The presentation strove to answer the question; Where do I find data on rural populations to answer hypothesis driven research questions? It then addressed the following objectives:
Identify primary and secondary sources of data
Recognize the procedures needed to obtain approvals to use personal record information in research
Locate common sources of county, district and state level data for rural populations
The examples provided in the presentation were based on a study the Edward Via College of Osteopathic Medicine is conducting on the chronic health conditions in Central Appalachia. It strives to determine not only what is “going wrong” in coal country, but what is going right.
Let’s look at one of the recommendations in the report (p. 14):
Recommendation 1:GME training should be expanded in ambulatory and community sites to reflect the current and evolving practice of medicine.
Rationale:As the proportion of health care delivered in ambulatory sites increases, the percentage of GME training that occurs external to inpatient units in ambulatory sites needs to be expanded to prepare graduating physicians for medical practice. GME trainees must be provided with educational experiences in practice environments where new competencies are utilized.
Consider the practice environment of Southwest Virginia – Rural communities, high percentage of persons who are uninsured/underinsured, high percentage of persons with comorbidities, limited access to behavioral health and specialty care.
GME is responsible for upholding a social contract with the public it serves. A physician in this area must be able to do multiple things and needs a broad scope of training. Southwest Virginia is a great training area for those who want to do many things very well, not the same thing over and over.
We want to hear from you! What do YOU think could be done to make sure physicians trained in Southwest Virginia are “provided with educational experiences in practice environments where new competencies are utilized.” ?
We’ll spend the next few weeks providing some highlights and commentary.
Challenges and Opportunities in Expanding GME Experience (p.17)
“Although the data on the impact of training sites on the quality of care provided by GME graduates is limited, there is a common misperception that only training in large academic centers can produce graduates who have the skills to provide high quality care. Asch and colleagues have found obstetrical outcomes are affected by training site, linking quality of training site with the outcomes of care provided by the trainees. However, other studies on this topic leave doubt about which markers should be used to evaluate physician practice quality in relation to residency training sites.
“In addition to concerns about quality of teaching and patient care in community and ambulatory settings, another barrier to expanding GME training to these sites is the lack of financial support for community-based programs. Present payment and training incentives for community-based training are insufficient to develop and maintain these ambulatory and community-based programs, even though it costs less to provide patient care and GME training in these sites, than AHCs and other teaching hospitals. The increased costs of AHCs and other teaching hospitals are in part due to their higher patient care costs. This includes the number of underinsured, biomedical research missions, and the maintenance of standby capacity for medically complex patients, in addition to the expenses incurred by teaching programs.”
For GMEC, this is key as training in Southwest Virginia offers the local, ambulatory, outpatient experience. On page 23, the report states, people “expect the medical education system to produce physician specialists who reflect the cultural and economic characteristics of the patients they serve“.
With this expectation in mind – the medical education community needs to recognize that the only way to fully prepare a future physician to serve in rural Appalachia is to train that student in Appalachia. Reviewing information about rural Southwest Virginia is not sufficient to produce a culturally competent doctor – immersion is required.