Description

The shortage of family physicians in rural areas is an ongoing problem. To address this shortage, rural healthcare organizations in Wisconsin came together to develop a solution that would provide rural training opportunities for physician residents, increasing their exposure to rural communities and their experience in rural practice. What began as the Wisconsin Rural Training Track Collaborative in 2012 was soon renamed the Wisconsin Collaborative for Rural Graduate Medical Education (WCRGME).

While WCRGME does not have a formal membership, they collaborate with many organizations from multiple communities. At the beginning of WCRGME, 9 healthcare organizations from Wisconsin towns like Ashland, Baraboo, and Monroe came together to promote the development of Rural Training Tracks (RTTs) in Wisconsin. This has expanded to over 60 rural hospital sites, residency programs, and partner organizations that are invested in rural graduate medical education (GME). WCRGME provides technical assistance and support to both existing programs and programs in development as a strategy to not only grow GME but sustain healthy programs in the future.

WCRGME members meet regularly via Zoom to share best practices, discuss needs and challenges, brainstorm collaborative solutions, and provide support for new initiatives. WCRGME also markets the state's rural training opportunities through national conferences, regional presentations to medical students, and through its website and social media platforms.

In 2012, the Rural Wisconsin Health Cooperative (RWHC) received a 3-year start-up grant from the Wisconsin Rural Physician Residency Assistance Program (WRPRAP) that allowed for the development of WCRGME. WRPRAP is funded by the Wisconsin state legislature through the passage of Wisconsin Act 190 which became effective July 1, 2010. The initial grant has been renewed through 2023 with continued funding anticipated in the future through WRPRAP and other sources.

Services offered

WCRGME's offers the following rural GME opportunities:

• 3 rural general surgery programs
• 2 hospitalist fellowship programs
• 2 emergency medicine fellowship programs
• 4 rural family medicine residencies
• 2 rural psychiatry residencies
• 1 rural pediatrics residency
• 1 rural OB/Gyn residency
• 1 rural Meds/Peds residency
• 1 rural dermatology residency
• 3 programs in development (family medicine residency, emergency medicine fellowship, hospitalist fellowship)
• 15 urban residencies with rural rotation options

Additional services provided:

• New program planning and rural rotation site development
• Informational presentations
• Annual Medical Education Administrators and Coordinators Workshop
• Annual Rural and Community Medical Educators Faculty Development Conference featuring a pre-conference Rural Research Spotlight Poster Fair and Residency Recruitment Fair
• Assistance with GME funding questions
• Development of statewide rural GME directory and website
• Provide rural-sensitive education, certification, and mentoring for faculty, community preceptors, and administrators/coordinators
• Accreditation and GME technical assistance
• Project management
• Best practice resources
• Promotion of rural GME at medical student events nationally and regionally
• Initiatives to recruit medical students into rural GME programs, including promotional videos, fairs, and presentations
• Rural Graduate Medical Education
• Technical assistance

Results

• Rural GME slots increased from 26 to 52 positions with more new programs in development.
• Developed rural training programs in primary care specialties including family medicine, general surgery, psychiatry, and OB/Gyn.
• Increased interest from traditional residency programs and hospitals wanting to offer rural experiences to their residents.
• A faculty development conference aimed at rural and community preceptors is held annually.
• GME Leadership Academy created in partnership with the Wisconsin Northern GME Consortium (WiNC) and Medical College of Wisconsin - Central Wisconsin Campus.
• Medical Education Administrators and Coordinators (MEAC) are now served by an annual workshop developed to provide networking and leadership development opportunities.
• Rural Coordinator Leadership Institute and Rural Coordinator Bootcamps held annually.

WCRGME received the Wisconsin Rural Partners award in 2015 in recognition of being one of Wisconsin's top rural development initiatives.

Publications:

Bruksch-Meck, K., Crouse, B., Quinn, G., McCart, L., & Traxler, K. (2018). Graduate Medical Initiatives to Develop the Physician Workforce in Rural Wisconsin. Wisconsin Medical Journal, 117(5), 201-207.

Challenges

• Even when a healthcare facility has interest in GME, there may be limited knowledge of how to establish or manage a residency program. Rural hospitals may also struggle with determining the optimal structure or potential program.
• WCRGME quickly realized that each of its members was in a different place with regards to organizational capacity, interest, and expertise. This resulted in the need to tailor presentations and training for different experience and interest levels.
• GME funding is complicated and there are many options available to rural hospitals. Understanding of Centers for Medicare & Medicaid Services (CMS) reimbursement, hospital types, and alternative funding sources is essential in development of GME at a regional scale.

Replication

  A centralized organization that can meet the needs and provide technical assistance for rural residency programs and sites is a great model. Rural healthcare facilities and traditional residency programs often have interest in GME and WCRGME works to leverage these networks in creating strong rural training opportunities.

WCRGME's Start a Rural GME Program section provides statistics, information, explanation of different versions of rural training programs, and future steps.

Contact Information

Lori Rodefeld, Director of Rural GME Development & Support
Wisconsin Collaborative for Rural GME
lrodefeld@RWHC.com