT 1200 minimum or ACT 27 minimum
•
•
Entering class of 10 admitted to Indiana State
University Undergraduate College with full-tuition
waiver.
Conditionally accepted to IU School of Medicine
•
•
Undergraduate college GPA 3.5 minimum
MCAT score equal to the mean of the entering class from
the previous year
Graduates from ISU/IUSM B/MD Program
•
Total Number of Physicians
34
•
Primary Care
20 (59%)
•
•
•
•
Family Medicine
Internal Medicine / Pediatrics
Pediatrics
Obstetrics/Gynecology
13
1
5
1
•
General Surgery
3 (8%)
•
Specialties
11 (32%)
•
•
•
•
•
•
•
In Residency Programs
Practicing in Indiana:
•
•
Anesthesiology
Diagnostic Radiology
Emergency Medicine
Neurology
Orthopedic Surgery
Practicing in Rural Indiana:
Practicing Out-Of-State:
6
1
2
1
1
11
19 (83%)
6 (3%)
4 (17%)
Indiana University School of Medicine – Terre Haute
Rural Medical Education Program
• Established 2008
• Recruit medical school applicants from rural areas of
Indiana
• College graduates apply to IUSM and then to IUSMTerre Haute RMEP program.
• 2 separate admissions interviews
• RMEP Interview Committee include rural community
members.
• Medical students are based for all 4 years of medical
school in Terre Haute.
Graduates from the IUSM-Terre Haute
Rural Medical Education Program
• Total Number of Physicians
31
• Primary Care
23 (74%)
•
•
•
•
•
Family Medicine:
Internal Medicine /Pediatrics:
Internal Medicine:
Obstetrics/Gynecology:
Pediatrics:
• Specialties
•
•
•
•
•
Anesthesiology:
Emergency Medicine/Pediatrics:
Emergency Medicine:
Neurology:
Physical Medicine and Rehabilitation:
15
1
3
1
3
8 (26%)
3
1
2
1
1
Primary Care Physicians as Change Agents
Physicians need training in:
• Community Engagement
• Leadership
• Population Health
to prepare them to work with partners within the
community and to adapt medical care to address population
health needs.
Sheline et al. Academic Medicine 2014 May 13 [Epub ahead of print]
Improving Population Health
• Manage chronic disease
• Redesign clinical care delivery systems
• Collaborate with interdisciplinary teams in the
community to develop and implement health
initiatives
Action Items of the
Rural Medical Education Program
(RMEP)
• Year 1: Rural Medicine through the Eyes of a Rural
Patient and a Rural Practice
• Year 2: Understanding the Community Context of Rural
Medicine
• Year 3: Problem-Solving in the Rural Community:
Research and Planning to Meet Community Needs
• Year 4: Leadership in Rural Medicine: Implementing
Change
RiCOH and CHP
Research in Community Health (RiCOH)
• Designed for undergraduate sophomore college students in the B/MD
program.
• Immersion population health research experience in hometown rural
community.
• Partnership with local health departments, community hospitals or
regional Area Health Education Center (AHEC).
Community Health Project (CHP)
• Designed for fourth-year medical students in the IUSM-Terre Haute
Rural Medical Education Program.
• Research project on health assessment and intervention.
“The overuse of U.S. emergency departments is responsible for
$38 billion in wasteful spending each year.”
• New England Health Institute (2010)
Purpose
• Identify and analyze the characteristics of frequent users
of the emergency department.
• Identify potential solutions to this issue.
Materials and Methods
• Define frequent user
• Identify frequent users from May 2012 to May 2013
• Collect patient information from ER records using HPF
Webstation
• Analyze the data in Microsoft Excel
Age Distribution of Frequent Users
100
91
90
82
80
72
Number of Patients
70
60
50
42
40
33
30
24
20
10
0
0-17
18-30
31-44
45-64
Age in Years
65-74
75+
Frequent User Gender Ratio
38%
62%
Male
Female
Mental Health History
• 43% of frequent users claim having a
history of mental health issues. Of
these:
•
•
•
•
•
67% claim anxiety
56% claim depression
23% claim substance abuse
17% claim bipolar disorder
8% claim they have had suicide ideations
ICD-9-CM Code for Principal Diagnosis
Top 5 Principal Diagnoses of Frequent Users
724.2 Lumbago (low back pain)
599.0 Urinary tract infection, site not specified
786.50 Unspecified Chest Pain
346.90 Unspecified migraine without mention of
intractible migraine without mention of status
migrainosus
789.00 Abdominal pain, unspecified site
0
50
100
150
Number of Encounters
200
What I have learned
•
•
•
•
•
•
•
How to think independently
How to write and read research papers
Research requires patience
The mechanics of an ER visit
The behind-the-scenes details of hospital work
The difficulties of emergency health care treatment
The value of primary care physicians
RiCOH and CHP
RiCOH provides students with initial exposure to research
and public health
CHP extends experience:
• Longitudinal
• Spring of 3rd year-Spring of 4th year
• Encouraged to return to hometown/community
CHP details
Objectives:
•
•
•
•
•
•
•
•
•
Demonstrate how to select study design
Evaluate available health ed materials
Write literature review
Recruit clinic staff and participants
Design or choose appropriate survey
Design appropriate intervention tool (if applicable)
Complete CITI training and IRB protocol
Collect and analyze data
Write final report
Previous Community
Health Projects
Topics included:
• Nutrition related(6)
• Sexual Health (2)
• Smoking Cessation (2)
• Emergency Department Usage (2)
• Resources for Autistic Families
• Alcohol Abuse among College Students
• Coronary Artery Disease
• Fall Prevention in the Elderly
Highlights
Emergency Room Study
• 2 studies spanning two different years
• Terre Haute
• Clinton
Tele-Health Education and Coronary Artery Disease
• Effectiveness of using tele-health in educating patients on
the risk factors of CAD
Benefits
Insight into Public Health
• Population health versus medicine
Interprofessional Education (IPE) component
Sustainable projects
• “Big picture” of particular topic in Indiana
Research experience required for most residencies
• Increases competitiveness
Contact Information
• Robin Danek, MPH, Robin.Danek@indstate.edu
• Taihung Duong, Ph.D. tduong@iupui.edu
• Priya Abhyankar pabhyankar@sycamores.indstate.edu