Traditions and Challenges in CommunityBased Health Professions Education

1
Traditions and Challenges in Community-Based
Health Professions Education

• West Virginia Faculty Development
  ConferenceThomas J. Bacon, Dr.P.H.
• September 20, 2003

2
History of AHEC

• Carnegie Commission Report 1970
• Federal Legislation 1971
• First AHECs Funded 1972
• AHEC Part of Safety Net Initiatives
• National Health Service Corps
• Community Health Centers
• Other (FNPs, PAs, Family Medicine)

3
Health Resources and Services Administration Burea
u of Health Professions
States With AHEC Programs
Shaded States AHEC Program
4
AHEC InfrastructureA National Network (Almost)

• 46 Programs in 44 States
• 181 Regional Centers
• Size of regions vary from 61 to 572,000 square
  miles
• Population of regions vary from 200,000 to 3.5
  million

5
Core Principles of Community-Based Health
Professions Education

• Academic- Community Partnerships
• Strengthen and broaden health professions
  education
• Expose students to the vitality of community
  practice
• Ultimately improve access by changing location
  patterns of graduates
• Improve quality of care

6
Core Principles of Community-Based Health
Professions Education

• AHEC/RHEP serve as the bridge to build and
  sustain those partnerships
• Successful partnerships require commitment on
  both sides to collaborate for the common good
• Once infrastructure is in place, a host of other
  initiatives can be developed, based on identified
  needs

7
Funding

• Federal
• AHEC - 33.1 Million
• HETC - 4.3 Million
• State
• Local

8
AHEC Educational Programs Services

• Community-Based Student Training
• Primary Care Residency Support
• Library/Information Resources
• Continuing Education
• Health Careers/Pipeline Programs
• Special Projects

9
National AHEC AccomplishmentsCommunity-Based
Student Training(2001-2002)

• Total training sites 20,572
• Sites per center 114
• Sites in medically underserved communities
  13,440

10
National AHEC AccomplishmentsCommunity-Based
Student Training(2001-2002)
Mental Health 1
Public Health 2
Other 1
Dentistry 4
Pharmacy 6
Medical Students 42
Adv. Practice Nurse 6
Physician Assistant 6
Allied Health 12
Nursing 18
11
National AHEC AccomplishmentsContinuing
Education(2001-2002)

• Continuing education courses 16,767
• Courses per center (average) 92
• Participants 28,060

12
National AHEC AccomplishmentsContinuing
Education by Discipline(2001-2002)
13
National AHEC AccomplishmentsHealth
Careers(2001-2002)

• High school students in intensive programs of 20
  hours or more 29,853
• Average participants per center 165

14
National AHEC AccomplishmentsHealth
Careers(2001-2002)
15
National AHEC AccomplishmentsOther Health
Careers Promotional Activities(2001-2002)

• Total school visits 11,397
• Students contacted 309,951
• Parents contacted 39,634
• Teachers counselor contacted 29,034

16
Primary Care Residency Programs with AHEC Support
AHEC Primary Care Residency
Academic Health Center
Family Medicine Rural Track Site
17
Family Practice Physicians Trained in
AHEC-Supported Residencies in North Carolina
Of the 2,224 practicing family physicians in
North Carolina, 38 completed an AHEC-supported
residency
1 Dot 1 AHEC-Supported Active Family and
General Practice Physician (854)
18
NC AHEC ProgramFamily Medicine Residencies

• Percentage of graduates staying in North Carolina
  to practice
• Academic health center 50
• AHEC-based 66
• AHEC rural track 75
• AHEC-trained residents more likely to settle in
  rural areas

19
(No Transcript)
20
AHEC/HETC Beyond the Numbers

• Involving students in community service
  Oklahoma
• Partnerships with migrant and community health
  centers Florida
• Innovations in health careers California, New
  York, North Carolina
• Using telemedicine to reach remote sites
  Nevada, Arkansas
• Responsiveness to state and national needs -
  National

21
2002 National AHEC Evaluative Study

• Funded by HRSA
• Conducted by UNC-CH/RTI/HSR, Inc.
• Site visited nine states
• Analyzed national data on AHEC/HETC
• Looked at characteristics of successful AHECs and
  barriers to success

22
2002 National AHEC Evaluative Study

• Findings AHEC Strengths/Competencies
• Community-based health professions education is
  the core competency and value of AHEC
• AHECs are viewed as neutral entities, enabling
  them to serve as a convener, catalyst, bridge
  builder
• AHECs are unique and valuable infrastructures for
  rolling out a wide array of federal and state
  initiatives
• Partnering at state and community levels is a
  central role for AHECs/HETCs

23
2002 National AHEC Evaluative Study

• Findings Successful AHECs/HETCs
• Leadership is critical to successful AHECs
• Successful AHECs are not overly bureaucratic
• AHECs have the capacity to respond quickly to
  emerging issues (e.g., bioterrorism education)
• Balanced funding is critical to long-term success

24
2002 National AHEC Evaluative Study

• Findings Concerns
• Mission Creep in states where state funding not
  stable
• Interdisciplinary training very difficult to do
• Quality issues not well addressed by AHECs
• National data via HRSA (CPMS/UPR) is work in
  progress
• AHEC Brand awareness relatively low among
  health professionals

25
2002 National AHEC Evaluative Study

• Recommendations
• AHECs/HETCs need better performance measures to
  demonstrate outcomes
• AHECs should integrate their work more closely
  with other safety net programs (CHCs, NHSC)
• Pipeline programs should fit more closely with
  community health care needs
• Need to increase emphasis on multidisciplinary
  programs
• AHECs should carefully assess benefits of
  technologies technology cant replace being
  there
• AHECs should increase their role in addressing
  workforce shortages

26
2002 National AHEC Evaluative Study

• Conclusions
• AHECs are complex interorganizational entities
  that mix history, local conditions and national
  priorities in unique combinations to achieve
  social and professional change
• AHECs are about relationships

27
Current Challenges/Threats

• Declining state budgets
• Serious workforce shortages
• Concerns over malpractice insurance
• Increased productivity pressures on practitioners
• Rapid advances in knowledge/technologys
  implications for undergraduate, graduate and
  continuing education
• Increasing regulatory pressures (HIPAA)

28
Conclusion

• Community-based education still essential
• We are a bargain because of the
  partnerships/collaborations we rely on
• We must stay focused on our core mission and
  principles
• We must remain innovative in a time of stress and
  change