UTMB FMR Rural Training Track - better than ever!

Challenge to Society: 177 of 254 (70%) Texas counties are rural.

Rural Training:
Residents will spend their first 20 rotation blocks training with the larger group of FM residents in standard Galveston area rotations.

PGY1 continuity clinic will be held in the Family Medicine Center in the University Hospital Clinics building. During rotation blocks 14 – 20, continuity clinics would be relocated to Weimar, TX in partnership with our local RTT faculty at the Youens-Duchicella Clinic. Rotation activities would continue to be in conjunction with the larger group of campus-based FM residents during this time.

At the completion of rotation block 20, RTT residents would relocate to the RTT site for the remainder of their training. They will maintain connection with the campus-based resident cohort via web-based conferencing of weekly Thursday afternoon didactic activities and periodic returns to campus for in-person participation.

Rural Site:
The RTT site is located 138 miles from Galveston in Weimar, Texas (on I-10 west of Houston) and in the year 2000, the population was 1,981. The local hospital, Colorado-Fayette Medical Center is a 38-bed facility organized as part of a private 501(c)(3) corporation.

The Curriculum:
Rotation blocks 1 - 20: Essential Skills in FM (Orientation), Principles of Family Medicine, FM Hospital Service 1-3, MICU, OB1-2, Emergency Medicine, Pediatric Urgent Care, Newborn Nursery, Community Medicine 1-2, Pedi Inpatient, Behavioral Medicine, Geriatrics, Ambulatory Peds1, Surgical Subspecialties, Neurology and Nephrology.

Rotation blocks 21-39: Surgery 1-2, FM Hospital Service 4-7, Ortho1-2 & Sports Med, Cardiology, Gynecology, FM Outpatient Procedures, Ambulatory FM, Ambulatory Peds 2, Electives 1-6.

What residents say about the RTT Experience:
Residents have reported that their rural training experience gave them the skills and background to be more competitive for rural practice jobs after residency. Generally, all felt comparable to their peers in terms of knowledge-base but that they may have a competitive edge in terms of “hands-on skills” and confidence related to performing procedures.

Residents reported learning a lot about “practice management” and the business of medicine in the rural track. Another benefit most residents cited is the immediacy of consultation/collaboration from specialists and other services. Residents feel that provider-to-provider communication is better in the rural setting (especially when a procedure/hospitalization is needed), as is continuity of care for patients and the ability to preserve the educational continuum when patients require specialty care.

If you are interested in the RTT, be sure to mention this during your interview process.

RRC approves 20+19 Rural Training Track Proposal!!!

Everyone,

I am extremely pleased to share the news that the RRC has just notified us of approval of our proposal for the 20+19 model of the Rural Training Track!!!!

The three residents currently enrolled in the Rural Training Track will complete their training under the previous integrated longitudinal model. From this point forward, no new residents will be accepted into that track. Current PGY1 residents and those thereafter considering the Rural Training Track would participate under the new format, outlined below.

Residents enrolled in the Rural Training Track will spend the first 20 rotations blocks in Galveston. Residents will then relocate to Weimar, TX to complete the final 19 rotation blocks of their training. Residents’ PGY1 continuity clinic will occur in Galveston, followed by PGY2 and 3 continuity clinic in Weimar. During blocks 14 – 20, residents would commute to Weimar for continuity clinics while completing rotation assignments in Galveston under much the same format as our current hybrid track (reversed).

For detailed curriculum information, interested residents should contact Dr. Nash. Additional details will be shared with residents and faculty at upcoming meetings.

It is likely that we will match resident applicants to this track for June 2010 start dates, final decision pending further discussion at Leadership and Residency Program Meeting. (Residents matching to the track would relocate to Weimar in approximately January 2012. Current PGY1 residents interested in participating could relocate to Weimar approximately January 2011.)

Many, many thanks to those involved in this project FOR THE PAST TEN YEARS, as we take this long anticipated major step forward!!! To Angela Shepherd, who started the dream and then allowed me to lead it when I came on board, to Dr. Thompson who has been always supportive, to Nita Caskey who has done as much or more footwork, sweat and effort as I have, and to our Weimar docs – Robert Youens, Jorge Duchicela and Olga Duchicela – who have hung in there with us all this time, keeping the faith that eventually if we hung in there long enough, it would happen. Also thanks to the residents who participated in all the early stages and growing pains! There have been so many people involved in this project over the years, I couldn’t possibly name them all.

With much gratitude and excitement,

Lisa R. Nash, DO, FAAFP
Program Director
UTMB Family Medicine Residency

Doctors of the Day, Austin TX

Drs. Miguel Guerra (RTT resident) and Jorge Duchicela (RTT faculty)!!

growing again

It's exciting times here in Galveston. Lately the news is all good regarding the future of UTMB. The powers in Austin seem to be behind rebuilding and finally the UTS Board of Regents has also pledged their support. The current tentative plan includes restoration of 500+ hospital beds here on the island, which will put us in great shape with our hospital service.

We're also taking advantage of this opportunity to seriously consider some changes the Residency program has been interested in for a long time. This is very timely, considering the national interest in the patient centered medical home. We are looking to move from the very large and not particularly patient-centered mega clinic housing all residents and faculty (approximately 40 - 50 doctors) to smaller clinics that more closely resemble environments where our graduates are likely to practice after graduation.

We have submitted a proposal to the RC-FM for approval to move 4 residents (two PGY2 and two PGY3) to our Stewart Road Family Health clinic, where they will join 3 - 4 faculty in that practice.

We have also submitted a proposal for expansion of the Rural Training Track to conduct the final 19 months of training at our rural site. This proposal is also for 4 residents, two PGY2 and two PGY3. It's taken 10 years and hurricane Ike to get to this point and I can't tell you how excited I am that we're finally taking this step. When we hear from the RC-FM, I will post a detailed outline of the new curriculum.

A third proposal in the works is for a new clinical site on the mainland that will mirror the Stewart Road Family Health clinic. That site should be ready for residents at the beginning of the 2010-2011 academic year. One year farther down the road potentially is a revitalization of an old partnership with the county public health system. That partnership was rated very highly by residents in the program during its lifetime and will be an excellent addition to our clinical site options if we are successful in negotiating that renewal.

Most likely we will retain some campus or near-campus presence as well, so that could bring our outpatient facilities to five sites. It is also quite likely that we may continue our hospital service in two locations - one on the mainland and one here on campus.

It's been awhile getting to this point, and some gloomy and disheartening times to live through getting here, but the future truly is beginning to look bright for the UTMB FM program!

RTT article

An article about our Rural Training Track was published in this month's edition of Texas Medicine.

Departmental Review

Recently, our Department underwent the most recent formal review. These occur roughly every 5 years and are rather a big deal in the land of academic medical centers. Among other things, the Departmental Review identifies strengths and suggests areas for improvement. For this post, I'd like to share with you the strengths identified by our reviewers.

• 8/8/8 FMRP scheduled for next review in about 18 months
• Adequate patient volume to support most aspects of outpatient and inpatient training, with the exception of maternity care. (Maternity care being an area we've been working on with various strategies for the past several years. More to follow on that front...)
• Resident graduates who remain to practice in the region
• Unusually high percentage of residents graduating this year entering various fellowship programs
• Strong commitment to rural education via a rural track residency program
• Residen tcohort who reports satisfaction with attending support in both the hospital and ambulatory settings
• Adequate administrative resources in support of residency training
• Strong faculty commitment to residency teaching in all clinical venues
• Appropriate educational relationships with other disciplines providing training for Family Medicine residents

Attention R1s!

R1s who are interested in the Rural Training Track and/or Ball High Prenatal Clinic for next academic year need to submit:

Rural Training Track - updated/current CV, copy of your ITE scores, and letter or email outlining the reason(s) for your interest in the program. We will be scheduling interviews with the RTT faculty in the very near future. As a reminder, the RTT faculty choose the residents who will participate in the RTT. Current R2s will automatically be enrolled for PGY3 unless I hear differently from you... Jaime and Rene. Submit documents to the Program Director.

Ball High Prenatal Clinic - email or letter (to me) outlining the reason(s) for your interest in participating. Generally speaking, this opportunity is appropriate for residents who have a higher than average interest in including maternity care as part of their future practice.

Deadline is Friday, March 14 at 5pm.

Dr. Youens on the cover!!

http://www.texas-ec.org/texascooppower/

This month's Texas Co-op Power magazine has a very nice article on rural family medicine, highlighting Dr. Youens' practice in Weimar, TX. This is, of course, the site of our Rural Training Track! The RTT and some of the residents are mentioned in the article.

RTT applications due!!

R1s interested in participating in the Rural Training Track in PGY2-3 need to turn in your CV and cover letter stating why you are interested to me by THIS FRIDAY!!! So far, I have only Rene's application, although several of you have expressed interest. Please get that to me ASAP. Thanks!

Update on 11:40 and 4:40 appt slots in FMC - for an as yet undetermined reason, those appt slots have not yet been eliminated. I am trying to get to the bottom of it and will update you on the action plan as soon as possible.