Rural Community Medicine Rotation

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Rural Community Medicine Rotation

• Physician Assistant Program
• Roanoke, VA
• Wilton Kennedy, DHSc, PA-C, Program Director
• Vicki Bierman, MSW, MSN, FNP-BC,
• Community Medicine Coordinator

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WHO ARE WE?

• Jefferson College of Health Sciences (JCHS) is a
  private, health sciences college in Roanoke,
  Virginia. The school was founded in 1914 and
  awards associate, baccalaureate and masters
  degrees, and is accredited by the Commission on
  Colleges of the Southern Association of Colleges
  and Schools.
• With a 83 year history of providing medical
  training and education, the school established a
  Physician Assistant (PA) program in 1997.
• JCHS is now integrated with Carilion Clinic, one
  of the largest health systems in Virginia.
• In the last two years the class size has
  increased from 30 to 40 students. In 2008, the
  program accepted the first class to receive a
  graduate degree of Master of Science in Physician
  Assistant.

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Community Medicine Rotation Purpose

• To develop student leadership skills,
• community health competencies,
• and to promote
• improved health outcomes in
• rural communities

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Rotation Objectives

• Provide
• Health Promotion Disease Prevention Programs to
  gain skills in community education utilizing
  health indicators from Healthy People 2010
• Biopsychosocial assessments with chronic disease
  patients
• Support for patient self-management during clinic
  visits community programs
• Literacy culturally appropriate patient
  education counseling for those at risk for
  disease or have chronic disease

• 5. Identify socio-cultural determinants of health
  for a rural community assessment of health
  needs
• 6. Collaborate communicate with other health
  professionals, providers, community agencies
  for effective disease management
• 7. Use a patient-centered, cross-cultural
  treatment approach with chronic disease patients

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Caring for Communities

• Federal and local grants have been received since
  2001 to fund the PA Caring for Communities
  community rotation.
• All clinical year students participate in a
  monthly community medicine rotation located in
  rural medically underserved communities.
• The preparation for this rotation begins during
  the didactic year when students learn
  communication skills, health education
  strategies, the Chronic Care model, and the
  Community Oriented Primary Care Model.
• Students learn to apply behavioral change
  strategies, patient self-management, and promote
  health education and patient support.

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WHAT DO WE DO?

• Chronic Care Medical Education Model

Year 1
First Semester
Second Semester
Year 2
Community Medicine Retention
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Community Medicine Rotation
Students provide chronic disease education,
service self-management support within rural,
medically underserved communities
Partner with Community Health Centers that
participate in health disparity
collaboratives Free clinics and mobile mission
units Local senior outreach organizations Local
YMCA Wellness Centers Migrant outreach
organizations Local health districts Local
schools
Outreach Focus
Clinical Focus
Patient-Provider Partnership
Cross-Cultural Care Biopsychosocial
assessments Patient Education Self-Management
Support with Action Plans
Problem-solving Identify Community resources
Assist partners by planning, implementing
evaluating health promotion education for
individuals across the lifespan Provide chronic
disease self-management programming within
communities
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WHERE HAVE WE BEEN?

• Established sites in 4 rural, medically
  underserved
• Virginia communities
• Lee, Wise Norton Counties
• 2001-2006
• Smyth County 2001-present
• Giles County 2006-present
• Franklin County 2007-present
• 218 students have participated
• 45 graduates working in rural communities

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Populations

• Across the lifespan
• Older Adults to Children
• Insured, uninsured, migrant workers
• Health screenings, education

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Smyth County
Sign on door no guns allowed inside

Saltville, Marion, Abington
Migrant Outreach
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CROSSROADS Medical Mission
Smyth County Stone Soup in Abington Town
Hall in Meadowview, VA
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Giles County
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Franklin County
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Healthy Weights for Healthy Kids, Tar Wars,
Health PALS (providers adopting local schools)
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HOW DID WE GET HERE?

• Community Needs Assessments
• PA students skills and knowledge are offered to
  community agencies
• Word of mouth from program participants and
  stakeholders associated with work of the students

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HOW DO WE DO IT?

• Grant Funding In-kind Donations
• In 2001, a HRSA training grant was received to
  establish a PA presence in rural Southwest
  Virginia
• Receipt of local healthcare grants
• Rural communities JCHS in-kind donations
• Funding supports
• community medicine coordinator position,
• supplies, mileage, student housing

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Students Administrative Duties

• Integrate into the rural community setting
• Communicate with community partners
• Continue to assess community needs
• Develop health promotion activities
• Organize office update calendar of events
• Contribute weekly to the discussion board
  digital drop box
• Prepare educational teaching plans
• Prepare transition memo attend transition
  meeting

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Collaboration
Maintain contact with community partners set
health care goals with clients

• Student responses
• We get out in the community, get to know
  people,
• find out what new programs are coming down
  the pipe
• We attend community health planning meetings to
  update local officials on our activities and the
  observed community health care needs
• We identify what resources are available for
  patients in the community and discover who to
  collaborate with for disease management

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Program Evaluation Methods

• Process Summative
• Preceptor evaluations
• Discussion board- journaling
• Transition meeting for students debriefing time
• Student provide pre and post rotation assessments

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Meeting Community Needs
Participate in a variety of Community Health
Programs
Mission of Mercy 2008
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Where are we going?
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JCHS PHYSICIAN ASSISTANT PROGRAM

• Building a Healthier Tomorrow

http//www.ruralhealth.jchs.edu/pa/