Rural Round-up; Training for under-resourced areas

Sommer Aldulaimi MD FAAFP discusses the way one urban-based Family Medicine Residency Program in Arizona, USA, has accomplished 45% of its graduating residents from the last three years working in rural practice and 100% of the graduates from the last three years working in healthcare professional shortage areas in North America.

Training Family Medicine residents for future practice in under-resourced areas domestically and abroad

The mission of The University of Arizona College of Medicine Family Medicine Residency (South Campus) is to train physicians to work in rural and underserved areas in Arizona and beyond. We had the honor this year of receiving the National Rural Training Track Collaboration Rural Recognition for having such a high percentage of residents go on to practice in rural areas after graduation. This is an honor that only 11 other residencies in the nation received!

How? We have employed several strategies. First, we start with recruiting the right residents to come to the program. We only interview medical students who show dedication to rural and underserved work through their volunteer, extracurricular activities, personal statement and letters. Then, during interviews, the degree to which they show dedication to the mission is accounted for in the final ranking of the applicants.

Then, we send residents every year to rural areas in Arizona to train as a required part of their education. The residents go for a month at a time and live in the rural community where they are working. Spending significant amounts of time in rural areas (16 weeks minimum over three years) allows the resident physicians to experience the professional and personal benefits of living and working in these underserved communities. The residents also travel to rural areas as parts of other specialty rotations throughout their residency to get even more exposure to rural practice. Each year, the Family Medicine residents rotate in family medicine, obstetrics, emergency medicine, geriatrics, rheumatology, and other electives in rural Arizona. The residents had the privilege to serve in diverse communities including Indian Health Services with several different tribes, towns on the US-Mexico Border, rural mountain towns, rural mining towns, frontier medicine, and others. There are also opportunities for rotations in rural British Columbia and Alaska to further expose residents to rural practice.

The next piece of the training that helps us accomplish our goals is a robust Global Health Track that three to five residents in each class participate in. Predominantly completed during the second and third years of residency, the track offers opportunities to develop expertise in the diagnosis and treatment of common tropical conditions and diseases, and to expand clinical knowledge and management skills in preparation for work in areas of limited resources. The Global heath track is comprised of a three weeks intensive global health course given through the college of medicine, and online global health ethics course, monthly global health journal clubs, quarterly global health oriented academic half days, volunteer in several clinics per year in Mexico, having two global health mentors, participation in a leprosy clinic with the CDC, asylum seekers exams and volunteer, attendance to a Global Health Conference during third year, a two month international rotation, a scholarly project, and other components. All graduates of the Global Health Track (Five years of graduates) are working in under-resourced areas in the US, and 80% of them continue to be involved in work abroad.

We, have a very diverse patient population that is sees including many Spanish speaking patients, Mexican Citizens, Border-Crossers, Asylum-Seekers, Native Americans, and many refugee patients from around the world. We started a dedicated refugee clinic as part of our own clinic to help better serve the complicated refugee patients who are seen in the clinic. The program also participates in a Spanish Language/Healthcare Disparities Distinction Track which is a two-year program that focuses on strengthening the Spanish language skills of residents in order to enhance the care of our bilingual patients noted above. They also cultivate discussions and host forums to help educate fellow residents in cultural competency and health care disparities in the Track.

We have also added many curricular components to help better train our residents to practice in under-resourced areas including a longitudinal point of care ultrasound curriculum, a longitudinal mock code/emergency curriculum, procedure labs, additional pediatric and emergency medicine rotations above the required amount, and work in the old county hospital for all their core inpatient family medicine blocks. We, take advantage of our unique position near the US-MX border and having rural areas and Indian Health Services so close and incorporate many different components to reach our mission of serving patients in rural and underserved areas domestically and abroad!