What makes a general practice doctor good? Or even great? Sometimes, it’s how long you have to sit in the waiting room.
One Appalachian doctor was recently asked why an appointment for 2:40 wasn’t seen until after 3:00. Her fantastic response outlines the realities for many physicians. A test result came back positive for cancer – advanced cancer. One patient can’t afford medication. Another’s spouse died. All in a single day.
“One reason we are late: we take time.”
Great doctors don’t see their patients as data on a chart. They see real human beings with unique problems that can often only be addressed by their primary care provider.
Visit the Rapha Family Wellness site to review the full article.
Active learning vs. lecture: What works best? According to a recent review of students in STEM classes, those with hand-on lessons have higher test scores , while those in traditional lecture classes were more likely to fail. As one article notes –
We know that learning is harder from the sidelines. If deep understanding is the objective, then the learner had best get out there and play the game.
So how does that apply to medical education? Students who are in a rural track at medical schools and students who have a preceptor in a rural region are able to interact with patients sooner – and learn more.
For example, at the Quillen College of Medicine, medical students can start working directly with patients as early as August in their first year by volunteering at the College’s free clinics. Whereas students in urban programs may not have any patient interaction until well into their second year.
Click here for more on the new active learning research.
The Rural Resident Research Symposium held at UVA-Wise in April included a presentation on “Finding Research Data Sources for Populations in Rural Virginia.” by Susan Meacham.
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.
View the presentation.
Last week, we started a discussion on, the 22nd report from the Council on Graduate Medical Education, titled; “The Role of Graduate Medical Education in the New Health Care Paradigm”
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.” ?
Recently HRSA released the 22nd report from the Council on Graduate Medical Education, titled; “The Role of Graduate Medical Education in the New Health Care Paradigm”
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.
VRHA has funds available to assist students who wish to attend the VRHA 2015 Annual Conference. Any full-time student studying a health-related profession may apply.
Funds will cover conference registration fees.
Completed forms must be e-mailed to email@example.com on or before September 4th. Winners will be announced on September 11th.
Download the application form and visit the conference website for additional event information.