UA medical students, rural physicians work side by side

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To help increase the number of physicians practicing in rural Arizona, every summer for the past 11 years a select group of physicians in rural communities throughout the state has mentored medical students from the University of Arizona College of Medicine in Tucson.

For four to six weeks in June and July, the physicians volunteer as preceptors, or mentors, to UA medical students between the first and second years of medical school. The students work at the physicians’ practice sites and reside in their communities.

The physicians are rural faculty members in the UA College of Medicine’s Rural Health Professions Program (RHPP), established in 1997 by the Arizona Legislature to encourage medical school graduates to practice medicine in rural communities.

The students are matched with rural physician-preceptors based on medical specialty interest and community preference. Physician specialties include family practice, pediatrics, internal medicine, obstetrics and gynecology and surgery. Thirty-five rural communities are participating in the RHPP and additional sites will be selected throughout the state. 

Communities hosting students this summer include Show Low, Snowflake, Springerville, Flagstaff, Payson, Douglas, Prescott, Williams and Yuma, as well as the following Native American sites:

* Chinle – Dr. Melissa Lee, medicine and pediatrics, mentoring Karren Seely, originally from Chandler and now in Mesa, June 2 to July 18.

* Cibecue/Whiteriver – Dr. Stephen Savoia, medicine, mentoring Anna Landau, of Tucson, June 30 to July 25. (Savoia has been an RHPP preceptor since 1998.)

* Polacca – Dr. Kristin Burkholder, family medicine, mentoring Briana Cranmer, of Cottonwood, June 16 to July 25. (This new site on the Hopi Reservation also includes physicians Dr. Ramesh Karra, an RHPP mentor in Elfrida in 2007 who completed his residency in family medicine at the UA College of Medicine in 2001, and Dr. Jon Stucki, a 2004 UA College of Medicine graduate who completed his residency in family medicine in Anchorage, Alaska.)

* Tuba City – Dr. Diana Hu, pediatrics, mentoring Janie Mercer, of Bullhead City, June 2 to 27. (Hu has been an RHPP preceptor since 1998.)

Native American medical student Rosalie Zhine, Navajo, of Flagstaff, is being mentored by Dr. Karen Saal, medicine, in Williams from June 2 to July 11.

The students will continue to work with their preceptors over the course of their three remaining years of medical training, returning to the rural communities in their third and fourth years.

“This program helps nurture students’ interest in a rural practice,” said Carol Galper, EdD, assistant dean for medical student education at the UA College of Medicine.

“Many of the students grew up in rural towns in Arizona and have a desire to practice in small communities, perhaps even returning to their hometowns.

“Their RHPP experiences help them understand the unique health-care needs of rural populations, as well as strategies to address these needs, and help them decide about where they want to practice in the future.”

By working side by side with a physician, consulting with patients, discussing lab results, helping to diagnose childhood ailments and observing surgeries, students learn about the unique health-care needs of rural populations and how to meet them. By returning to the same community during each year of medical school, students learn to appreciate the area’s culture and community character and begin to experience the lifestyle of rural residents.

Each year, 15 first-year UA medical students are selected for RHPP. This year, the Arizona Area Health Education Centers (the Arizona AHEC Program) provided funding for three additional RHPP students. 

“With the expansion of the medical school to the Phoenix campus, AHEC funding will help us provide RHPP opportunities to these students as well,” Galper said.

RHPP students receive intensive preparation, including a course covering managed-care issues, referral needs, the impact of poverty and lack of health care, environmental health concerns, the influence of culture and the role of physicians in rural communities. 

RHPP students learn to use telemedicine technology in communities linked to the Arizona Telemedicine Program (ATP), a health care telecommunications network that allows rural physicians and patients to have real-time online medical consultations with specialists at the UA College of Medicine in Tucson.

The system also allows rural physician-preceptors and their students to “virtually” attend grand rounds lectures at the UA College of Medicine. This year, the RHPP course was teleconferenced between Tucson and Phoenix, with instruction originating alternately in Tucson and Phoenix.

Rural physician-preceptors enhance their teaching skills by attending faculty development and continuing medical education programs conducted by the UA College of Medicine.

To minimize disruption of the physicians’ medical practices, the programs are offered regionally as well as by video links provided by ATP to the UA College of Medicine and the Regional Behavioral Health Authorities of the Arizona Department of Health Services/Division of Behavioral Health Service Services.

RHPP students develop long-term relationships with their rural physician-preceptors, who act as medical and career counselors, helping the students make informed choices when they decide where they will practice medicine.

Upon graduation, RHPP students are more likely to select primary care specialties than their classmates: 75 percent versus 56 percent of UA College of Medicine graduates. This year, 63 percent of the RHPP graduates in the Class of 2008 chose a residency in Arizona, compared to 42 percent of their classmates.

“We now have other graduates throughout the state, in places like San Luis, Yuma, Pinetop, Fort Mohave, Camp Verde, Flagstaff, Safford and Prescott, with more graduates returning each year,” Galper said.

“It is exciting to see these physicians return to Arizona and to have them teach our RHPP students. RHPP has come full circle.”

For more information about RHPP, visit www.medicine.arizona.edu/pcrm/RHPP/rhpp.html.

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