This document describes a model for rural health education for first-year medical students at Texas A&M College of Medicine. The program aims to help students understand barriers to healthcare in rural communities. Students are paired with underserved families in Holland, Texas and work in interprofessional teams to address the families' healthcare needs and goals. Over two years, 27 students participated. A survey found that 93% of students increased their knowledge of difficulties associated with rural living and healthcare access barriers. The program was successful in enhancing students' understanding of social determinants of health and rural community issues early in their medical education.

1. A Model for Rural Health Education for
First Year Medical Students:
Understanding Barriers to Care
Ruth L. Bush, M.D., J.D., M.P.H.
Vice Dean for Academic Affairs and Vice Dean,
Bryan/College Station Campus
Professor of Surgery, Texas A & M College of Medicine
The Muster 2014

2. Disclosures
• Faculty: Ruth L. Bush
• Relationships with
commercial interests:
–None

3. What is the Problem?
Shortage of US primary care physicians – most
concern in rural populations
• 9% physicians located where
20% of population resides (rural
areas)
• 3% of current medical school
graduates plan to enter rural
practice
• Rural upbringing
• Expressed plan to eventually become a family/primary care
physician
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4. Texas Rural Populations & Physicians
• 23 Counties with
0 primary care
physicians
• 16 Counties with
1 primary care
physician
• 138 Counties with
2 or more primary
care physicians
4

5. Medical Challenges in Rural Communities
Longer travel distances
Higher costs of medical care
High fixed overhead per-patient revenue
Fewer healthcare providers
More emphasis on generalists
Higher dependency on Medicare and Medicaid reimbursement
Higher rates of chronic disease
5

6. How do we provide solutions to this
problem?
Add education about these issues to
students’ experiences!
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7. Setting & Rotation Structure
• Multidisciplinary teams: physicians, hospital chaplains,
social workers, nurse educators, and 1st and 2nd year
TAM-COM students
• Paired with underserved families in a Holland, Texas
(pop. 1,121) rural community
• Primary goal: To facilitate and improve family’s interface
with health care resources and expose students to rural
health care barriers
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8. Purpose
1. Enhance students’ knowledge of barriers to
health care access and chronic healthcare
needs in a rural population
2. Provide educational experiences within an
interprofessional environment
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9. Benefit to Students
9
Early
exposure to
rural medicine
Understanding
of rural
communities’
issues
Encouraged to
pursue rural
primary care

10. Methods
Physicians
• Students created monthly interactive presentations and
handouts for families to facilitate conversation around
heath views, needs, and concerns
• Short term goals set by families – students research and
find resources or ask questions pertinent to their specific
families’ health concerns
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Rural
Health
Care
Teams
1st & 2nd
year
medical
students
Hospital
Chaplains
Social
Workers
Nurse
Educators
Families

11. Methods: First Year Curriculum
• 13 students in 2010-2011
• Families recruited by school nurse based on
health care needs of the children
• Students placed in small groups (2-3) and
assigned to family
– Presentations: disseminate information
– Handouts: facilitate conversation
– Discussions
• Students also worked with mentors to set goals
and reflect on progress
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12. First-Year Families
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13. Methods: Second Year Curriculum
• 6 returning participants, 16 first year students, and
nursing students
• Families given option to participate again, new families
recruited
• Physician/mentor present with each group
• Students provided:
– Interactive presentations on health care topics
– Guidance for meetings (2nd-year students)
• Health fair held during the final meeting, and training
session for students was held at the school
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14. Second-Year Families
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15. What impacts did this make on the
students?
How will it impact rural healthcare?
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Participation Survey

16. Results: Changes in Students
• 27 medical students participated in 2 years
• 93% increased knowledge about difficulties
associated with rural living and barriers to health
care access
• Increased knowledge of
– Health concerns/struggles prevalent in a rural
community
– The importance of the physician-patient relationship

17. Results
• Increased interest in primary care residencies
after completing program
• Program helped with
development as future
physician (25 students)
– Listening skills
– More understanding of
circumstances
surrounding rural living
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18. Discussion
• Early exposure to medical issues in rural
community influences students’ approach to
medicine
• Accomplished one of the core medical education
competencies
• Students’ “people skills” improved, developing
future relationships with patients
– Compassion
– Patience
– Listening to patients and circumstances
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19. Discussion: Rural Populations
Decreased
• Number of health care providers
• Fewer specialists
• Services provided by medical facilities
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Increased
• Rate of chronic diseases
• Elderly and children
• Unemployment and underemployment
rates
• Poor, uninsured, underinsured
residents
• Distance to healthcare
• Cost of healthcare

20. Conclusions
• Understanding: Participants were able to understand healthcare
disparities affecting rural families and to understand alternative
medical resources necessary for optimized healthcare.
• Awareness: Students’ awareness of social determinants of health
and global health issues was increased.
• Knowledge: Communication skills and clinical knowledge was
expanded early in students’ medical education
• Professional development: increase overall
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21. 21
Thank you!
Ruth Bush, MD, JD, MPH
rbush@medicine.tamhsc.edu