West Virginia Rural Health Education Partnerships
West Virginia Area Health Education Centers
2007 General Program Description
Chronological History and Background
The foundation for community based training can be traced back to roughly 30 years of development and
advances in medical and health professions education in the state.
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In 1972, West Virginia received its first AHEC grant and the Charleston (WV) Division of the West Virginia
University (WVU) School of Medicine was established through the support of some of these funds.
1972 West Virginia School for Osteopathic Medicine (WVSOM) opened in Lewisburg.
1973 the Marshall University School of Medicine opened in Huntington.
1989 First Statewide Rural Health Conference held in Logan hosted by Sen. Earl Ray Tomblin and focus was on
need for community based health professions training. Dr. Robert Walker was one of the first to initiate this
discussion.
Gov. Caperton in response to Pew Commission report, initiated discussion around state support of three medical
schools.
Gov. Caperton called special session in fall 1991 to deal with “medical schools’ war.”
This session passed the Rural Health Initiative Act providing funding for schools and communities to engage in
changes to health professions education as a means to increase retention of state trained health professionals.
Hilda R. Heady is hired by WVU with approval of Vice Chancellor to direct the RHI program under the State
Rural Health Advisory Panel as specified in the legislation.
Oversight responsibilities and funding was directed to the University System of WV, now HEPC, and the Vice
Chancellor for Health Sciences. Funds were roughly $2 million to schools to restore base budget funding lost
since 1988; $2 million to schools for changes to accommodate rural rotations and rural health curriculum; and $2
million for community support and development of training sites.
1991 state received $6 million W. K. Kellogg grant (Community Partnership Initiative) over five years to create
four rural community based academic health training sites. Kellogg CPI grant is headed by Dr. Bill Carlton under
a statewide governing board.
Both Kellogg CPI grant and the state funded RHI program with 8 regional consortia ran in tandem for four years.
1994 plans to integrate Kellogg CPI program and RHI program were initiated with the goal of full integration by
1996.
1995 RHI Act reauthorized and an additional $1.5 million appropriated to joint program, $500,000 went to the
schools, and $3 million for community site support.
1995 Kellogg and RHI are joined and partnership is named WV Rural Health Education Partnerships.
TRACKER system is designed by Mike McCarthy at MU SoM, and launched in 1996 to schedule rotations, track
students and residents, log learning activities, and track program graduates. Hilda R. Heady is appointed
Executive Director for combined program by Dr. Donald Weston and approved by the state Rural Health Panel.
The Governor makes appointments to the Panel per legislation and reflective of the leadership in both programs.
1995 USWV (now HEPC) board approves resolution to direct schools to make rural rotations a degree
requirement with full implementation by 1996 per request of the Vice Chancellor. PERD audit is conducted, the
RHI panel proceeds to sunset, the reauthorization bill includes membership up of new State Rural Health
Advisory Panel, and the Act is reauthorized for three years.
1998 the Recruitment and Retention Committee’s make up and functions are specified in WV Code as a
committee of the State Rural Health Advisory Panel.
2000 RHI reauthorized for three years, PERD audit conducted.
2001 federal AHEC grant submitted and received at $2 million for three years to create four to five regional
centers in collaboration with state funded RHEP program. Grant is to WVU with cooperative agreements to MU
and WVSOM to each start up a center, and WVU Eastern Division subcontracted to start a center.
2003, 2004, 2005 RHI reauthorized for one year each, PERD audit conducted each year.
2003 and 2004 strategic planning process in WVRHEP seeks ways to ‘merge’ RHEP consortia, share resources,
refine policies, and increase effectiveness of program. Consortia reduced from 12 to 8, with one AHEC Center
and three RHEP regions joining into one organization.
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Partnership approves policy to encourage wider distribution of medical student rotations by designating sites
based on level of need, referred to as the Levels policy, effective July 1, 2005.
2006 RHI reauthorized for three years to 2009
2007 AHEC continuation grant approved to 2009 to support five regional centers. Each program supports the
other synergistically, collaborating closely, and sharing responsibilities and resources. Each Center hosts
interdisciplinary teams, lead by at least one medical resident, of health professional students and medical residents
for rural rotations in which the team addresses an identified public health issue and needs specific to the
communities in which they train.
The Infrastructure
Critical to this partnership are the local rural health agencies, organizations, and community leaders with
compatible missions, goals and objectives, who, with the health sciences centers, are willing to provide faculty/preceptors,
learning resources and technical support for the students and trainees. Also, WVRHEP enters into contracts and
affiliation agreements with community providers and organizations to support student and resident training.
WVRHEP/AHEC infrastructure:
 8 geographic regional partnerships (one region has three sub-regional boards and geographic areas), each
with its own board and serving all of WV’s 55 counties.
 476 partnership training sites; 374 of these training sites are located in communities with a federal
designation as a Health Professions Shortage Area (HPSA) or a Medically Underserved Area (MUA)
(148 sites are both) and serve primarily underserved populations. These training sites include:
o 45 community health centers
o 14 county health departments,
(CHCs),
o 40 physical therapy agencies or
o 47 federally qualified health
rehabilitation center sites,
centers (FQHCs),
o 15 healthcare for the homeless
o 8 rural health clinics (RHCs),
facilities,
o 28 small rural hospitals, 25
o 13 school based health centers,
dental offices,
o 3 free clinics, and
o 37 pharmacies,
o 1 migrant health center
For a complete guide to WVRHEP Consortia and WV AHEC Centers, please refer to
http://www.wvrhep.org and http://www.wvahec.org
 682 field faculty serving as student/resident preceptors include:
o 306 medicine
o 23 physician assistants
o 115 nursing
o 9 medical technologists
o 93 pharmacy
o 5 social workers
o 50 physical therapy
o 3 occupational therapists
o 43 dentistry
o 2 clinical psychologist
o 31 nurse practitioners
o 2 certified nurse-midwives
 Each geographic region has a physical office located in the lead agency facilities or a modular/renovated
space to accommodate the program. Each region is staffed by an RHEP site coordinator, site secretary,
and in some regions a community services worker. AHEC Centers have a Center Director, a secretary,
and in some cases an associate director or other field worker. All RHEP regions also maintain housing
resources for students and residents. Most are through lease and rental agreements, while two consortia
own these properties for housing.
Policies Overview
The Panel oversees all policy development and implementation through its various committees. A standard
policy and procedure format is used for all policy statements. All approved policies are listed chronologically on the web
site, http://www.wvrhep.org/policies/97_02.html. All documents are in PDF with adobe reader necessary to review the
documents. Any partner, panel member, school, or staff member can initiate the process to develop a policy. All policy
statements must however, initiate within a committee, then be sent to relevant committees for review, and then finally
approved by the Panel. The policy process specifies the group or person responsible for implementation and oversight of
each policy. Policy areas include: fiscal management, structure and roles of Panel and local governing/regional consortia
boards, the rural health curriculum (including roles of field faculty, designation of training sites, faculty development,
definitions of students for tracking purposes, definitions of community service learning, etc). The Panel committees’ roles
and functions are:
1. Advisory Panel (State Rural Health) is charged in legislation to advise the Vice Chancellor for Health Sciences
of HEPC in the conduct and oversight of the WV Rural Health Education Partnerships program. In 2002, the
Panel also took on the oversight responsibility for the WV Area Health Education Centers grant program in an
advisory capacity to the grantee institution.
2. AHEC Center Directors’ Group is responsible for maintaining communications between the Centers and the
state program office. This group meets monthly and discusses: current status of AHEC grant funding and
reporting requirements, Centers’ progress toward meeting program objectives, other funding opportunities for
Centers, announcements regarding pertinent training, workshops and conferences, partnership opportunities,
including joint projects with RHEP, and individual Center updates. The AHEC Center Directors’ Group
and the Site Coordinators’ Groups meet jointly three to four times per year.
3. Curriculum and Outreach (Clinical and Community Service-Learning curricula) The Joint Outreach and
Curriculum Committee is comprised of school representatives, community members from local consortia boards,
RHEP site coordinators and AHEC center directors, and state level staff. This committee works closely with the
Schools’ Committee in reviewing community service and service-learning projects and makes recommendations
on any and all outreach activities in which students participate. This committee develops curricular requirements
related to the RHEP/AHEC Programs and recommends and reviews policy in the areas of service learning,
outreach and curriculum.
4. Evaluation is responsible for establishing the evaluation plan and policies for the program which includes
coordinating all data collection and information that describe the performance and impact of WVRHEP, the
feedback of this information throughout the partnership system, and overseeing the data analysis for the annual
report and the HEPC legislative report card to the legislature.
5. Faculty Development oversees the annual Faculty Development conference held each year for
WVRHEP/WVAHEC faculty. The committee gathers feedback from field faculty on development of teaching
skills and other needs in continuing education and faculty development. The committee also provides support to
the On-Site Clinical Directors and the implementation of this role within each consortium.
6. Finance The Finance Committee of the WVRHEP/WVAHEC reviews and recommends to the full panel the
annual budge. The committee also works with the WVRHEP/WVAHEC staff in formation of fiscal policies and
advises on all other fiscal matters as appropriate. The membership of the committee of the WVRHEP/WVAHEC
shall consist of the following: a lead agency site Administrator, two Site Coordinators, an AHEC Center Director,
four community members, a representative from the Schools’ committee, one annually rotating slot for each of
the three fiscal agents from the schools to serve as a resource person, not as a voting member, and one member of
the LRC committee to serve as a resource person, not as a voting member.
7. Information Technology supports the WRHEP/WVAHEC in all technical matters, reviewing new technologies
for improving communication, student education and overall productivity. This committee also overviews
WVRHEP’s web resources and TRACKER as the programs resource for data collection and evaluation of
students rotations.
8. Recruitment and Retention coordinates state, campus and community efforts to recruit and retain primary care
providers in rural underserved areas. The committee identifies problems and gaps and coordinates policies,
activities and program development and plays a key role in state-funded incentive programs-one administered by
the HEPC and the other by the Division of Rural Health and Recruitment in the Bureau for Public Health.
9. RHEP Site Coordinators’ Group comprised of field site coordinators from each of the 8 regional consortia.
meets once per month to discuss joint projects/program, curriculum requirements, evaluation data, committee
reports/requests and any and all other business that affect the partnership program. The group also host speakers
at their monthly in order to receive updates and information on other statewide collaboratives. Coordinator
meetings allow coordinators to share ideas and network with colleagues to continually monitor quality
improvement of the partnership, educational requirements, and all other aspects of student education and rotation
management. State level staff members attend these meetings to keep coordinators informed of statewide
program goals, objectives, challenges and accomplishments and to communicate state level policies and
procedures crucial to program improvement.
10. Schools’ Committee is comprised of school representatives from all institutions involved in the RHEP/AHEC
Program and reviews policy and procedures that directly affect school curriculum and the RHEP curriculum
components. This committee works closely with all Panel committees and works as partners with the regional
consortia to problem-solve issues and continually improve rural rotation experiences for health profession
students.
Evaluation and Research
The evaluation system of WVRHEP/AHEC includes three basic areas of assessment: 1) the influence that
RHEP/AHEC training has on students' attitudes and career plans, 2) the students’ experiences in RHEP/AHEC as a means
to improve the curriculum and management of the program, and 3) the tracking of practice locations of graduates to gage
the numbers recruited to rural and/or underserved areas of the state. The database is also used to record the types of
community service learning activities of students and the number of people impacted by these student provided services.
An electronic (web-based) WVRHEP evaluation was initiated January 1, 2001 and includes a Baseline Data
Questionnaire for medical, nursing, and dental students and a post-rotation evaluation, the Student Evaluation of Rural
Field Experience, for all RHEP students. Prior to that date, evaluations were conducted by paper questionnaires. In 2003
and 2004, questions regarding the AHEC IDTs were added to the post rotation evaluations. In addition, students complete
an evaluation of each Interdisciplinary Training Session that they attend while at their rural site. In addition to the
RHEP/AHEC evaluation each school also conducts their own assessments of field faculty and other elements of the
community based rotations many times as part of their accreditation requirements. The RHEP/AHEC staff members
cooperate fully with all schools needing evaluation data for these purposes.
Student questionnaires confidentially solicit narrative and quantitative (e.g., Likert formatted questions)
information on student attitudes and career plans, including feelings of self-efficacy toward a variety of rural-relevant
issues, such as their knowledge of the quality of care in rural settings, and attitudes about rural lifestyle and caring for
poor populations. Questionnaires also solicit suggestions from students on how to improve the rural training experience
and draw on findings from other evaluation data currently in use such as the Evaluation Form for Students Participating
in Interdisciplinary Teaching Sessions. The benefits of this evaluation are numerous and include the opportunity to:
(a) gather data useful for modification/improvement of the WVRHEP curriculum
(b) demonstrate the effectiveness of the WVRHEP curriculum
(c) use of the WVRHEP tracking system, TRACKER© that includes information on medical student career
choices and information on career choices of other health disciplines
(d) share curricular innovations and modifications with other states facing similar problems in the recruitment
and retention of health professionals in rural and underserved areas.
We also conduct research on program effectiveness by surveying WVRHEP/AHEC graduates in rural practice.
Rural practitioner surveys were conducted in 2003 and 2005, and another is planned for 2008. These surveys have
included assessment of practitioner attitudes about the influence of rural health training for and selection of rural practice
choices, factors contributing to practice site selection, accessibility of practice to the indigent, payment demographics of
patient population, time in rural practice and active preceptor status. Some of the findings of these surveys follow as
appendix A. For respondents of the various disciplines, a significant percentage reported that WVRHEP/AHEC had an
influence on rural practice selection and that the academic and community curriculum aided in preparation for this. Rural
physician respondents have reported that the majority of their patient clientele has Medicare, Medicaid or no insurance.
For physicians, a statistical correlation has been made between time in rural practice and active WVRHEP/AHEC
preceptor status. Presentations involving these survey results have been given to PERD members, to WVRHEP/AHEC
committees, and at the 2006 conference of the Southern Group for Educational Affairs.
Research is conducted in the WVRHEP/AHEC partnership in oral health, coronary artery disease, and other areas.
The partnership, with its training mission and inclusion of research opportunities for students and faculty, offers a
platform with access to research problems and potential subjects in rural communities. Many peer-review journal articles
have resulted from these collaborative research efforts and these are included in the list of journal articles attached as
Appendix B.
Journal Articles
We keep track of all professional, peer reviewed journal articles, and presentations in which WVRHEP is
described and attributed as the support system for the content of the article. Some of these articles are specifically about
health professions community based training, recruitment and retention, and others are about specific research that has
been and/or is being conducted through the WVRHEP/AHEC community base infrastructure and training system. A list
of these articles is attached as Appendix B and copies can be provided upon request. Selected copies of representative
articles are included here with this document.
Overall Partnership Outcomes
From 1999 to 2006, the number of physicians who participated in the WVRHEP/AHEC program and are now in
rural practice increased from 88 to 213, an increase of 142%, or at an average annual rate of 13.5%. Between 1992 and
2006, WVRHEP has helped recruit 820 health professionals in rural underserved areas of the state. These health
professionals include:
o 213 physicians
o 57 physical therapists
o 157 pharmacists
o 24 dental hygienists
o 80 dentists
o 6 medical technologists
o 131 PAs
o 2 occupational therapist
o 92NPs and nurse educators
o 1 masters in public health
o 56 nurses
o 1 certified nurse midwife.
WVRHEP/WVAHEC trainees provide a myriad of health care services in the local communities, with the goal of
promoting health promotion and disease prevention activities. These services, such as tobacco cessation, diabetes support
groups, nutrition and life style education, health fairs, etc; average over 70,000 participants per year. In 2006, students
provided prevention and health education services to 74,326 rural West Virginians and completed 1,869 rural rotations for
9,930 weeks of training.
WVRHEP began tracking these services in 1995-96 and since that time a total of 1.2 million rural West
Virginians have been served. In July, 2002, WVRHEP began connecting these services to the West Virginia Healthy
People 2010 Objectives. In 2006, dental and dental hygiene students provided 14,280 clinical procedures and 448
outreach activities. These procedures resulted in almost $2.2 million in uncompensated oral health care services. In
addition, since 1995, WVRHEP dental and dental hygiene students have provided over $10 million in uncompensated
dental care to 70,564 rural patients.
The Rural Health Curriculum
The rural health curriculum is based on degree required rural rotations in each of the participating schools
curricula and contains objectives for discipline specific clinical and community service learning. These rotations must
take place in the designated rural health training sites. While students may do clinical rotations throughout the state,
students can only get credit for their rural rotations if these rotations take place in rural areas, communities, small towns,
and/or shortage designated areas. All data is collected on these rotations and is driven by student activities in these
locations. There is a list of restricted cities in the state in which a student may not receive credit for these rotations. These
cities (including their suburbs which may or may not have the same zip codes) are: Charleston (including South
Charleston, Dunbar, Nitro, Institute, Cross Lanes, Kanawha City, and St. Albans); Clarksburg (including Bridgeport and
Nutter Fort); Fairmont; Huntington (including Barboursville), Martinsburg, Morgantown (including Little Falls, Sabraton,
Star City, and Westover); Parkersburg (including Vienna), Weirton, and Wheeling. Ridgeley is also restricted. It is
across the river from Cumberland, MD just across the WV line and is considered part of the city.
The percentages of the curriculum devoted to clinical objectives and community service learning was established
by the Panel in policy following a year of research, debate, and compromise among the campus and community partners
of the partnership. The students spend 80% of their time completing the clinical objectives for the discipline specific
objectives of their degreed program, i.e. if the student is completing an ambulatory pharmacy rotation the do so in the
rural setting completing the same objective they would have if the rotation was at their respective campus; if the student is
completing a family medicine rotation the same is true for these objectives and so on. Students and residents then spend
up to 20% of their time in community service learning consisting of one or a combination of the following: community
service learning projects, interdisciplinary educational experiences, and/or community based participatory or translational
research.
Students may develop their own project or select from a number of on going projects in the geographic region in
which they are placed. The AHEC Interdisciplinary teams consist of at least one medical resident, who serves as the team
leader, and a team of RHEP students from other disciplines. This Interdisciplinary Team (IDT) chooses one project that
all learners work on together. These projects address public health issues in the region or a specific county and students
are required to develop written goals, objectives, and strategies as well as a final report. All students completing the
community service-learning portion of the curriculum are required to develop a written reflective report consistent with
their learning objectives for the experience.
The Partnership
The partnership consists of community volunteers, campus and field faculty, state level agency administrators,
lead agency personnel, RHEP/AHEC staff, students and residents, and legislators some of whom serve on local boards.
Our partners are also programs with similar mission focus including the pipeline programs in the state of which
RHEP/AHEC is one. There are many levels within the partnership and these are too many to describe. For example there
are partnerships at the local level that may be unique to one region, one county, or one community. We track the
collaborations and partnership work at the state level when we work on our mutual missions. These partners are statewide
health promotion and disease prevention initiatives which utilize the RHEP/AHEC infrastructure and human resources to
further our mutual missions. Examples of these projects include: the Coronary Artery Risk Detection in Appalachian
Communities (CARDIAC) Project which has two components, a school-based surveillance and intervention initiative,
and a targeted individualized approach toward identification and referral for treatment of those individuals with the most
severe genetic cause of death from premature CVD: familial hypercholesterolemia (FH). Over 50,000 school aged
children have been screened since 1998 and many and their families have engaged in interventions through the
CARDIAC-RHEP/AHEC partnership to reduce their risks of heart disease, diabetes, and obesity.
WV AHEC/WVRHEP also works with such programs as the Recruitable Community Project (RCP) of the
West Virginia Department for Public Health that focuses on helping medically underserved rural West Virginia
communities recruit health care providers and offers rural clinical experiences, and some funding, to medical residents,
physician assistant and nurse practitioner students. RCP empowers communities by involving pro-active community
members in local economic development, screening and selection of health care providers, the recruitment process,
increased familiarity of rural sites, opportunity fairs, etc.
RHEP/AHEC works closely with the Health Sciences Scholarship Program administered by HEPC to add
financial incentives and the rural health curriculum as a means to maximize recruitment and retention strategies. The
Recruitment and Retention Committee staffed by Alicia Tyler is a committee of the Rural Health Advisory Panel and was
specified in code in 1998.
WV AHEC/WVRHEP is works with the Health Sciences and Technology Academy (HSTA) in the 22
counties where HSTA clubs and students are located. Our AHEC Centers engage in health careers activities with school
students in areas not served by HSTA and to bring in students who may not be eligible for HSTA.
The extensive WVRHEP/AHEC educational network provides the platform for a host of disease prevention and
health promotion activities and other state and federal grant programs as well as research projects. The local communities
and health sciences centers have used the state funded RHEP system to successfully compete for these sources of funding.
For the AHEC grant program, the WVRHEP dollars are used as cost share match to secure receipt of the federal funds.
Examples of some of these grants, which average $5.07 million per year, are:
 $6.3 million over 7 years for an NIH grant to WVU School of Dentistry and University of Pittsburgh School of
Medical Dentistry in Webster and Nicholas Counties.
 $2.4 million over three years to establish 4 AHEC Centers in the state.
 $1.4 million per year in funding from various sources for HSTA which is statewide.
 $1.4 million per year in funding from various sources for CARDIAC which is statewide.
 $1.35 million over 5 years in funding from the Robert Wood Johnson Foundation for the dental pipeline program
which is statewide.
For more information, please contact:
Hilda R. Heady, MSW, Executive Director
and Associate Vice President for Rural Health
Office of Rural Health
P.O. Box 9003
Morgantown, WV
26506-9003
304.293.4996