Rural Background for 2004 update in this area
1) You wrote at some point that 20% of Americans live in rural areas and 9% of MD's there----any idea where these figures came from???
Cecil Shepps center at UNC and Tom Ricketts did the studies for ORHP
2) You wrote that studies done in 1976 and 1981 showed that students with lower MCAT's went rural as compared to traditional students. Do you remember the particulars about these or any resource that we could contact for more details?
Dona Harris did the studies when she was in Utah, others have noted the same
Paul James is working on an update of selections for rural at Iowa
The osteopathic schools have slightly lower MCAT and much better rural practice records
Rockford also has some success in this area
http://www.unmc.edu/Community/ruralmeded/model/medsch/rockford_rural_health.htm
Guidance on affirmative action admissions policies On June 23
3) Need the reference to your study regarding the success of the Nebraska (and Missouri and Pennsylvania) small in-state colleges as incubators for rural med students, etc.
The overall presentation of this concept is at http://www.unmc.edu/Community/ruralmeded/fewyoung.htm
most of the items and links and data are here.
The key issue is the need for young professionals in rural communities, economics, jobs, leadership, services, all follow. The key then is to encourage, educated, train, and support the kids who will choose rural (or underserved) and stay there.
Also you could talk to Howard Rabinowitz, he agrees, but is not as strong in his support of this small college concept as I, but he has had far more experience and has used it best. He also has tried to take all of his experience and studies to other medical schools many times and has not been successful.
LCME issues - Accreditation and Demands of Rural Practice
LCME can stir up preparation for site visits regarding preceptorships but then usually the efforts are lauded in reports. A
Also RHOP program at http://www.unmc.edu/Community/ruralmeded/model/medsch/rural_health_opportunities_progr.htm
lots of comparisons at this site
Missouri is a negative example where they forgot to assess the likelihood of a high school student returning to the rural areas. They did the anti-brain drain program for the brightest, who then left for Stanford and MIT after college anyway. If they had chosen the ones who were more likely to stay around, they would have invested in the future of their state and the future of the small towns of the state through their young professionals
To understand the college situation, this is essential: Centralization and Regionalization
You cannot understand how to accomplish long term changes in rural communities without understanding how education, rural public health, and a whole host of business and government policies promote centralization. State By State Education Status
4) We think that at one time you mentioned something about a study in 1992 that showed a drop in FP interest with a decrease in med school class size. Maybe not yours---we're not at all sure???
Actually a drop in FP match correlating with decrease med school class size 4 years previously. The thought being that the serving all purpose types were cut out when the medical schools got more selective.
Author was:
Patrick J. Fahey, MD Professor of Family Medicine B0902 Cramblett Hall 456 West 10th Avenue Columbus, OH 43210 Phone: 614-293-8007 Fax: 614-293-5419 Practice Office OSU Rardin Family Practice Center 2231 North High Street Columbus, OH 43201 Phone: 614-293-2700 Fax: 614-293-2720 Professional Interests My primary educational responsibility is teaching medical students in their first three years of medical school plus family practice residents. Selected Publications
Fahey PJ, Sachs L, Bauer LC: Declining class size and the decline in graduates choosing family medicine. Academic Medicine 1992; 10(10): 680-4.
5) We'd very much like to use your quote about rural patients, "They don't care how much you know until they know how much you care." Is it original with you and/or is it in a published article that you or someone else wrote that we can quote?
Here is the entire email and the author from Family-L list serve, this is not original to this author, by the way. Not sure who the original is. We were discussing caring vs competence in the email listing., this or the predoc list serve have some good info:
Patients want clinically competent physicians who listen to them and care about them. I also believe what our patients fear most about a doctor is that we won't believe them, and how easy it is for us to underestimate how frightening their illnesses, traumas, surgeries, etc can be to them.
One of my mantras which nauseates the residents sometimes is, "They don't care how much you know until the know how much you care." We must be deliberate in teaching our residents how to communicate this at each visit. They must be able to do it without exhausting themselves emotionally and must be efficient at it. On the other hand, this type of communication can't just be an act. There has to be a genuine interest in our patients welfare expressed. I call this part of growing up in medicine. It’s a process that takes us from the very idealistic through disillusionment and often cynicism and eventually to a balanced view of what we can and can't expect of ourselves, our patients and the system in which we work. It brings us to the conclusion that it doesn't have to "cost" too much to care and that is a very valuable gift we give our patients. It also helps us recognize what a gift the patients give us in their confidence and trust in us when they ask us to help them.
Of course the patients want us to be knowledgeable and competent as well. This is more easily taught. However, I wonder if our system of drumming competence into our learners sometimes drums out the compassion. I also believe that the current entrepreneurial climate which permeates our profession goes a long way to drum compassion and empathy out of us, not to mention the allegiance out of our patients. "Lijoi, Andre" <alijoi@WELLSPAN.ORG >
It fits nicely as a companion piece to Dr. Jordan Cohen's address to the AAMC last Nov about the need to improve med school adm search for committed, compassionate applicants.
Actually you might want to review the following site, I think it does a good job with Cohen's stuff http://www.unmc.edu/Community/ruralmeded/service_orientation.htm
Other previous work by Cohen and my comments at http://www.unmc.edu/Community/ruralmeded/why_docs_dont.htm
Cohen needs to visit rural areas
If you want to see what happens when a key leader works closely with rural underserved areas, try out Tom Bruce in his book, Improving Rural Health or this site at http://www.unmc.edu/Community/ruralmeded/model/medsch/arkansas_approach.htm
This work in Arkansas is more detail and longer than what we have at Nebraska, but illustrates the community-driven approach. More about this at http://www.unmc.edu/Community/ruralmeded/community_driven_approach.htm
More on Community Driven Approach
You overhear them debating the strengths and weaknesses of articulated tractors.... Jeff Stearns RMED program
A good weekend is what you killed rather than who got killed.
Scheduling time off for residents becomes increasingly difficult in hunting season.
Students searching for an FP residency mark off programs in cities that are too expensive to raise a family.
Medical Schools Overseas Changing Admissions
Description of Admissions Approach