A presentation at the 37th Annual Rural Health Conference by: - Michael Glasser, PhD, University of Illinois College of Medicine, National Center for Rural Health Professions Evaluation and Research assistant dean - Kelli Hill, Hamilton Memorial Hospital SEIgrow coordinator - Martin MacDowell, DrPH, University of Illinois National Center for Rural Health Professions associate professor; Health Professions Education associate director - Vicki Weidenbacher-Hoper, University of Illinois National Center for Rural Health Professions assistant director

1. Building and Evaluating a Rural
Community-based Immersion
Program
Vicki Weidenbacher-Hoper, MSW,1 Kelli Hill-Stover, BS2 Michael
Glasser, PhD,1 Martin MacDowell, DrPH, MBA1, Dorene Ewell3,
Aaron Jannings4
1 National Center for Rural Health Professions, University of Illinois at Rockford
2 South Central Area Health Education Center, Rend Lake Community College, Ina, Illinois
3 SEIgrow, Harrisburg Medical Center, Harrisburg, Illinois
4 Rural Medical Education (RMED) Program, University of Illinois at Rockford

2. Learning Objectives
• Learn how to develop/maintain partnerships in rural
communities in order to develop and offer rural
community-based immersion programs.
• Learn how to develop, implement and evaluate the various
components of a rural 3-5 day interprofessional immersion
education program. This will include insights from a RHE
student and a RHE sponsoring hospital.
• Share success stories and unique challenges and offer
session participants the opportunity to discuss and provide
new ideas as well as practical information that will aid in
developing new and improved rural immersion programs.

3. National Center for Rural Health
Professions
• Located on the University of Illinois Regional Health Science campus
in Rockford, IL. Part of a land-grant University – mission to serve
the state.
• Established in 2003.
• The purpose of the National Center for Rural Health Professions
(NCRHP) is to meet the health care needs of rural Illinois residents
through collaborative projects involving multiple health professions
and emphasize recruitment, retention and health care delivery
initiatives that will positively impact the health and well being of
both rural residents and their communities.
• NCRHP web site http://www.ncrhp.uic.edu/index.cfm.

4. Background
• Immersion education comes from elementary
and secondary language acquisition programs
developed in Canada in the 1960s (Zink et al.,
2008).
• Adopted by health professions educators as a
teaching strategy to help students develop
greater cultural competency.
• Vary in purpose and length but common feature
is an “eye-opening” experience for students.

5. Background cont.
• Local community and health care workers become
educators (Zink et al., 2008).
• Rabinowitz’s work suggests that a curricular experience
in a rural community is an important ingredient for
increasing the numbers of rural primary care physicians
(Zink et al., 2008).
• Literature lacking in regards to curricular components
of this experience in medical education, especially in a
rural setting (Zink et al., 2008).

6. Rural Health Experience (RHE)

7. What is the Rural Health Experience?
• 3 to 5 day immersion program shadowing
health professionals and other community
interactions in a rural area.
• Intended for college, graduate or professional
level students in their 1st and 2nd years of a
health professions program (medicine,
nursing, pharmacy, public health, social work,
dentistry, physical therapy and others).

8. Objectives of the Rural Health
Experience (RHE)
• Learn about the social and health characteristics,
needs, and resources of a specific rural community.
• Understand the roles and responsibilities of different
healthcare providers in a rural community.
• Reflect on a future career as a healthcare provider in a
rural community and potential interest in this location
as a future career location.

9. RHE Components
• Student meets with the hospital CEO and/or other leadership staff –
ideally has lunch/dinner.
• Hospital Tour.
• Emergency Medical Technician or Emergency Room shadowing experience.
• Shadowing at the local health department
• In addition to the above, two experiences shadowing professional level
clinicians i.e. physician, pharmacist, physical therapist, social worker, public
health. Shadowing of tech level positions i.e. x-ray tech, ultra sound tech,
etc. not appropriate level for shadowing experience.
• Ideally, attendance at an interprofessional team meeting i.e. hospice,
discharge planning, home health etc.

10. Establishing RHEs
• Partnerships
– University, hospitals, communities
• Funding
– Federal Grants
– State Grants
– Contracts , i.e. hospitals, civic organizations
• Timing of experience
– Student schedules
– Hospital schedules
• Availability of housing
• Availability of a variety of supportive health
professionals for student(s) to shadow in the community

11. 5 Day RHE
SAMPLE SCHEDULE

12. Why Should a Student Complete an
Interprofessional Rural Immersion
Program?
• Defines areas of interest.
• Exposure to a rural community, healthcare facilities,
and personnel.
• Experience how the different health professions and
care settings interact to provide patient care.
• Offered through a University – provides credibility
related to being an educational experience.

13. Student Feedback from the RHE
• I’ve learned that rural healthcare professionals wear more hats than those
that work in larger locations. This is more exciting because they aren’t
always doing the same thing over and over.” Student Participant 1
• “I felt I was really able to understand each specialty in the rural healthcare
system and was able to witness how each department worked along with
each other to treat patient needs. I also learned the benefits and some
issues that rural healthcare providers face.” Student Participant 2
• “I think this experience has really shown me what to expect in rural
healthcare. I have realized after this experience that even though it may
not be the most luxurious job, I am passionate about helping others and I
would enjoy helping those in the rural communities especially coming from
one.” Student Participant 3

14. Why Should a Hospital Participate in a
Rural Health Immersion Experience?
• Access to health professions students with rural interests who will be
looking for employment after completion of their training. Provides an
opportunity for the student to see themselves in a specific rural
community.
• Opportunity for hospital staff to engage in teaching.
• Opportunity to highlight community.
• Contribute to the development of qualified and competent rural health
professionals.
• Investment in the community – contributes to the overall good of the
community.

15. Key Information for an Interested
Hospital to Consider
• Are there key personnel (CEO, pharmacist, primary care physician) who
are willing to participate? Do they like their job/profession and will they
depict their profession in a positive light to the student(s)?
• Is there a person on site at the hospital to coordinate experience i.e. meet
with providers both internal and external to coordinate student’s
schedule, meet student, be available to both student and providers during
the experience to coordinate/adjust student’s schedule.
• Are there enough clinical activities for the student(s) to observe during the
experience? Is patient volume sufficient at each clinical area?
• Is there adequate housing and dining options for student(s) during stay?

16. Why Should Rural Academic Programs
Offer a RHE?
• Acknowledgement that educating health professionals within a rural environment
is an effective strategy for increasing health professional knowledge and
experience of working or living in a rural environment (Whelan et al., 2008).
• Rural placements can provide enhanced access to day to day clinical practice
learning opportunities, including clinical decision-making, a clearer experience of
the social forces involved in meeting both individual and community health care
needs and can enhance the recruitment and retention of rural doctors (Page &
Birden, 2008).
• Students who observe or shadow in an urban hospital before beginning medical
school are less likely to choose family medicine (Avery et al., 2012).
• A university can assist in screening students as related to rural intent. The selected
RHE students need to have evidence of sincere interest in considering a rural
career path so the RHE is of potential benefit to the rural community. It should not
just be a “visit to the country”.

17. RHE Evaluation
• Student pre/post tool – examples of questions
– I understand multiple health professions and effective ways they can work
together.
– I understand the needs of rural healthcare and know how to work with
different health related disciplines.
– I can identify healthcare needs of rural populations (especially as compared to
urban).
– I feel interdisciplinary education/training should be required for all health
professionals.
• Hospital post survey – examples of questions
– Were the goals and objectives of the RHE made clear in your view?
– What were the positive aspects of participating in the RHE for your hospital?
Please be specific.
– What were the challenges for your hospital in being a participating site for the
RHE? Please be specific.
– How was the quality of students you were able to choose from when selecting
a RHE student participant(s)?
– What disciplines were you seeking to participate in the RHE at your hospital?

18. Community and Hospital
Characteristics
Community Population
(2012)
Type of Hospital
Fairfield, IL
Fairfield Memorial Hospital
Federal HPSA Designation Area
5,087 Critical Access Hospital
272 employees
Harrisburg, IL
Harrisburg Medical Center
Federal HPSA Designation Area
9,034 72 beds - In-patient behavioral
health service for both adults and
geriatric adults.
509 employees
McLeansboro, IL
Hamilton Memorial Hospital
Federal HPSA Designation Area
2,850 Critical Access Hospital
150 employees
Olney, IL
Richland Memorial Hospital
Federal HPSA Designation Area
9,092 Not-for-profit - licensed at 134 beds
165 employees

19. Student Background Characteristics
Variable N=13 %
Gender
Female
Male
9
4
70
30
Health Professions Program
Medicine
Pre-Med (undergrad)
Pharmacy
Doctoral Level
Undergraduate
4
4
3
1
1
31
31
23
8
8
Location of RHE Experience
Hamilton Memorial Hospital
Fairfield Memorial Hospital
Richland Memorial Hospital
Harrisburg Medical Center
5
3
3
2
38
23
23
15

20. Qualitative Analysis
• Students completed a reflective paper.
• Student reflective papers were analyzed using:
– Atlas.ti Version 6.2.16 (ATLAS.ti Scientific Software
Development GmbH, Berlin).
• Papers were read and coded for comments
and passages reflective of RHE learning
objectives.

21. Theme Frequencies and Examples from Narratives
Theme # and % of
Quotations
Quote illustrating experience relating
to code
Health characteristics, needs
and resources
120 (40.9%) In my three short days, I saw a wide
variety of services offered to the residents
of Hamilton County.
There were a few primary care doctors on
staff who worked with nurse practitioners
in both the clinic and the ER. Specialists
would visit periodically, often once a week,
or patients in serious condition would
have to be transferred to the closest large
hospital…
Social characteristics, needs
and resources
36 (12.3%) Without support from the hospital, the
community would not enjoy the
exceptional care that is provided and
without the community, the hospital
wouldn’t be able to exist.

22. Theme # of Quotations Quote illustrating experience relating
to code
Roles and responsibilities of
different health care providers
109 (37.2%) I was able to observe how a PT, PTA, OT
and ST work together for the better care of
their patients.
I learned about other services that public
health provides including medical cards,
smoking and tobacco hotlines and
vaccinations.
Reflect on future career as a
healthcare provider
19 (6.5%) It just reinforced my desire to settle in a
rural setting.
This experience and time spent with Dr.
Absolutely boosted by interest in family
medicine as a future profession in
medicine.
Reflect on the potential
interest of this location as a
future career site
9 (3.1%) I would tell others who asked about my
trip in the following days that the people
in McLeansboro “said all of the magic
words”.
Theme Frequencies and Examples from Narratives

23. Share success stories and challenges

24. References
1) Zink T, Halaas G, Finstad D, Brooks K. “The rural physician associate
program: the value of immersion learning for third-year medical
students”. Journal of Rural Health 2008;24(4)353-59.
2) Avery D, Wheat J, Leeper J, McKnight J, Ballard B, Chen J. “Admission
factors predicting family medicine specialty choice: A literature review
and exploratory study among students in the rural medical scholars
program”. Journal of Rural Health 2012;28(2)128-136.
3) Whelan J, Spencer J and Rooney K. “A ‘RIPPER’ Project: Advancing rural
interprofessional health education at the University of Tasmania”. Rural
and Remote Health 2008;8 1-9.
4) Page S, Birden H. “Twelve tips on rural medical placements: What has
worked to make them successful”. Rural and Remote Health
2008;30(6)592-596.