We ¢ FINAL REPORT RURAL EXTERNSHIP PROJECT SUMMER, 1974 Lakes Area Regional Medical Program, Inc. 2929 Main Street . Buffalo, New York 14214 Robert J. Beebee Project Director John R.F. Ingall, M.D. Executive Director EVALUATION REPORT . LAKES AREA REGIONAL MEDICAL PROGRAM, INC. . 1974 RURAL EXTERNSHIP PROJECT I. BACKGROUND 7 The Rural Externship Project was developed by the Lakes Area Regional Medical Program in an attempt to alleviate the problem of shortages in | health care personnel in rural areas. The goal of the Project is to increase the availability of all health professionals in the rural areas _of Western New York State and Northwestern Pennsylvania. Nine health science students participated in the Project in 1970, the first year of operation. The number of student participants. in 1974 was 57. In 1971, there were 22 externs; in 1972, there were 34; and in 1973, there were 55. | | In addition to the principal objective of interesting health science students in a rural health career following graduation, other objectives of the Rural Externship Project are: 1. To enable students to participate in an interdisciplinary "team" approach to health care based, in many cases, in a rural or semi-rural hospital setting; 2. To expose students to rural health care delivery; 3. To expose students to a rural community and rural life style through actually living in a rural community; and 4. To make students more aware of the characteristics and problems of rural health practice. Il. PROJECT ORGANIZATION General administration of the Project was S managed by the project director who is a member of the Lakes Area Regional Medical Program. staff. An advisory committee was formed which consisted of representatives from each of the health science schools at the State University of New York at Buffalo, student representatives, past preceptors, health planners, and | - hospital administrators. This committee, together with the Lakes Area Regional Medical Program as sponsoring agency, determined program policy, advised the director relative to specific problems, and will a plans and recommendations for future continuance of the Project. Health disciplines involved in the 1974 Project included medicine, pharmacy, dentistry, nursing, physical therapy, podiatry, and others as listed in Table I. TABLE I: Externs by Discipline #8 Medicine oat - 36.8. Pharmacy | 10 17.5 Nursing 6 10.5, Dentistry 5 8.8. Physicial Therapy | 5 8.8 Medical Technology 2 | 3.5 Podiatry 2 3.5 Hospital Administration ] 7 1.8 ‘Medical Record Technology. 1 1.8 ' Nutrition 1 1.8 Occupational Therapy 1 1.8 Public Health d 1.8 Speech Pathology ] 1.3 -3- There were 182 applicants for the 57 externship positions available. Several factors were taken into consideration in selecting the externs. Among the most important ones were years completed in professional school, place of residence, and the needs and requests of the various preceptor | sites for a ‘particular distribution of students in the health disciplines. Second, third, and fourth year students were usually favored over first year students because the experience would be more productive and meaningful | to both the student and to his preceptor. In addition, advanced students are nearer. to the time when they must decide where they will practice. III. OPERATION OF PROJECT Close working relationships were developed between the principal - preceptors and their students. The externs lived in the communities where _ they worked. In addition to the principal preceptors, there were many others who supervised the externs for brief periods, so that the total number of preceptors involved in the program was over one hundred. This permitted the extern to benefit from a broad professional experience with a number of preceptors in various disciplines and specialties. Basically, operation of the program called for a moderate amount of structuring and scheduling, enough to provide stability of planning, but at. the same time not being too rigid, thereby allowing some degree of freedom of action for the externs. This permitted them to participate in deciding how they would like to spend part of their time, according to their own individually developed interests. | On June 18th of this year, a general orientation meeting for preceptors and externs was held in the Lakes Area Regional Medical Program offices. Approximately 85% of the externs attended this meeting. _ -4- Chautauqua County in particular held a number of orientation, discussion, and critique sessions while the project was in operation. In addition, the Chautauqua County group formed a planning and advisory committee which functioned before and during the program period. This committee was an important factor in the outstanding success of the | Chautauqua County effort. | | -Externs were paid a stipend of $75 per week. Housing was arranged by the externs , except in Chautauqua County where the W.C.A. Hospital provided rooms. The diversity of experience of the externs was most extensive. In addition to having contacts with all hospital departments, most of them went out into the community under the supervision of various preceptors and enjoyed an enriching experience in many aspects of health care delivery and delivery of health related services. This occurred in rural, semi- rural, and small urban areas and included patients from each of these areas. Medical and dental offices were involved, as well as. public health offices, social service agencies, nursing homes, community: pharmacies, family practice centers, physicians’ home visits, and home visits with the Visiting Nurses Association and public health nurses. IV. COSTS . The following is the budgetary breakdown of the 1974 Rural Externship Project: Stipends | $33 ,800 Salaries & Benefits 12,700 Travel © 2,850 Publications 700° Other | _250 TOTAL $50,300 -5- V. PUBLICITY . Interpretation of the 1974 Rural Externship Program to health | professionals and the general public in the region was excellent. Externs were well received by both the professional and the general community. Many newspaper articles appeared in a large number of local papers, and the © project was carried on the wire services. Articles included several | feature stories of personal interviews with externs: and preceptors. Accounts of the undertaking were heard on radio stations. Letters were written to area legislators concerning the project. Interested and favorable replies were received. VI. RESULTS AND EVALUATION Comments of preceptors and externs alike have been overwhelmingly favorable and enthusiastic. Many of the externs have asserted that they . plan on a rural practice following graduation. Specific quotations appear in attachments to this review. | | | Following are several tables selected from the evaluation questionnaires of students and preceptors. These tables are significant in their indication of attitudinal changes. on the part of the externs. They point out clearly the substantial degree of success apparent at this time in accomplishing the Project's objectives. Contact will be maintained with the students whenever possible so as to be able to determine the degree of accomplishment of goals and objectives over the longer term of several years. -6- TABLE II: Career Plans of Students Regarding Rural Practice On both the pre-program questionnaire and the questionnaire given after the Externship students were asked the following two questions: ‘J. Would you consider the possibility of working in a rural ‘area when you complete your training? 2. Do you have plans to work in a rural area when you complete your training? "Yes" Before "Yes" After - Would you consider...? 81.5%. 97,12 Do you plan...? . 815% 42.9% (N= 54) — (N= 35) TABLE III After completion of the program, students and preceptors were asked: _ "Would you like to see this program incorporated into the school curriculum?" . Students Preceptors Yes | 68. 6% 56.3% No ne 11.4% 25.0% Uncertain - 20.0% | 18.6% TOTAL 100.0% 99.9% (N = 35) (N= 36) -7- TABLE IV - Answers to the post-program questionnaire indicated that several significant changes had occurred in the students’ perceptions of rural practice. For example, "How would you rate the facilities available to the health professionals of a rural area?" Preceptors Students Before After Excellent 47.2% . | 5.8% ~ . 17.1%. Very Good 30.6% | 9.66 31.4% Good 16.7% 40.4% 8310..4 Fair 38.5% 20.0% - Poor 8.8 5.88 0.08 | TOTAL 100.12 100.1% 99.9% (N= 36) (N= 54) (N= 35). | TABLE V. "What is your overall impression of the quality of health care services offered by your profession in a rural as opposed to a metropolitan area?" | | Students ' - Before After Excellent 58% 28.6% Very Good 13.5% 45.7% Good oo 44.2% — 22.9% Fair - | - 30.8% 2.9% Poor __ 5.8% | __ 0.0% TOTAL 100.1% 100.1% (N= 54) (N= 35) -8- TABLE VI "The facilities most in need of development/improvement relative to | health care needs in rural areas are primarily related to:" Preceptors Students Before After Prevention 28.6% 36.5% 41.7% Primary Care — 40.0% . 38.1% 30.6% Rehabilitation 31.4% 25.4% 27.8% TOTAL 100.08 ==-—'100.0% +~—S100.1% (N= 36) (N= 54) (N= 35) TABLE VIT "I believe that the variety of health care services provided in rural areas is as great as in metropolitan areas." Preceptors Students Agree 52.8% 13.2% 31.4% Disagree . 41.7% . 66.0% «87.1% Don't Know _ 5.6% 20.8% = 1.4 TOTAL | 100.1% * 100.0% 99.9% (N = 36) (N = 54) (N = 35) VII. SUMMARY AND RECOMMENDATIONS Fifty-seven externs participated in the 1974 program, funded entirely by the Lakes Area Regional Medical Program. | : Externs were placed in all nine counties of the region. . Reports ‘on the results of the 1974 program were generally very favorable, from both preceptors and students. . 42.9% of the externs are definitely planning on rural heal th practice following graduation; 97. 1% are considering it. | Problems involved were basically minimal. Such concerns as housing, board, and personality conflicts offered only minor difficulties. _ The basic structure of the program was generally accepted. General activity guidelines and schedules allowing for ample flexibility were by and large the methods of choice of preceptors and students alike. Existing preceptors are more than willing to continue in a future | project, with several others already asking to be included in a 1975 program. | | The following specific recommendations for a future summer program are offered: | a. Generally speaking, a continuation of the 1974 mode of operation, especially with reference to program structure, content, and scheduling. Ridigity should be avoided. Most externs and pre- ceptor sites prefer flexibility. b. Preparation of brief outlines for preceptors in the various health _ disciplines so that they can understand more fully what they might cover, also including project background and what is expected of the preceptors. -10- c. Where possible, each extern should be assigned a primary pre- ceptor to whom (s)he can relate over the eight-week period. ‘d. Recruit more advanced health students. Those who are in the later years of their studies are able to benefit more from their “experience and make it a more satisfying one for their preceptors also. Besides, the advanced students are nearer to the time when _ they must decide on their locale of practice. e. More in-depth screening of student applications. A longer, more detailed application form could help accomplish this, seeking | more know] edge of students’ interests and background. | A final recommendation can be made which will serve also as a fitting . conclusion to this report. It may be stated simply that it is to be hoped that continuity of the project can occur, thereby assuring steady and progressive future implementation of its goals and objectives. In this manner, the Rural Externship Project will impart a lasting effect upon the region it seeks to serve. -11- Selected Student Comments Following Their Externship Experience "I feel this type of program would be extremely interesting and helpful to professional students uncertain of the area in which they intend to practice.” "T feel this is beneficial for all students working toward a career in the medical profession -- what could be better than working in your profession and being exposed to related health professions." . "The experience, both clinical and patient contact, has been invaluable." "IT personally feel that the first-hand experience makes the classwork more relevant." . "I was surprised to find such competency in a smal] hospital." "I was not sure that health care would be as integrated as it was. The health professions were really interested in knowing the total picture. " "IT have lived in a rural community all my life and this summer's experiences have served to confirm and expand my previous expectancies." "The regular medical care was what I expected, but the atmosphere that pre- vailed was unique -- that of a small united community." "I expected medical practice in the rural area to be somewhat ‘backwards' and I found this a to be true at all." "I feel that this sort of exposure has enhanced my educational career greatly." "I was very satisfied with this year's program. It proved to be an invaluable experience for me.” . a "! think it would be very challenging and self-satisfying to be employed in a rural setting; people seem to be more dependent on you, and more grateful for your services." "I will practice in a rural area with no reservations." "I enjoy the atmosphere in rural areas; although not sophistic.ted, there jis still an air of professionalism on the part of the pharmacist. I also enjoyed the confidence the rural people had in the pharmacist in many areas." "Overall, I think it is a great program, and-I wouldn't have traded my two summers for anything. I hope others got as much out of it as I have. The one important lesson I've learned is that all disciplines must work together to deliver quality medical care, no matter whether it is rural or metropolitan. The people in Jamestown were great and more. than willing to help." -12- Student Comments (Continued) "I think the program is very good. It offers the student some practical experience in his aspired discipline and provides a little incentive along side. I would encourage that the program be considered in future years." "I felt the program was a definite success. The people and experiences I encountered greatly enriched my appreciation of pharmacy, health care, and the patient. The encouragement 'I received from my preceptors was deeply appreciated. I am going to strongly recommend the program to anyone in Pharmacy School as invaluable experience in their undergraduate training." "Thank you for allowing me to participate in this program. I gained © valuable clinical experience and enjoyed living in Wyoming County." "I enjoyed the program very much. It has helped me greatly. I hope that I may participate next year. Thank you.” -13- LOCATION Andover, New York Arcade, New York Batavia, New York Bradford, Pennsylvania Dunkirk, New York Erie, Pennsylvania Franklinville, New York Gowanda, New York. 1974 RU - EXTERN Richard Cudahy Leonard Wagner Robert Baron Arthur Goodman Kim Keneske Patti Kulka - Debra McCracken | Janet Schoonmaker Margaret Mitchel] David Nash Lucienne Conti William Davis Rita DePhilip Sui-Hing-Ho Candace Johnson Helen Li Joel Owerbach Terri Smith George Walker John Norbund Stanley Scott PARTICIPANTS RAL_EXTERNSHIP PROJECT DISCIPLINE Medicine Medicine Public Health — Pharmacy - Medical Records Speech Pathology Nursing Physical Therapy Medicine Medicine Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Physical Therapy Pharmacy . Medicine © Dentistry PRECEPTOR Daniel Tartaglia, M.D. Gerald Diesfeld, M.D. Victoria Markellis, M.D. William Killen-. - Genevieve Chiodo, RMA : Ann Confer Dorothy Ekas, R.N. Melody Pollock, RPT George McNaughton George McNaughton Frank Mozdy, RP Frank Mozdy, RP Frank Mozdy, RP Frank Mozdy, RP Frank Mozdy, RP Frank Mozdy, RP Frank Mozdy, RP Ange LaFuria Frank Mozdy, RP Ovid Knight, M.D. Robert Watson, D.D.S. -14- LOCATION Jamestown, New York Lewiston, New York Lockport, New York Mayville, New York Newfane, New York N. Tonawanda, New York - PARTICIPANTS 1974 RURAL EXTERNSHIP PROJECT EXTERN Marc Fedder Joseph Felsen P. Scott Forsberg Peter Guzzetti Marsha Larson. Bruce Nohejl Cheryl Nohejl James Nord Rita Pridgen Albert Schlisserman Martha Slye ’ George Toufexis Dale Voelker Jonathan Woodcock David Wuertzer Elaine Jansen David Cavallaro Jessica Kort Stephen Stockton Mary Costello Mark Strassberg Kathleen Szymkowski — Barbara Penn Joseph Bylebyl ~ Mark Polis DISCIPLINE Medicine Medicine . Physical Therapy Dentistry Nursing Medicine Medicine © - Physical Therapy. Nursing Medicine Hospital Admin. Medicine Dentistry Medicine Podiatry Medical Technology | Podiatry Physical Therapy Dentistry Nursing Medicine Nutrition Medicine Medicine Medicine PRECEPTOR John Voltmann, M.D. Carl Hammerstrom, M.D. George Lawn, D.M., P.T. F. Palmer Lindblom, D.D.S. Marilyn Hale Glen Ebersole, M.D. Lillian Ney, M.D. George Lawn, D.M., P.T. Cynthia Dauch, Ed.D. H. Gregory Thorsell, M. D. Murray Marsh R.X. Williams, M.D. ’ Charles Sinatra, D.D. so Wilson Shaw, M.D. Bert & Eunice Klein, D. Pe M. " Polly Artley, ASCP Gordon Mittleton, D.P. Mm. Hanna Juul John Kugler, D.D.S. Arnold Mazur, M.D. Arnold Mazur, M.D. Arnold Mazur, M.D. Consan Dy, M.D. ichard Carlson, M.D. arry Byleby], M.D. -15- LOCATION Olean, New York . Perry, New York Springville, New York | Warsaw, New York Wellsville, New York West Seneca, New York PARTICIPANTS 1974 RURAL EXTERNSHIP PROJECT EXTERN | ‘Robert Krall Ellen To Victor Vena Joseph Graham David Sokal Susan Bruch | Fabia Kwiecinski John Verby Vivian Wasik Marilyn Jordan Warren Krutchick DISCIPLINE Medicine — Medical Technology. Pharmacy Medicine Medicine Occupational Therapy Medicine ‘Medicine — Nursing | Nursing Dentistry PRECEPTOR Arthur Beck, M.D. Elaine Brown - Donald Jones Paul Murphy, M.D. Timothy Siebel, M.D. Gail Riley, OTR R.T. Williams, M.D. M.F. Smallwood, M.D. Patricia Stopen, R.N. Wellsville Nursing Home Ronald Zeilin, D.D.S.