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07/12/2010

South County Magazine, July 2010

Rural Training

What does it take to make a really good doctor? Academics and on-the-job training, as in many other professions, but for a longer period of time and with more intensity.

UC Davis School of Medicine in Sacramento launched a program in mid-2007 that provides on-the-job training and immersion in a community setting, in rural clinics and hospitals away from the school. Called Rural- PRIME, it is now in place at Mee Memorial Hospital in King City.

The unique program is designed to train the best and the brightest students for a fulfilling life in rural primary care medicine. “This program was designed specifically to train doctors for rural practice,” said Dr. Bruce Greenberg, the coordinating physician for Mee Memorial. “Every UC medical campus has a PRIME (Program in Medical Education) with a different emphasis and at Davis it is rural medicine.”

Dr. Greenberg said the emphasis on rural medicine and the connection to UC Davis goes back decades. Dr. Hughes Andrus, who practiced in King City during the late ‘40s and ‘50s, left to teach at UC Davis’ then new school of medicine in the family practice department. He was one of Dr. Greenberg’s professors. “That’s our original link,’ said Dr. Greenberg. “But it wasn’t until much later that the school developed a program with a specific emphasis on rural care.

“This is really an extension of what we have been doing with the California Association of Family Practice preceptorships for years. That’s probably one of the reasons we were chosen. We already had experience working with medical students.”

It all started at a class reunion Dr. Greenberg attended at UC Davis in 2005. “I was sitting at the table with the dean of the medical school. I had been teaching with Natividad through UC San Francisco and asked the dean about bringing the training here to King City. She said it sounded like a good idea since we were already doing some teaching for students at the end of their third and fourth years of medical school.”

Two years later, UC Davis started Rural-PRIME in response to a UC wide initiative to focus on specific medical school tracks on underserved populations. The program leadership worked with interested rural hospitals, clinics and physicians all over the state to set up clinical rotations for the Rural-PRIME students in their third year of medical school. The idea stalled for a while because the funds, which came from Prop. 1D, were frozen. Then in 2009 the funding thawed. “I received an email in 2009 asking if we were interested in becoming a Rural-PRIME site.”

A real commitment from the hospital administration was needed and the new CEO Lex Smith gave it a thumbs up right away. “This is a great partnership between us and the UC Davis School of Medicine,” said Smith. “It builds on a long-standing relationship with UC Davis and is part of our commitment towards becoming a UC Davis Rural Center of Excellence.”

Why is the training of rural physicians so important? By 2015, California will be facing a huge shortage of physicians. According to information from UC Davis, 20 percent of the population in California lives in rural areas, but only 9 percent of physicians practice rurally. With these disparities rural patients have poorer outcomes on several measures than their urban counterparts: higher levels of chronic conditions, higher rates of hospitalizations and higher rates of cancer deaths. Rural-PRIME was developed to address the lack of access in rural areas, and to reduce health care disparities in rural populations.

Here’s how it works: Twelve students from each class at UC Davis are accepted into the Rural-PRIME program. The program is highly competitive, with approximately 150 candidates vying for the 12 spots. The 12 students rotate among the participating medical sites which now include King City. The students, who are in their third year of medical school, spend four to eight weeks in primary care (a combination of family practice and internal medicine), pediatrics and obstetrics. “The students see the patients under the physician’s supervision,” said Dr. Greenberg. “They can do the initial exam and talk with the preceptor physician about the patient diagnosis and what is the next step. But,” he emphasized, “the physician is the one who introduces the medical student to the patient and completely oversees the care. Some of the rotations are more focused on out-patient care in the clinic setting and some more on the inpatient or hospital side.”

This didn’t all just happen with a snap of the fingers. A team from UC Davis School of Medicine came down in March for the preliminary discussions and then returned in April and again in May to nail down the details of how the program will work. “The training is good for both the students and the physicians,” said Dr. Greenberg. “As rural physicians, we really want to give these up-and-coming doctors the best training possible so they will be prepared when they leave medical school.”

All the student classroom coursework is completed through distance learning via video connections between King City and the UC Davis School of Medicine campus in Sacramento. Additionally, using telecommunication links, the students as well as the local physicians will be able to talk to faculty and specialists at UC Davis. “We hope to have it so that while UC Davis medical students are in Kings City, patients might benefit from a telemedicine consult with one of our specialists, whether it be in pediatric neurology, endocrinology, dermatology, infectious disease or psychiatry,” said Dr. Suzanne Eidson-Ton, Co- Director for the program, based at the UC Davis Medical Center in Sacramento. “It is not only a consultation, but education for the student and the presenting primary care physician.”

The first doctor-in-training, Manuel Tapia, arrived toward the end of May and worked with the medical staff at Mee Memorial for a month, just the first of many. Real, on-the-job training and finding out what being a rural community doctor is all about. Good for them, good for the community and good for Mee Memorial.

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