Microsoft Word - ImpactofaPrimaryCareArticle.docx Published by University of Minnesota Libraries Publishing Impact of a Primary Care Focused Regional Medical Campus on Recruitment into Primary Care Residencies Amanda Davis, MD; Stoney Abercrombie, MD; Nathan Bradford, MD DOI: https://doi.org/10.24926/jrmc.v2i1.1780 Journal of Regional Medical Campuses, Vol. 2, Issue 2 (2019) z.umn.edu/JRMC All work in JRMC is licensed under CC BY-NC Amanda Davis, MD; Dr. Davis is the Assistant Dean for Student Affairs for MUSC-AnMed Health Clinical Campus and on the faculty of the AnMed Health Family Medicine Residency Program. Stoney Abercrombie, MD; Dr. Abercrombie is the Campus Dean of MUSC-AnMed Health Clinical Campus and Director of Medical Student Education at AnMed Health. Nathan Bradford, MD; Dr. Bradford is the Internal Medicine Site Director for MUSC-AnMed Health Clinical Campus, and on the faculty of the AnMed Health Family Medicine Residency Program. Corresponding author: Dr. Amanda Davis; AnMed Health Family Medicine Residency Program 2000 East Greenville Street Suite 3600, Anderson, SC 29621 Phone: 864-512-1473 Fax: 864-224-8100 Email: amanda.davis1@anmedhealth.org All work in JRMC is licensed under CC BY-NC Volume 1, Issue 6 (2019) Journal of Regional Medical Campuses Original Reports Impact of a Primary Care Focused Regional Medical Campus on Recruitment into Primary Care Residencies Amanda Davis, MD; Stoney Abercrombie, MD; Nathan Bradford, MD Abstract AnMed Health is a community-based nonprofit hospital system in Anderson, South Carolina with a single residency in Family Medicine. In July 2014, a class of 12 third-year medical students associated with Medical University of South Carolina-Charleston (MUSC-C) and Edward Via College of Osteopathic Medicine-Carolinas Campus (VCOM-CC) began their clinical training at AnMed. Since that time, 58 medical students have completed their clinical training at AnMed Health, 71% have entered primary care residencies, and 38% have matched into family medicine. According to a Health Resources and Services Administration report, the growth in primary care physician supply will not be adequate to meet demand in 2020, with a projected shortage of 20 400 physicians.1 One way to increase medical student enrollment in primary care residencies may be through primary care focused regional medical campuses. Important factors in primary care specialty choice include longitudinal primary care experiences, an institutional culture which supports primary care, and student exposure to primary care faculty as leaders in the institution.2 Regional medical campuses are uniquely positioned to provide all of these factors. AnMed Health, founded in 1908, is a 461-bed, 3 hospital system located in Anderson, South Carolina. This city of 27 000 with county population of 198 000 is located in the northwest corner of South Carolina halfway between Atlanta and Charlotte.3 We are 225 miles north of the main campus of the Medical University of South Carolina (MUSC), located in Charleston. AnMed Health has a single residency program in Family Medicine that dates back to 1975 and has graduated 353 residents. Starting in 1976, the residency clinic served as a rural family medicine rotation site for MUSC third- year medical students. In 2014, MUSC-C and AnMed Health committed to an exclusive academic relationship to develop a clinical campus mainly for students interested in primary care. The goal was to have a total of 24 students at the regional campus (12 third- and 12 fourth-year medical students). Realizing how long it would take to develop a new campus and receive LCME accreditation, a joint decision was made to invite VCOM-CC clinical students to train at our site as we developed our campus. VCOM-CC was appreciative of this opportunity but fully understood that the commitment would only be for 5 years. We began with an initial MUSC-C pilot class of 2 students, followed by 6 students for the next few years. These classes were supplemented with VCOM-CC students to reach a class size of 12. In July 2020, we will have 24 students from MUSC (12 third- and 12 fourth-year students). In 2015, the LCME gave us initial accreditation as a parallel clinical campus. The LCME accreditation process involved a site visit. The goal of the LCME visit was to ensure that we were providing a comparable academic experience. We could also highlight what made the regional medical campus unique. We were tasked to show that all core clinical rotations completed in AnMed Health share the same objectives, requirements, and evaluation process as rotations completed at MUSC-C. We also had to show how we planned to track objective measures between both campuses (scores on shelf exams, procedure logs, etc.) to prove comparability of the academic experience. To accomplish this, we have site directors for each required rotation who work closely with their clerkship director counterpart at MUSC-C. This involves a yearly face to face meeting, with the MUSC-C clerkship directors visiting our clinical site. In addition, as a large group we have a monthly teleconference with MUSC-C clerkship directors and academic leadership, and 2 retreats per academic year (one in-person). All third-year rotations are completed in Anderson. Our dedicated group of site directors is supplemented by almost 200 additional medical staff members. All core fourth-year rotations can be completed in Anderson. Some students choose to return to MUSC-C for additional rotations in their specialty choice with many doing acting internships at other DOI: https://doi.org/10.24926/jrmc.ADDHERE Journal of Regional Medical Campuses, Vol. 1, Issue 6 Original Reports sites around the country. On average, we have 5 of our 12 fourth-year students doing away rotations per block. Unique to our regional campus, all of our third-year medical students participate in a longitudinal primary care rotation at Anderson Free Clinic. The clinic is a nonprofit entity, open Monday through Friday, staffed almost entirely by volunteers. There is a fully stocked pharmacy, and the clinic also provides mental health counseling, drug and alcohol counseling, and dental health services. Each student spends 20 sessions (every other Thursday afternoon) seeing 2-4 patients each session. The students follow a consistent set of patients for the year, with an average usual provider continuity rate of 67%. They serve as the primary care physician for their patients by writing prescriptions, ordering diagnostic tests, making referrals, and writing notes. They learn chronic disease management and hone their motivational interviewing skills related to drug and alcohol abuse, smoking cessation, diet, and exercise. There are 5 core preceptors for the medical student clinic (2 attend each clinic session). All are primary care physicians; 4 trained in family medicine and one in internal medicine-pediatrics. In addition to their time at the Anderson Free Clinic, our medical students are also involved with primary care community outreach. They volunteer at the local Hispanic Health Fair, have started to conduct influenza vaccination clinics at the local Salvation Army, and serve on local community boards and hospital committees. As of June 2019, we have graduated 58 students (5 classes: 7 MUSC-C and 51 VCOM-CC students). Of these, 71% have matched into primary care residencies (family medicine, internal medicine, pediatrics, or obstetrics and gynecology) and 38% matched in family medicine. In 2019, MUSC-C matched 41% of its graduates into primary care residencies, and 8% in family medicine.4 From 2015-2018, VCOM’s combined campuses (Carolinas, Auburn, and Virginia) matched 64% into primary care residencies, and 25% into family medicine.5 We will continue to track the 19 students who matched in pediatrics, internal medicine, and obstetrics to see if they specialize within their field. Several factors have led to this relatively high percentage of graduates in primary care, especially family medicine. Most of our graduates to date are from VCOM-CC, which has a reputation for matching a high percentage of students in primary care. Also, students who are interested in primary care from both MUSC and VCOM self-select to our campus. Finally, the primary care focus of our campus maintains and promotes student interest in primary care. Another goal of our Medical Student Education program is to recruit 1-2 graduates for our Family Medicine Residency each year (out of an intern class of 11). From 2015-2019, we have had 6 of our medical student graduates join our nationally competitive residency program. Many students entering family medicine choose to return to their home states to do residency training. This is being addressed presently by recruiting students for our clinical campus at the time of admission to medical school. Emphasis is given for interest in primary care and connection to South Carolina. We also hope to recruit our medical students to return to Anderson to practice once they complete their residency training. We will have our first graduate (Family Medicine) join our medical staff this year. Most of our medical student graduates are still in residency training. MUSC-C, a large academic health center and medical school since 1824, desires to produce greater numbers of primary care physicians for South Carolina. With limited clinical space for additional students in the Charleston area, the decision was made in 2014 to develop a clinical campus at AnMed Health in Anderson, SC with an emphasis on primary care education. After 5 graduating classes of students (58) from MUSC and VCOM-CC, we are pleased to have 71% of our graduates entering primary care residencies with 38% in family medicine. Our goal is to maintain this high percentage as we transition to an exclusive MUSC campus. Primary care focused regional medical campuses appear to be successful in attracting graduates to enter primary care residencies. References 1. HRSA, Projecting the Supply and Demand for Primary Care Practitioners trough 2020, https://bhw.hrsa.gov/health- workforce-analysis/primary-care-2020. Accessed February 12, 2019. 2. Bland CJ, Meurer LN, Maldonado G. Determinants of primary care specialty choice: a non-statistical meta-analysis of the literature. Acad Med. 1995 Jul;70(7):620-41. https://journals.lww.com/academicmedicine/Citation/1995/1 2000/Academic_Medicine.1.aspx Accessed March 3, 2019. 3. United States Census Bureau, https://www.census.gov/quickfacts/fact/table/andersoncoun tysouthcarolina/PST045217. Accessed February 14, 2019. DOI: https://doi.org/10.24926/jrmc.ADDHERE Journal of Regional Medical Campuses, Vol. 1, Issue 6 Original Reports 4. Medical University of South Carolina, https://education.musc.edu/colleges/medicine/about/facts. Accessed June 5, 2019. 5. Edward Via College of Osteopathic Medicine https://vcom.cld.bz/VCOM-Outcomes-Report/26/. Accessed June 5, 2019.