Family Medicine Residency Program

Celebrating Complexity in the Emerging Diversity of Rural Medical Education

RRT Collaborative Annual MeetingSpokane, Washington

April 11-13, 2018

Oregon FIRSTFamily Medicine Integrated Rural

Student Training

Speakers

• Dwight W. Smith MD – Director, Oregon FIRST

• Kristi Coleman MD– Co-Director, Oregon FIRST– Associate Director for Medical Student

Education– Education Director for Campus for Rural

Health

Rural Residency’s Recruitment Goals

• Fill in the match.• Get good quality residents.• Get residents that are ready for rigors

of a rural residency.• Get residents that fulfill your mission.

OREGON FIRST:FAMILY MEDICINE INTEGRATED RURAL

STUDENT TRAINING¡ Brief Residency Background

¡ The Oregon FIRST goals¡ An individualized 4th year medical school curriculum

¡ Increased residency readiness

¡ Healthcare workforce needs for Oregon

Cascades East Family Medicine Residency Program

¡ Established in 1994

¡ Sky Lakes Medical Center in Klamath Falls, OR

¡ One of the most rural and remote based 3 year

training programs in the nation

Residency Training Outcomes¡ Approximately 50% of our grads stay in

Oregon after graduation

¡ 60% practice in communities with

populations of 25,000 or less

¡ 63% are in Health Professional Shortage

Areas

Cascades East Family Medicine¡ 8 residents per class, total of 24 residents

¡ Family Medicine Center

¡ Patient-Centered Primary Care Medical Home¡ Tier 4 Certification Status

¡ Team-based care

¡ 12+ FTE Faculty – Department of Family Medicine¡ Inter-professional Approach

OREGON FIRST:FAMILY MEDICINE INTEGRATEDRURAL STUDENT TRAINING

¡ Student Selection¡ One to Two students per year

¡ Pre-identified interest in rural Family Medicine Training

¡ Prefer students from OHSU’s Rural Scholars Program

¡ They will spend their Fourth Year of medical school at

Cascades East Family Medicine Residency in Klamath Falls

¡ Started in AY 2014-2015

¡ 1st graduates this June

Oregon FIRST Selection¡ Selection occurs in the mid-point of the third year

¡ Personal Statement of Interest

¡ USMLE, Transcript, 2 Letters of Recommendation

¡ Course evaluation summary from OHSU Dean's office

¡ Expectation: match with our residency

¡ Consider applying for an NRMP Waiver/LCME approval for

integrated track, we did not apply.

Oregon FIRST Highlights¡ Increase residency readiness for OHSU students

going into rural Family Medicine

¡ Allow students to individualize their learning plan

around rural primary care

¡ Decreased cost to students

¡ Interviewing travel costs ($10,000)

¡ Tuition waiver or loan forgiveness with service

requirement

Fourth Year Curriculum¡ Sequential rotations in core specialties and care delivery sites

¡ Combined with longitudinal experiences with

¡ Chronic disease management

¡ Population-based health

¡ Own Panel of continuity patients

¡ Setting of a Learner-Centered Medical Home within a PCMH

¡ Daily dedicated learning time with noon conference series

¡ Monthly procedure simulation workshops

¡ Wilderness Medicine curriculum

¡ Mentor junior medical students and rural programs

Summer August September October November December January February March April May June

1 2 3 4 5 6 7 8 9 10 114 weeks 4 weeks 4 weeks 4 weeks 4 weeks 4 weeks 4 weeks 4 weeks 2 week 4 weeks 4 weeks

Bloc

k

TWO-WEEK ELECTI

VE

Fall Break 9/22-9/26

Summ

er Break 6/23-6/27

Spring Break 3/24-3/27

Oregon FIRST/Cascades East Fourth Year Medical Student Curriculum

ELECTIVEELECTIVEELECTIVE

Elective/Selective Choices

Transition to Residency - Portland 1 week

Oregon FIRST Rural Continuity 1

GRADUATIO

N W

EEK 6/1-6/5

Family Med Inpt

SUB-I

Long

itudi

nal

Cu

rric

ulum

Outpatient Family Medicine

Pulmonology

DermatologyAnesthesiaPodiatryRadiology

ELECTIVE

Winter Break 12/22-1/2

CardiologyGastroenterologyEmergency Medicine

ENT

TABLE KEY

Noon lecture series, procedure workshopsWilderness Medicine Track - lectures, conference and AWLS

Rural/Frontier Family MedicineOB

Palliative CareGeriatrics

BLUE FILL = OHSU Requirements in Portland

Wellness/ Preventative Care

Procedures

OHSU Inter-cessions

Orientation and Family

Med Inpt

YELLOW FILL = INPATIENT Selective

GREEN FILL = ELECTIVE

Oregon FIRST Rural Continuity 4Oregon FIRST Rural Continuity 3Oregon FIRST Rural Continuity 2

OHSU Inter-cessions

ELECTIVE

Family Medicine Clinic - 1 half day per weekScholarly Project - Deep Dives - longitudinal population research on own patient panel -1 half day per week

OB SELECTIVE

Residency Considerations

¡ Faculty Oversight

¡ Engaged and experienced teaching faculty

¡ Two faculty with protected time for mentoring and training

Financial Considerations¡ Cost savings to student

¡ Faculty teaching time and program administration

¡ Precepting time

¡ Equipment, supplies, space

¡ Tuition

Outcomes for First 4 Years

• 1st Oregon FIRST student class graduating from residency in May.

• Placement in: – Oakridge, pop 3000– Gold Beach, pop 2200– Anticipate 3rd Graduate will stay in Klamath

Falls, pop 20,000

• Successful residents

Challenges/Lessons Learned

• NRMP/LCME waiver• ? Quality of applicant's• Is 4 years too long? Burnout?• Decision made in 3rd year, will there be students

that change their mind?• How to best assess the quality of applicants with

less accessible info (No MSPE).• Coordinating UME and GME rotation timelines

and requirements

OREGON FIRST:FAMILY MEDICINE INTEGRATEDRURAL STUDENT TRAINING• Individualized Learning• Increased Residency Readiness• Decreased Cost to Students• Improved Healthcare

Workforce for Oregon

Questions?