Implementing TRUST: A New Medical Training Track for Rural and Underserved Students at UW

1. Creating and Implementing a New Rural / Underserved Medical Student Training TrackTRUST at the University of Washington

2. TRUST: Targeted Rural UnderServed Track • Introduction • TRUST Admissions • TRUST Year 1 • TRUST Year 2 • TRUST Years 3 & 4 • Challenges • Discussion

3. The WWAMI Program 1971-2009 17% 66% 61% 70% 59%

4. Rural/Underserved Programs • R/UOP: 1988 • WRITE: 1996 • Underserved Pathway: 2006 • Rural required third-year clerkships (Family • Medicine, Internal Medicine, OB/GYN) • Rural clinical electives

5. TRUST Continuum

6. TRUST Admissions: A Separate Process • Where have you lived/worked from birth until • present? • How do you imagine your personal and • professional lives intersecting ten years from now? • What obstacles have you overcome in your life to • get to the point of applying for medical school? • Why have you applied to participate in the TRUST • program?

7. Pre-Matriculation Experience Grand Coulee, Washington

8. Pre-Matriculation Experience • 2 weeks before starting 1st year • Hospital • First observation of a birth • First mentor experience created • EMS • Public Health • Shadowing

9. TRUST: The Students’ First Year Experience • TRUST rural health class addressing: • Rural social life • Scope of practice • Benefits/pitfalls • Economics

10. Continuity with the Pre-Mat Site • Hands on experience with visits • to Pre-mat site • Growth in skills becomes evident • to student and preceptor • Mentorship continues • Continuity of care manifests

11. Journal Club • Focus on health policy discussions • High student interest evident from lively discussions • Open to other interested students

12. R/UOP • Month long immersion • clinical experience • Approx 120 of 216 • students will participate • in Summer 2010 • Most students complete a • community-oriented • scholarly project • Highly rated

13. The Students’ Second Year Experience in Seattle: Building TRUST Scholar Cohesion • All TRUST students are together in Seattle for their • second year where they: • Continue participation in the Underserved Pathway • Participate in the Rural Health Class • Continue and build relationship with School of • Medicine college mentor

14. Underserved Pathway Diagram Year I Year II Year III Year IV Pre-Clinical Electives, Selectives, RUOP, Preceptorships in underserved sites Clinical Block Rotations, Core Clerkships, Electives in underserved sites Service Learning – CHAP, SITC, Volunteer activities Mentorship – Quarterly contacts with mentors, faculty/staff support Web Module Web Module Web Module Web Module Independent Investigative Inquiry

15. Underserved Pathway Core Curriculum (web-based) • Teaches fund of knowledge in underserved • medicine • 12 web-based modules with interactive elements • Pathway students complete two modules per year • In person/video conferencing sessions to build • community with mentor and others

16. UP Provides Core Support for TRUST Scholars • Pathway as curricular base • Pre-matriculation Mentor’s role • New courses (rural health) • Community building and support • Journal Club across years • “Face to face” module completion • Social gatherings

17. Mentorship: TRUST Scholars Have Many Opportunities • Pre-matriculation site mentor • Regional Dean - home state mentor • School of Medicine College mentor with • underserved service background • Underserved Pathway faculty

18. Mentorship Purposes • To establish a long-term mentoring relationship • between student and healthcare provider working • in an underserved setting • To nurture the student’s career goals • To provide career and educational counseling • To introduce students to working in an underserved • setting

19. TRUST: The Students’ Third Year Experience • 15 WRITE (WWAMI Rural Integrated Training • Experience) sites across the region • 20 weeks of integrated training • Immersion experience - Significant clinical • responsibilities • Significant outcomes • Two thirds of students choose primary care • One third of students choose rural practice

20. 15 WRITE Sites in 5 WWAMI States Grand Coulee W W W W W W W W W W W W Chelan Port Angeles Libby Whitefish Sandpoint W W W Ellensburg Moses Lake Spokane Lewistown Helena McCall W Powell Hailey Boise W Lander Wasilla Anchorage Cheyenne Juneau WRITE Site WWAMI Regional Office Note: Alaska not to scale

21. TRUST:The Students’ Fourth Year Experience • Work on career development • Participate in sub-internships • Establish links with regional • residency programs • Explore integrated residency

22. Challenges • Funding • Program administration costs • Student scholarships and/or loan repayment • Student travel costs • Program evaluation • Faculty Development • Regional challenges - students across four years, • faculty across four states

23. Challenges • Pipeline starting with K-12 • Connections with communities including training site support • Balance of rural and urban opportunities • Engaging other medical specialties • Linkages with regional residency programs