Rural Practice Management 

Overview:

The Rural Practice Management rotation is a required rotation in the HSM fourth year curriculum. It can also be an elective rotation in PGY2 or PGY3. These rotations occur in the rural physician’s office and in other locations included in the rural physician’s usual practice. The teaching of rural medicine in the program includes this rotation as well as experiences in the Family Medicine Center, the noon conference series, and on other rotations (see other curricula).

Goals:

1. At the completion of this rotation, the resident will have an understanding of the practice of rural medicine.
2. At the completion of this rotation, the resident will have gained knowledge and skills in the areas of rural medicine pertinent to the practice of family medicine.

Objectives:

At the completion of this rotation, the resident will have demonstrated to the satisfaction of the rural medicine preceptor:

• medical knowledge in rural medicine pertinent to the practice of family medicine, including the appropriate evaluation and treatment of (MK): medical illnesses common in rural practice and injuries common in rural practice. Residents will learn about illnesses and injuries commonly seen in the Family Medicine Center, but will learn to evaluate and manage these conditions in a rural setting, typically without the ready availability of subspecialty consultants. In addition, residents will learn aspects of practice management and community medicine characteristic of practice in a rural setting.
• the ability to perform an appropriate history and physical examination on the rural medicine patient and to present these findings to another physician in an appropriate manner (PC).
• the ability to interpret appropriate data related to the rural medicine patient and arrive at reasonable diagnostic and management decisions, weighing alternatives, benefits and risks of diagnostic and therapeutic options, and co-managing patients appropriately with other specialists (PC).
• the ability to make appropriate decisions to assure high-quality care in a cost-effective manner (SBP).
• communication and interpersonal skills which facilitate positive and therapeutic relationships (ICS).
• the ability to work cooperatively with other health professionals as part of a healthcare team (PC).
• compassion, respect and integrity; responsiveness to the needs of patients and society that supersedes self-interest; accountability to patients, society and the profession; a commitment to excellence and on-going professional development (P).
• a commitment to ethical principles pertaining to the provision or withholding of clinical care, confidentiality of patient information, informed consent and business practices (P).
• sensitivity and responsiveness to a patient’s culture, age, gender and disabilities (P).

There are no specific procedural requirements for this rotation. However, there is a separate Procedures Curriculum, and residents may gain experience meeting these requirements during this rotation. Procedures typically performed by residents on this rotation include (PC): anoscopy, cryotherapy, electrosurgery, excision and destruction of skin lesions, incision and drainage of soft tissues abscesses, interpretation of radiographs and EKG’s, removal of foreign bodies, laceration repair and endoscopy.

Implementation:

This is a preceptorial rotation, so the resident is assigned to a particular rural physician or rural medicine group. The resident will accompany the rural physician during his/her professional activities in the rural physician’s office and in other locations involved in the preceptor’s usual practice. In the course of seeing patients, the rural physician will provide experiential learning, role-modeling and one-on-one teaching to the resident. At the discretion of the preceptor, the resident may be assigned to research specific topics in rural medicine.

The resident is responsible for contacting the rural physician prior to the start of the rotation to arrange a schedule for the rotation. Modifications may be made at the Director’s discretion to the resident’s usual residency obligations in order to facilitate attendance to the rural rotation. This may include usual obligations to his/her Family Medicine Center population, including attending scheduled clinics, caring for continuity patients admitted to Memorial Hospital and rounding in the nursing home The resident is not expected to attend noon conferences, but must continue to abide by duty-hour restrictions in keeping with usual program policies. Upon completion of the rotation, the resident must complete and return the evaluation form provided by the program.

Evaluation:

The rural medicine preceptor will complete an evaluation form at the end of the rotation. Residents will specifically be evaluated on the following ACGME Milestones:

• PC-1: Cares for acutely ill or injured patients in urgent/emergent situations and in all settings.
• PC-2: Cares for patients with chronic conditions.
• PC-3: Partners with the patient, family, and community to improve health through disease prevention and health promotion.
• MK-1: Demonstrates medical knowledge of sufficient breadth and depth to practice family medicine.
• PROF-2: Demonstrates professional conduct and accountability.
• PROF-3: Demonstrates humanism and cultural proficiency.
• SBP-1: Provides cost-conscious medical care.
• PBLI-2: Demonstrates self-directed learning.
• C-2: Communicates effectively with patients, families and the public.