Project: The Rural Health Scholars Program (Project #38)

Lead Agency: University of Mississippi Medical Center, Department of Medicine (UMMC)

From 2008-2011, the Delta Health Alliance has partnered with the University of Mississippi Medical Center (UMMC), School of Medicine to implement the Rural Health Scholars project. Initiated in the summer of 2008, the primary purpose of this project was to promote and encourage new healthcare physicians to choose careers in primary care in the rural Mississippi Delta.

The Rural Health Scholars Program began addressing Mississippi’s doctor shortage by placing fourth year medical (M4) students and primary care residents in rural and medically underserved areas. The following goals were established for this program:

1. To establish a permanent healthcare educational environment in the Mississippi Delta to be incorporated into the curricula for M4 students and primary care residents,
2. To identify primary care providers to serve as preceptors in the 18 designated Delta counties and establish a collaborative relationship with them,
3. To recruit M4 students and primary care residents to participate in a month-long rotation in a rural clinic,
4. To create an increased awareness of primary care in rural locations and the cultural aspects of a small community practice,
5. To train and recruit primary care providers to practice in the Delta.

In the 2010-2011 cycle the project expanded to provide 24 clinical rotations in Rural Medicine for UMMC’s Internal Medicine and Family Medicine programs. The graph below explains program expansion in numbers from 2008-2010.

In the first half of the 2011-2012 cycle 6 learners completed clinical rotations. These clinical rotations were designed to provide a positive experience for the learner/trainee, to increase awareness of primary care practice in rural areas, and to encourage consideration of practice opportunities in the Delta subsequent to the rotation there. Learners work alongside a physician or preceptor at each site, providing medical services to patients. The graph below shows the increase in patient encounters realized during the 2010-2011 cycle.

The program also experienced a growth in preceptor participation from 2008-2010 (see graph below).

Participating preceptor sites were in the following Delta counties: Bolivar, Holmes, Humphreys, Leflore, Yazoo, and Warren.

During their clinical rotations, M4 students and residents maintained a daily journal of their experiences with preceptor sites. These journals provide program staff with personal testimonies and are used to evaluate the impact this project has had on its participants. The following are quotes pulled from the journals maintained by our learners:

M4 student interested in Med/Peds

• “This is my last week at the doctor’s clinic. I am going to miss them all like crazy. The month has flown by and I have had such a great experience.”
• “The people here were such a joy to learn from and I can’t say enough about my preceptor and his staff.”
• “Just today we treated another case of Rheumatoid Arthritis and did well-child visits all before lunch. I love the diversity of rural medicine. I can’t wait to start my own practice.”

M4 student interested in Internal Medicine

• “Overall this has been a great experience and I would recommend it to all medical students, regardless of the specialty they are interested in. Working in a rural health clinic allows you to be exposed to patients with multiple comorbidities. This experience was also very rewarding because patients truly appreciate your services.”

M4 student interested in Internal Medicine

• “When I started this rotation, I was not really at all considering doing general practice and didn’t expect that to change. However, I am considering it much more seriously after this rotation. I kind of like the idea of being a small town doctor, I would like to be able to fill that role.”

M4 student interested in Med/Peds

• “This opportunity has opened my eyes to an entire world of opportunity to serve right here in my own state. I know I am much more likely to consider a career in primary care and/or a career in an underserved part of the state as a result of my experience sponsored by the Delta Health Alliance.”
• “When I think about my career, I know it is going to be in a place where physicians are needed. Not where they are in great excess. I have seen advanced pathology in the delta that is related to non-compliance, lack of education, and lack of access to care. I know that physicians can make a great impact.”

Internal Medicine Resident

• “This has been a great month. I enjoyed getting to know all the doctors and nurses. This has been very helpful to me to see a few different aspects of medicine outside of an academic setting. Private world medicine is much different.”
• “The month overall was great. I would highly recommend doing this rotation to the rest of my fellow residents.”

M4 student interested in Family Medicine

• “Today’s clinic was sort of sad for me because it was my last official day. I’m really going to miss working with everyone. I have learned a lot this month and am more confident with my physical exam and have a good grasp on what is normal and normal variants. “
• “My preceptor is a great teacher. My perception of family medicine has really changed. This rotation has been a great asset to me and I would highly recommend that students participate.”

M4 student interested in Internal Medicine

• “This was a very worthwhile and rewarding experience. I’m glad I got the chance to do this during my training, as I know it will help me become a better doctor. The people here were all very friendly and grateful and I am so happy that I was able to make a small contribution to their lives.”
• “An average of about 40 patients came through clinic each day. We saw many different kinds of patients. It became an important focus to me to find regiments for these patients that were both affordable and accessible. This required a different kind of treatment planning than I am used to at the university. I also felt like the preceptors were excellent examples of how to relate on a personal level with your patients while maintaining a professional atmosphere.”

M4 student interested in Internal Medicine

• “All in all it was a great experience that I would highly recommend to anyone.”

Internal Medicine Resident

• “It has been great getting this much exposure. I am definitely trying to decide where I want to eventually be and what I want to be doing. I love that as internists we have so many options. My preceptor in indeed a valuable asset to Warren County and I can see myself patterning a lot after him.”
• “I’d heard great things about my preceptor and my first day was not a letdown. I found many of his patients eager to assist with my development, allowing me to learn through their medical stories. My preceptor definitely has inspired me already in so many ways.”

M4 student interested in Internal Medicine

• “It is nice that I have been here for a while because I am now seeing some patients that I saw earlier in the month. It is nice to have a little continuity of care. That is something that you don’t get much of in medical school.”

M4 student interested in Internal Medicine

• “I learned so much in my month here. While I added to my knowledge and skills in the practice of medicine, I also took away invaluable experience learning from the patients that I saw. I learned how patient’s access to health care is visibly limited, how many patients walk miles to get to the doctor only to not be able to fill prescriptions due to the expense.”
• “I took every opportunity I had with patients to learn from them as well as to educate them on anything from medicines to simple hygiene. Rural clinics serve a vital role not only as healthcare providers but also as friends and neighbors.”

Impact to Date:

To date, a total of 53 learners have completed rural rotations in six Mississippi Delta counties. 95% of program participants expressed that they will strongly consider practicing in the rural setting. The presence of learners at preceptor sites allowed for more patients to be seen in a shorter period of time.

Learners who completed this program are faced with the choice of practicing medicine in either the rural or urban setting. Program alumni are being followed to see if they choose to practice in the rural setting. Program staff are encouraged that program alumni will strongly consider practicing rural medicine.