Journal of Regional Medical Campuses

Regional Medical Campuses in Canada

Aaron Johnston — 2024-12-19

Background:

Regional Medical Campuses (RMCs) are an established part of the Distributed Medical Education (DME) landscape in Canada. Combined model RMCs, offering both preclinical and clinical education have shown promising results in producing physicians who work in rural and regional settings and are currently a key avenue of expansion of medical training in Canada. Existing literature suggests that new RMCs carefully consider the communities and health systems they are a part of, and lessons learned from comparable RMCs as part of their development.

Methods:

We identified 4 specific domains of interest for comparing RMCs across Canada based on important elements identified in existing literature: Community, Organization, Hospitals, and Physicians. We searched high quality, publicly accessible data sources for information relevant to these domains, aggregated relevant information, and used statistical techniques to understand the range of settings for existing and proposed RMCs in Canada.

Results:

We found that Canadian RMCs have been deployed into a wide variety of small to medium size urban settings and have a variety of organizational profiles. RMCs were associated with 1 to 3 large hospitals, but the size of these associate hospitals also varied greatly. We found that the environments of proposed RMCs differed somewhat from existing RMCs and included examples of novel organizational constructs, settings with smaller urban population sizes, smaller hospitals, and settings with smaller and decreasing physician workforce.

Discussion:

The combined model RMC has proven to be a robust construct across Canada, deployed in a wide variety of different settings. Our data shows that the settings and structure of proposed new RMCs are somewhat different than existing RMCs. While the robust nature of the RMC model suggests that deployment into new settings is reasonable, the data also clearly shows areas that may be opportunities and challenges for each of these new, proposed, settings.

Conclusion:

There is a wealth of publicly accessible data is available about Canadian communities and health systems, which can be compiled into domains of interest for RMCs. Our study establishes a baseline data set for Canadian RMCs that will be useful for those contemplating future implementations. Proposed RMCs may be able to use this data to predict both challenges and opportunities, as well as to identify existing RMCs with similar profiles, where information exchange may be of highest value.

Addressing the Rural and Underserved Healthcare Workforce Needs: Residency Specialty Selection and Workforce Outcomes of the WWAMI AHEC Scholars Program

Kenya Morales-Luna — 2024-12-19

Introduction: The availability of well-trained healthcare providers in rural and medically underserved areas in the United States is crucial for improving health outcomes. The Area Health Education Center (AHEC) Scholars program, funded by the Health Resources and Services Administration (HRSA), is a national effort to address these persistent healthcare shortages through a health professional student certificate program. This is a descriptive study of graduates of the University of Washington WWAMI AHEC Scholars program’s residency selection and workforce outcomes.

Methods: From July 2022 to December 2023, our research team conducted a follow-up survey and online search to locate WWAMI AHEC Scholars graduates from the 2018 and 2019 cohorts. Data was collected on graduates' residency selection for MD/DO graduates. For all other participants, we documented their current healthcare professions, practice locations (rural and/or medically underserved areas), and whether the practice was a federally qualified health center.

Results: We located 94.1% (159) of WWAMI AHEC Scholars Graduates. Among the 47 MD/DO students, 61.7% (29) matched into primary care. Additionally, 13.4% (13) of participants from other healthcare programs were located in rural areas and 26.7% (26) in medically underserved areas, highlighting the program's impact on the current maldistribution of healthcare providers.

Conclusion: The WWAMI AHEC Scholars Program offers a promising model for encouraging rural and underserved practice. However, more outcome-based research is needed to understand the long-term impact of this program.

Alleviating the Physician Shortage by Increasing Medical Student and Resident Physician Capacity in the North Midwest (Iowa, Minnesota, North Dakota, South Dakota, Wisconsin)

Nicholas Leifeld — 2024-12-19

The authors’ central goal was to design a plan for the anticipated physician deficit in the North Midwest region of the United States. We analyzed the Association of American Medical Colleges’ (AAMC) 2024 projections, which have forewarned of a significant shortage by 2036. This study addresses this challenge by proposing targeted plans to augment medical student and resident capacity in Iowa, Minnesota, North Dakota, South Dakota, and Wisconsin. The purpose was to develop plans for each state to ensure an adequate supply of physicians to meet the growing demands on the healthcare systems. The calculations identified the approximate balance between the growing healthcare needs of the North Midwest region and the capacity of the existing medical education and residency training programs. We suggested the incremental expansion of medical student seats and residency positions over the next 10 years. We outlined how to bridge the physician gap while avoiding any undue stress on the existing systems.

The application of these strategies could establish a robust physician workforce that meets the healthcare demands of each North Midwest state. Ultimately, the overarching goal was to provide a baseline approximation to aid in estimating the current need for the expansion of medical educational systems.

Fostering Interprofessional Education During Required Clerkships for Medical Students Across Regional Campuses

Stephanie Freed — 2024-12-19

It remains complex and challenging to deliver interprofessional education at medical schools with geographically distributed campuses. Indiana University School of Medicine (IUSM) expanded its interprofessional education directly into clinical training by implementing a simple exercise in required clerkships on all nine of its campuses and with various health system partners that achieves the goals of interprofessional education and in which students find value.

Methods: Between the academic years 2022-2023 and 2023-2024, IUSM medical students on every campus and across health systems, interviewed and reflected on the role of one healthcare professional involved in the care of a patient during each required clinical rotation. They interviewed different healthcare professionals and/or healthcare professions students to gain broad exposure and perspectives.

Results: All IUSM students on all its campuses interacted with a variety of healthcare professionals during their 3^rd and 4_th year clinical rotations statewide (n=6357 encounters). Across all campuses, 88% of interactions occurred with healthcare professionals rather than healthcare professions students. Statewide, between 84% and 95% of students reported that they ‘Strongly Agreed/Agreed’ that the experience contributed to the development of their interprofessional collaboration skills and knowledge, and that they found the assignment valuable.

Conclusion: Our interprofessional assignment offers medical schools with multiple campuses a promising solution to the challenges of delivering high-quality, and meaningful interprofessional education. It requires minimal to no resources, ensures comparability, and helps prepare students for real-world teamwork.

Entrepreneurship in Medical Education: Evaluation of the Entrepreneurship in Healthcare Seminar Series

Amanda Mac — 2024-12-19

Background: Innovation and entrepreneurship are central to healthcare. Physicians are ideally positioned to create sustainable healthcare innovations. However, few medical programs in Canada provide training for students to pursue innovation and entrepreneurship. We created the Entrepreneurship in Healthcare Seminar Series (EHSS), a novel initiative designed to teach medical students about developing innovations and launching entrepreneurial ventures. We evaluated the EHSS based on medical student feedback and suggest future directions.

Methods: EHSS consisted of seven sessions per academic year, each led by a physician-entrepreneur. The session topics outlined a methodological approach to developing a medical start-up, from ideation to implementation, including a formal talk and question/answer period. Quantitative and qualitative evaluations of the program were acquired from anonymized feedback forms with quantitative questions rated on a 5-point Likert scale.

Results: From October 2020 to May 2022, there were a total of 258 unique attendees, of which 199 completed feedback forms (77.1%). 88% of attendees agreed or strongly agreed that the sessions were engaging and well-organized, learning objectives were met, and skills gained will be useful in practical settings. Three key themes arose from attendee open-text responses: importance of aligning personal and professional values with entrepreneurial pursuits, significance of mentorship, and that innovation requires proactive identification of healthcare gaps and creative solutions.

Discussion: Through EHSS, medical students gained a comprehensive overview of medical entrepreneurship and networking opportunities with physician-entrepreneurs. Future work involves expanding the seminar series to include an experiential learning component to apply foundations learnt from the lectures while receiving mentorship.

The Impact of the 2020 Medicaid Expansion in a Community Clinic Serving the Marshallese Population in a Rural State

Robert Brand — 2024-12-19

Introduction

In December of 2020, the US government passed into law a bill allowing states to enroll Compact of Free Association citizens (including citizens of the Republic of the Marshall Islands) into Medicaid. This study analyzes the impact of this expansion on the healthcare of Marshallese patients at a dedicated community clinic on a regional medical campus, serving this unique population.

Methods

Through retrospective review of patients who utilized the community clinic either before (05/2020 to 02/2021) or after (05/2021 to 02/2022) the Medicaid expansion, this study sought to compare patients’ insurance information, number of total patients visiting the clinic, number of total patient visits, referrals per patient, and completed referrals per patient were compared between time periods.

Results

A total of 378 patients utilized the clinic during the study period. The results demonstrated a significant increase in patient utilization of healthcare services (20.1% vs. 8.7%, p<0.01), percentage of clinic visits that included referrals (23.6% vs. 16.5%, p<0.01), and percentage of completed referrals following the Medicaid expansion (16.1% vs. 10.5%, p=0.03). Analyses of comorbidities indicated similar disease burden in both pre and post cohorts.

Conclusion

The study’s findings suggest an increase in the use of healthcare services following the expansion of Medicaid services to previously uninsured patients. Existing literature documents the gaps in primary care services for underrepresented and uninsured populations in the United States and the significant consequences of lack of access to care. Findings from this study can aid health policymakers in designing and implementing new strategies to increase healthcare access and utilization in target populations. Future research is needed to determine how these healthcare-related behaviors affect patient health and how expanding healthcare policies may elucidate such results on a larger scale.

In Memoriam: Elizabeth Ryan, EdD

Paula Termuhlen — 2024-12-19

Elizabeth Ruth Ryan, EdD passed away peacefully on October 31, 2024, after a brief illness. She was surrounded by family at the time of her death and was cared for by former students during her hospitalization.

Dr. Ryan was passionate about her work in medical education. She served as the Director and Associate Dean for the Northwest-Gary Campus of the Indiana University School of Medicine from 2018-2023. Since 2023, she served the Indiana University Medical School in the role of Associate Dean for Educational Integration and Professor of Clinical Family Medicine. Her contributions to the growth and development of future physicians spanned decades. Her simple motto of “work hard, be nice and earn your credibility” brought her the love and respect of those with whom she worked.

Dr. Ryan was generous with her time. Representing the voice of a first-gen college graduate who worked her way up through the ranks, she was a member of the Steering Committee of the AAMC Group on Regional Medical Campuses and formerly served on the Executive Board of the AAMC Central Group on Educational Affairs. The Journal of Regional Medical Campuses benefitted from Dr. Ryan’s outstanding contributions as an author and reviewer.

Her passing leaves a hole in the hearts of those who had the privilege of knowing Elizabeth.