Enhancing a Rural Curriculum with Public Content John Bowling, DO Ana Luz Chiapa-Scifres, MS, MPH Disclosure Statement

• All individuals have disclosed no relevant financial relationships with any “commercial interests.” Purpose of Program

• HRSA Interdisciplinary and Interprofessional Graduate Joint Degree • Improve and expand the content and practice of in the Rural Scholars program. • 3 program components • Implementation of public health modules in ROME curriculum • Implementation of dual degree fellowship (DO/MPH) • Implementation of interprofessional collaboration through the Research Project Rural Scholars Curriculum Map

• Pre-matriculation • Rural Medicine Courses – Year 1 and Year 2 • Continuity Experience • Community Health Research Project • Core Clinical Clerkships – Year 3 • Clinical Rotations – Year 4

Family Medicine Continuity Site

Family Medicine Continuity Site Public Health Modules

• Goal: To increase competencies in public health and preventive medicine in the rural workforce • Each module consists of: • 6-7 contact hours • School of Public Health faculty lead sessions • Case studies related to rural health Module Framework

• Each module - 3 sessions • 2-3 hours each • Quiz • Review topics • Case Study related to rural health • Team-based class discussion Public Health Modules

Year 1 Year 2

Semester 1 Semester 2 Semester 3 Semester 4

Biostatistics Health Environmental Epidemiology Systems and Health Policy Community Health Module Topics

Epidemiology Biostatistics Community Health

• Descriptive • Study design • Determinants of epidemiology • Descriptive health • Surveillance statistics • Social determinants • Screening • Inferential statistics of health • Prevention and • Behavior change control of and motivational communicable and interviewing non-communicable • Smoking cessation diseases • Immunizations • Study design Module Topics

Environmental Health Health Systems and Policy

• Environmental pollutants • Core functions of public health • Outcomes of environmental • Public health governmental exposures agencies • Environmental policies • U.S. health policy process • Regulatory agencies • utilization and • Injuries costs • Rural environmental exposures • • Occupational health and safety • Health care systems Example of Module Objectives

• Epidemiology

Session Learning Objectives AACOM Osteopathic Core Competencies for By the end of this session, the student Medical Students: should be able to: Counseling for Health Promotion/Disease VIII Prevention • Define the terms epidemiology, epidemic, epidemiologist, and explain their importance. Apply quantitative epidemiological principles to inform clinical practice with 5. • Define, calculate and use the most commonly regard to screening and prevention used rates. (include limitations of study designs). • Define the terms incidence and prevalence, and provide examples of each. Identify and use existing sources of health 6. data as well as appropriate prevention • Identify, locate, and use existing sources of guidelines. data.

http://www.aacom.org/InfoFor/educators/mec/cc/D ocuments/CoreCompetencyReport2012.pdf Community Health

AACOM Osteopathic Core Competencies for Session Learning Objectives Medical Students: By the end of this session, the student should be able to: IX Cultural Competencies • Understand the framework of social Demonstrate effective communication that determinants of health. takes into consideration the ability to elicit • Understand the impact that social 7. another’s perspective, present concerns from determinants have on the health of another’s perspective, refrain from behaviors individuals and communities. that cause others to become defensive. • Identify the importance and effectiveness of health behavior change counseling. XII. Public Health Systems Competencies • Describe the theoretical basis for modern approaches to behavior change counseling. Apply understanding of the interaction of public health and health care systems in the 1. practice of osteopathic medicine as it affects health promotion and disease prevention. Environmental Health

Session Learning Objectives AACOM Osteopathic Core Competencies for By the end of this session, the student should Medical Students: Environmental and be able to: XI (OEM) • Identify and describe environmental policies and regulatory agencies, and their role in Understand the policy framework and major rural environmental health and safety 2. pieces of legislation and regulations related to environmental and occupational health • Describe the importance of injuries as a community health problem Complete an environmental health history, recognize potential environmental hazards 4. • Synthesize and discuss challenges faced by and sentinel illnesses, and make referrals for rural health of environmental conditions with environmental etiologies. exposures in the rural community XII Public Health Systems

Recognize the impact of environmental 6. influences on human health. Health Systems and Policy

Session Learning Objectives AACOM Osteopathic Core Competencies for By the end of this session, the student should Medical Students: be able to: XII Public Health Systems • State the three core functions of public health. Assess and address the factors influencing 3. • Be able to discuss factors driving growth in the use of health services. U.S. health care costs. Understand the role of health policy on • Become familiar with current trends in health 8. populations and individuals. insurance. Biostatistics

Session Learning Objectives AACOM Osteopathic Core Competencies for By the end of this session, the student should Medical Students: be able to: X Evaluation of Health Sciences Literature • Describe the key characteristics of experimental, quasi-experimental and Use appropriate tools to critically appraise 2. health science literature for its validity, observational studies (cross-sectional, case reliability, impact, and applicability. control, cohort and ecologic studies). Judge the statistical and clinical significance • Evaluate the quality of studies and level of 4. of findings in the health science literature. evidence studies provide. • Apply principles of descriptive and analytic biostatistics to evaluate scholarly literature. Prevention topics

Year 1 Year 2 Year 3

• Cancer prevention • Lifestyle modifications • Asthma and screening in CV disease • Tuberculosis • Skin cancer • Oral health preventive • COPD • Lung cancer • Cardiac conditions • Colorectal cancer • Disaster management and preparedness prevention • Well woman exams • Diabetes management and prevention • Women’s health • Psychosocial problems Successes and Challenges

Successes Challenges • All 5 modules have been • Agreeing and selecting the implemented content • Prevention threads • Understanding and integrating incorporated two different learning models • SPH faculty developed great • Scheduling case presentations Dual Degree Fellowship DO/MPH • Goal: To increase the number of rural physicians with public health training in the form of a Master of Public Health • 2 options to obtain an MPH • Through on-line classes • Taking year off between 3rd and 4th year • Full Tuition Scholarship and Stipend • MPH – Professional Option • 12 transfer credits – TCOM, 30 SPH credits Community Health Research Project

• Community Health Research Project • Part of Rural Scholars Curriculum • Takes place throughout 4 years of • Give students experience in community responsiveness, leadership, and scholarly activity. • Interprofessional Goal: To promote interprofessional collaboration between medical and public health professions.