Faculty Chair:

John Andazola, MD

Contacts:

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Required Experiences:

Rural experiences in:

Lovington, New Mexico (Nor-Lea Hospital)

Silver City, New Mexico (Hildalgo Medical Services)

Lordsburg, New Mexico (Hildalgo Medical Services)

Various FQHC locations in Dona Ana County, New Mexico (La Clinica de Familia)

 

Weekly Schedule PGY 2 or 3:

Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
	Rural	Rural	Rural	Rural	Rural/Clinic
	Rural	Rural	Rural	Rural	Rural/Clinic

Optional Experience:

A second Rural elective is available

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Requirements:

ACGME

No specific requirements

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Description of Rotation or Educational Experience

All residents are required to have a rural experience. New Mexico is largely a rural state and one of the goal of the residency is to produce physicians who practice in these communities. The one month Rural Elective is intended to provide residents with a “field experience” however the majority of the residents rural education will occur during the 36 months of the residents education. Thus the Medical Knowledge and Patient Care sections of this curriculum will be the same as the FMC, FMS, ER Pediatric and Maternity Care rotations.

Brief Intro to Rural Medicine

Family medicine is the specialty most likely to be found in rural communities. Family physicians constitute nearly 90 percent of all primary care rural physicians’ and are the only source of medical care in many remote rural communities. The low population density that characterizes rural areas often cannot support the practices of physicians in the narrower subspecialties.

Rural family medicine presents an exciting and challenging opportunity for family physicians. The rural family physician has an opportunity to practice a broad scope of family medicine. Limits are usually based only on the physician’s training, experience and demonstrated abilities.

Most rural family physicians express a high degree of satisfaction with rural practice, even in the smallest communities. Among the many reasons for satisfaction expressed by rural family physicians is the feeling that their services are essential to their communities and deeply appreciated by the people they serve. Satisfied rural family physicians often cite their ability to provide continuing and comprehensive care to a broad mix of individuals and families from all socioeconomic backgrounds.

Expectations:

Residents:

Residents are expected to arrive to the rural clinics on time and to dress and act in a professional manner. They are expected to contact the Rural preceptors’ office prior to their first day on the rotation in order arrange the initial meeting time and location on day one of the rotation. It is expected that while at the preceptors’ office the residents will be respectful of the office space and personnel. The resident is responsible for maintaining a procedure log as well as completing assigned readings.

Faculty:

Rural faculty will provide precepting of cases and procedures as seen in rural clinics and hospitals. The Rural faculty are expected to allow the resident to participate in active patient care and procedures when appropriate. The preceptors should also provide time and allowance for explanation and teaching of patient conditions and their treatments, as well as issues facing the rural physician. Evaluation from each of the community preceptors to be completed timely at the end of each rotation.  All documentation of patient care by resident is to be reviewed by preceptors and attestation provided as per CMS guidelines.

Call:

Call will be determined by the location, but the ACGME duty hour restriction will apply.

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Patient Care

See the FMC, FMS, ED, Pediatrics, and Maternity care curricula

The objectives below should be followed during your entire residency if you plan to enter rural practice. Your advisor can help you guide your education to meet these objectives.

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:

Competencies

Objectives

In the appropriate setting, the resident should demonstrate the ability to:

• Identify obstacles to accessing care for individuals and families in rural settings, and engage in strategies to overcome these obstacles
• Develop respectful therapeutic relationships with vulnerable patients and families
• Define and assess health literacy
• Use an interpreter effectively
• Elicit patients’ health beliefs
• Engage in motivational interviewing (MI) or similar communication styles and
  behavior change strategies
• Describe and apply methods to enhance patient self-management/adherence
• Develop and implement a brief health promotion or health education presentation that is appropriate to the patient’s health literacy
• Define and implement health promotion and risk-/harm-reduction strategies
• Demonstrate familiarity with treatment guidelines for common medical conditions
• Develop an effective advocacy strategy to have an impact and influence change on the organizational and political levels
• Apply elements of the PCMH to an ambulatory health center
• Demonstrate ability to work within an interdisciplinary team
• Describe the role of health coaches and health promoters in an interdisciplinary
  team and demonstrate ability to incorporate their contributions into a patient care
  plan
• Demonstrate ability to collaborate with traditional/community healers
• Employ the fundamentals of community-based needs assessment
• Explain and apply asset-mapping techniques
• Identify key community stakeholders/leaders and establish communication strategies related to patient and community needs
• Acquire patient/community feedback through various venues (e.g., key informant interviews, focus groups) to be used as needs assessments for services and feedback on health delivery
• Describe resources available in the community and how to help patients access
  them
• Identify and use patient and community epidemiological data, needs assessments, and disease registries that pertain to the target patients and populations
• Identify environmental and occupational health risks and hazards in a community and ways to overcome them
• Apply COPC strategies
• Advocate for patients’ and communities’ needs at the local, regional, and national levels
• Engage in self-care practices that prevent burnout and in organizational activities that sustain and enhance professional satisfaction

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Medical Knowledge

See the FMC, FMS, ED, Pediatrics, and Maternity care curricula

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to:

Competencies

Objectives

In addition to the core clinical and health systems knowledge required of all family
medicine residents, in the appropriate setting, the resident should demonstrate the
ability to apply knowledge of the following:

Common clinical presentations in rural settings

• Chronic disease prevention and management in children and adults
• Child preventive care and issues related to growth and development
• Educational needs assessment and knowledge of resources to address learning
  disabilities
• Recognition of and treatment protocols for child, elder, or partner abuse
• Limitations of access to care based on real or perceived stigmatization of certain
  populations (including but not limited to patients who have HIV; lesbian, gay,
  bisexual, and transgender [LGBT] individuals; individuals who use intravenous
  [IV] drugs)
• Reproductive needs
  • Effect of culture on women’s health/reproductive health care options
  • Counseling and care of adolescents regarding sexuality, reproductive
    health, and prevention of sexually transmitted infections (STIs)
  • Care of pregnant adolescents and their families
  • Impact of legislation on women’s health and reproductive health care
    options
  • Disparities in care based on access to options
• Communicable disease
  • Prevalence and presentation in special populations: recent immigrants,
    individuals who are homeless, men who have sex with men (MSM),
    individuals who use IV drugs, adolescents, and prison populations
  • STI and HIV/AIDS prevention, diagnosis, and treatment
  • Common parasitic infections in immigrant populations
  • Tuberculosis screening, diagnosis, and treatment
• Mental health needs in special populations
  • Individuals who are homeless; immigrants/refugees; adolescents; LGBT
    individuals; individuals who use substances
  • Posttraumatic stress disorder (PTSD) related to exposure to violence, immigration experiences, war, and torture among immigrant groups
• Psychiatric emergencies, including familiarity with available transfer and referral resources
• Understanding of oral health fundamentals in a population that may not have ready access to dental care and what services may be provided in a family medicine office
• Screening, diagnosis, and treatment for substance use disorders in different population subgroups
• Practice of safe opioid prescribing for chronic pain, including identifying and addressing substance use disorders in patients who have chronic pain
• Counseling in behavior change strategies regarding nutrition, physical activity, substance use, and sexual practices/behaviors
• Violence, homicide, gun violence, and accident prevention
• Occupational hazards and work injuries commonly associated with rural settings (e.g., among farm workers, small industries, and service workers)
• Motor vehicle and bicycle safety
• Family systems and community ecology

 

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Practice- Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning. Residents are expected to develop skills and habits to be able to:

Competencies

• Identify strengths, deficiencies and limits in one’s knowledge and expertise;

• Set learning and improvement goals

• Use information technology to optimize learning

• Participate in the education of patients, families, students, residents and other health professionals, as documented by evaluations of a resident’s teaching abilities by faculty and/or learners

Objectives

• Recognizes his/her own strengths and limitations
• Asks questions as an engaged, critical learner
• Uses information technology to manage information, access on-line medical information, and support their own education

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Systems Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to:

Competencies

• Work effectively in various health care delivery settings and systems relevant to their clinical specialty

• Advocate for quality patient care and optimal patient care systems

• Work in interprofessional teams to enhance patient safety and improve patient care quality

• Participate in identifying systems errors and in implementing potential systems solutions

Objectives

Environmental and socioeconomic factors that affect the health and safety of
patients

• Patterns of employment
• Educational opportunities and barriers to learning in rural school systems
• Opportunities for and barriers to physical activity and healthy nutrition
• Exposure to violence within family and community
• Impact of historical violence and disenfranchisement on current social structures
• Opportunities for and barriers to political and social involvement by community
  members
• Safety issues in neighborhoods
• Patterns of discrimination
• History of incarceration/deportation of patients or family members
• Occupational and environmental health hazards
• Patterns of substance use and addiction
• Social service support and federally qualified health center resources, including elder care and childcare, housing, transportation, and employment agencies
• Local data regarding health disparities in different racial, ethnic, and
  disadvantaged groups
• Historical relevance of discriminatory laws and policies that have led to all of the above

Health systems issues and community engagement in urban settings

• Principles and practice of community-oriented primary care (COPC)
• Principles of authentic community partnerships
• Components of the chronic care model
• Models of interprofessional team care
• Models of health service delivery and sustainability in urban settings, including community health centers and hospital-based ambulatory networks
• Principles of risk reduction and harm reduction
• Community epidemiology
• Principles of community-based participatory research
• Elements of the patient-centered medical home (PCMH)
• Political structure and values, and their legislative influence on the community

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Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:

Competencies

• Compassion, integrity, and respect for others

• Responsiveness to patient needs that supersedes self-interest

• Respect for patient privacy and autonomy

• Accountability to patients, society, and the profession

• Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation

Objectives

• Accepts responsibility for patient care
• Consistently performs in a punctual, reliable and collegial manner
• Demonstrates dress, hygiene and manner of speech that consistently reflect appropriate standards
• Demonstrates a responsiveness to the needs of patients and society that supercedes self-interest

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Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to:

Competencies

• Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds
• Communicate effectively with physicians, other health professionals, and health related agencies
• Work effectively as a member of leader of a health care team or other professional group

Objectives

• Makes organized and effective oral presentations
• Communicates with consultants using tele-medicine, Phone or other distance communication to achieve the best car for the patient.

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Teaching Methods

Residents will provide medical care to patients under the direct supervision of the attending physician. They will be supervised on all procedures performed. Residents will participate in weekly conferences if they are located within a 50 mile radius of the residency program. Residents will be assigned specific reading topics to be completed by the end of their month on the service.

Assessment Method (residents)

All procedures will be recorded on New Innovations by residents. Evaluation from each of the community preceptors to be completed at the end of the rotation.  All documentation of patient care by resident is to be reviewed by preceptors and attestation provided as per CMS guidelines.

Assessment Method (Program Evaluation)

Residents will be provided with an evaluation of their experiences and given the opportunity to provide feedback of the rotation during their quarterly IEP assessments.

Level of Supervision

The resident is directly supervised by the attending physician during all procedures performed. An Attending will be available the entire time the resident is on the rotation. An Attending will be available at all times during continuity clinic visits.

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Educational Resources

Readings:

 

Web Resources

Rural Information Center — The Rural Information Center (RIC) provides information and referral services to local, tribal, state, and federal government officials; community organizations; rural electric and telephone cooperatives; libraries; businesses; and, citizens working to maintain the vitality of America’s rural areas.

Rural Assistance Center — A product of the U.S. Department of Health and Human Services’ Rural Initiative, RAC helps rural communities and other rural stakeholders access the full range of available programs, funding, and research that can enable them to provide quality health and human services to rural residents.

National Rural Health Association — A national membership organization whose mission is to improve the health and health care of rural Americans and to provide leadership on rural issues through advocacy, communications, education and research.. Site offers educational resources, association products, journal article abstracts, and links to NRHA state chapters.

The National Rural Recruitment and Retention Network — Group of 45 state-based organizations cooperating to help place physicians in rural areas. Online form allows easy registration with the network.

Bureau of Primary Health Care Programs — The Bureau of Primary Health Care (BPHC) provides support for high quality community-based preventive and primary care to underserved populations and people with special needs.

National Organization of State Offices of Rural Health (NOSORH) — The NOSORH was initiated to become an influential voice for state rural health concerns. The members of NOSORH strive to develop increased communication and involvement with the 50 State Offices of Rural Health, build strong relationships with other health care groups, and find sources of revenue to improve its effectiveness.

Health Professional Shortage Areas — Provides lists of all areas, population groups, and facilities designated as primary medical care, mental health, and dental health professional shortage areas (HPSAs).

National Health Service Corp. — The NHSC brings together clinicians and the communities that need them.