Microsoft Word - Integrated Residency.docx Published by University of Minnesota Libraries Publishing Integrated Residency helps retain students in a regional campus residency program David L. Bramm, MD; Paula Clawson DOI: https://doi.org/10.24926/jrmc.vXiX.XXX Journal of Regional Medical Campuses, Vol. 1, Issue 4 (2018) z.umn.edu/JRMC All work in JRMC is licensed under CC BY-NC David L. Bramm MD; Dr. Bramm retired from his Family Medicine practice in 2015 and is now the director of the Rural Medicine Program at the UAB School of Medicine, Huntsville Regional Medical Campus in Huntsville, Alabama. Paula Clawson; Ms. Clawson is the Rural Medicine Program administrator at the UAB School of Medicine, Huntsville Regional Medical Campus in Huntsville, Alabama. David L. Bramm MD; davidbramm@uabmc.edu, UAB School of Medicine, Huntsville Regional Medical Campus, 301 Governors Drive SW, Huntsville AL 35801 (Office): 256-551-4609 (Mobile): 256-508-2189 (Fax): 256-551-4451 All work in JRMC is licensed under CC BY-NC Volume 1, Issue 4 (2018) Journal of Regional Medical Campuses Original Report Integrated Residency helps retain students in a regional campus residency program David L. Bramm, MD; Paula Clawson Abstract The Family Medicine Integrated Residency (IR) at the UAB School of Medicine, Huntsville Regional Medicine Campus is designed to attract rural students and to fully prepare them for Family Medicine Residency. It also provides a recruiting method for the residency to retain in-state medical school graduates. The 2017-18 pilot year had 5 fourth year medical students enrolled and they all matched in the Huntsville residency. Keywords: Integrated residency. Regional campus residency. Rural medical students. Alternative residency models. Since 2005, only 32.2% of the UAB Huntsville Family Medicine Residency has been filled with graduates of Alabama medical schools.1 This is concerning because in Alabama, 74.7% of physicians who do both their undergraduate and graduate medical training in-state set up practice in Alabama.2 This residency program accepts 12 interns per year. It is housed in the Huntsville Regional Medical Campus of the UAB School of Medicine (HRMC). The HRMC teaches clinical skills to a cohort of third and fourth year students, approximately 35 in each class. Included in these classes are a special track of Rural Medicine Program (RMP) students who grew up in rural Alabama, expressed an interest in rural family medicine, and have been exposed to a special rural curriculum. Even RMP students, who would seem likely to train in-state, tend to go elsewhere for residency. The entire UAB medical school graduates about 175 medical students annually. Additionally, 72 students graduate from the University of South Alabama College of Medicine. Though it would seem that the Huntsville residency could attract a majority of its intern class from in-state graduates, that has not been the case as of late. It is hard to quantify why in-state students do not choose the Huntsville residency. Perhaps the reason is the successful recruiting the program does at the regional and national level; RMP students may see this as an opportunity to spread their wings outside of Alabama before returning home to set up practice (to date, 96% of the RMP graduates set up practice in Alabama3). In an effort to increase in-state intern numbers and to further cement RMP students in Alabama, the Family Medicine Residency and RMP launched an Integrated Residency (IR) in 2017-18. The IR combines the requirements of fourth year medical school with intern experiences. Although IR students are not obligated to choose the Huntsville Family Medicine residency, all of the IR students matched in this residency in its pilot year. The IR is fashioned after a similar program at the University of Missouri School of Medicine. The Missouri program has operated since 1992 and every participant has chosen to match into their residency.4 The Integrated Residency is open to HRMC students from rural Alabama. The rural background requirement is because the funding source is specific to creating rural physicians for Alabama. It is well documented that students most likely to enter rural Family Medicine are those who were raised in a rural area, intend rural practice, intend primary care, and participate in a rural program.5 Applications are submitted in the spring of the third year with the interview and selection process duplicating the regular residency selection process. Selected IR students are notified in May and may begin some IR activities that fit in their schedule prior to the fourth year, which starts in late June. IRs engage in a more rigorous fourth year schedule, which includes a pulmonary medicine/critical care rotation designed specifically for IR students, a family medicine acting internship in UAB’s Huntsville Family Medicine Clinic and required rotations in normal fourth year elective offerings of anesthesia, nephrology, emergency medicine, and cardiology. The fourth-year specialty preceptors in Huntsville are community preceptors which were informed of the Integrated Residency goals. These preceptors expressed enthusiasm for working with students whom they expected to stay in Huntsville for residency. Even with these required rotations, students have time to take some additional electives of their choosing. These students had an acting internship in rural family medicine in the third year, and we hope to add a fourth rural rotation for IR students. DOI: https://doi.org/10.24926/jrmc.ADDHERE Journal of Regional Medical Campuses, Vol. 1, Issue 4 Original Report Additionally, the IR student must attend at least 50% of family medicine resident didactic sessions, at least 50% of the campus’ M & M conferences and Grand Rounds, and work 36 half-days in the Family Medicine Clinic under the tutelage of a senior resident mentor. The clinic work allows the IR student to become familiar with those in the patient panel they will assume when the mentor graduates. Students are required to post passing scores in Step 2 and be successful in each component of the curriculum. There are periodic reviews of the student to be sure they are fulfilling their obligations. Either party (the student or the residency) may back out of the agreement prior to the NRMP Match Day. The student must complete the ERAS application and rank their residency choices with NRMP. During this pilot year, all 5 IR students chose not to interview at other programs and chose the Huntsville residency as their only program for Match. Each Integrated Resident receives a scholarship of $20 000 to reduce medical school debt and are eligible for up to $5000 travel expense for conferences and medical mission trips. Different institutions handle this scholarship differently and offer varying amounts, but at Missouri 21 out of 23 integrated residents said they would have applied to the program even if the scholarship was nonexistent.4 In the 2018 Match, 9 of the 12 Huntsville interns (75%) are from in-state medical schools. It is impossible to know if any of the IR students would have chosen other residencies if not for this program. We know through conversation with RMP graduates from 2017 that 2 of those who matched out-of-state into Family Medicine would have chosen Huntsville if the IR had been available to them. REFERENCES 1. Date on file. University of Alabama School of Medicine Family Medicine Residency Huntsville. 2. 2017 State Physician Workforce Date Report, AAMC. Nov 2017. Alabama Profile: aamc.org/download/484510/data/albamaprofile.pdf 3. Data on file. University of Alabama School of Medicine Rural Medicine Program. 4. Ringdahl E, Kruse RL, Lindbloom EJ, Zweig SC. The University of Missouri integrated residency: Evaluating a 4-year curriculum. Fam Med. 2009;41(7):476-480.