|Medical School study illustrates benefits of rural-based curriculum|
A study conducted at the School of Medicine and Health Sciences illustrates that third-year medical students who participated in an alternative, rural-based curriculum emphasizing continuity-of-care scored at least as well in national examinations as students who took the traditional curriculum.
The study, published in the July issue of Academic Medicine, the Journal of the Association of American Medical Colleges, compared the test results and specialty training choices of 29 students who enrolled in the Rural Opportunities in Medical Education (ROME) program with 296 students who took the standard third-year curriculum, over a six-year period ending in 2004.
Results show that UND medical students who participated in the ROME program performed about the same as their classmates on national board examinations and, as a group, appeared to have a better grasp of patient care compared to students who were educated in the urban hospital-based program.
After earning their medical (M.D.) degrees, a total of 62 percent of the ROME graduates selected primary care residencies (family medicine, internal medicine or combined medicine-pediatrics) for further training, compared to 36 percent of traditional program graduates. Thirty-eight percent of ROME graduates selected family medicine as compared to 16 percent of traditional students. Twenty-one percent of ROME students selected general internal medicine as compared with 11 percent of traditional students.
The study's authors are Roger Schauer, director of predoctoral education in the school's Department of Family and Community Medicine, and Dean Schieve, evaluation consultant and principal with the firm, DMD Consulting in Grand Forks. The article is titled, "Performance of Medical Students in a Nontraditional Rural Clinical Program, 1998-99 through 2003-04."
"These findings suggest that students in remote, rural, longitudinal, integrated learning environments can attain fund-of-knowledge scores comparable to the scores of students in traditional clerkships," said Schauer, "and may, as in this study, receive higher ratings for
ROME students spend seven months of their third year in a rural community, such as Devils Lake, Hettinger, Williston or Jamestown. Under the supervision of practicing physicians, they see a variety of patients and follow them through their treatment, providing continuity-of-care; whereas in the traditional format, students learn medicine in increments, devoting several weeks or more to the study of individual medical specialties.
"The approach used with ROME, in which students learn medicine in an integrated manner, emphasizing continuity-of-care, provides a rich experience as students get to know patients and family -- and the community -- over a longer time period," Schauer said.
The study shows that "there are alternative ways of doing what we do," he said, "that lead to comparable -- if not better -- outcomes as compared with traditional clerkships."
These findings "are consistent with the findings of other programs around the world that have taken a risk and done things differently," he said. "It shows that there is another way of teaching medical students, that we have to think 'out of the box,' if we want to put out primary care doctors, and those interested in rural practice.
"We don't have to do things the way we've always done them," he said, "and that's really the message."
Since the ROME program was initiated in 1998, 43 students have participated in it, with an
additional five students currently enrolled. All but one have said that, given the chance, he or
she would choose to go through the ROME program again, Schauer said.
At least three students who participated in ROME established their practices in rural communities in-state after residency, he said. "These have returned (to rural practice) after residency, and we're going to have more. They are more committed to rural primary care."
Schauer credits the school's initiation of and long-term commitment to the ROME program to Dean H. David Wilson, who provided leadership to develop a rural-based educational opportunity. "ROME would not be in place without Dr. Wilson," he said. Collaboration by the school's clinical science departments is also critical to the success of the ROME program.
Central to the success of ROME has been "the mentoring and teaching by community physicians and the support of hospitals and clinics in Devils Lake, Hettinger, Jamestown and Williston," he said.
Currently, two medical students are taking their third year of medical education through ROME at West River Regional Health System in Hettinger and three others will begin later this year in Williston and Jamestown.