Rural communities are facing shortages of a major
resource: healthcare professionals. A 2014 analysis from
HRSA's National Center for Health Workforce Analysis (no
longer available online) put this in
perspective—of the 32 health occupations
studied, over 80 percent had fewer providers per capita
in rural areas than in urban. Challenges such as economic
and educational disparities, coupled with rural
isolation, present hurdles in the recruitment and
retention of a skilled workforce in these areas.
Institutions across the country are seeking to address
these issues by designing ways in which students can
learn without having to leave their communities. These
initiatives help rural communities "grow their
own" healthcare professionals and allow rural
workers to advance their careers. New advances in
technology and information sharing have led some
universities to move from the traditional classroom
structure toward distance education courses and hybrid
(distance/on-site) programs that allow professionals to
keep working in their communities with minimal
disruptions for coursework. This helps students take
their newly acquired knowledge and skills back to the
hospitals and clinics where they currently work.
Rural students often face challenges that inhibit them
from attending traditional classes, according to Sue
Skillman, Deputy Director of the WWAMI Center for
Health Workforce Studies (WWAMI). Jobs, families and
location can stop some students from pursuing degrees,
Skillman said, but distance education courses give
students an alternative to conventional classroom
But with any change comes criticism. Some opponents don't
think distance education programs offer the same quality
as traditional classroom learning. Skillman, however,
sees great promise in this new form of learning. She said
that adding clinical training requirements and laboratory
experiences are ways that institutions can blend hands-on
components with online learning to create a better
education environment for students.
Some of the following institutions are doing just that.
Alaska OT Students Attend Nebraska School Via Video
Although vastly different, universities in Alaska and
Nebraska share something in common—a desire to
deliver healthcare to rural regions with limited access.
Creighton University in Omaha, Neb., and the University
of Alaska-Anchorage (UAA) have teamed up to create a
unique hybrid learning model that gives occupational
therapy (OT) students, regardless of location, a chance
to earn their doctorate degrees.
These two unlikely partners came together in 2008 to
address Alaska's shortage of therapists and its
maldistribution of rehabilitation services. Many factors,
such as the state's geography, remoteness, harsh climate
and scarce training resources, had contributed to this
problem; as a result, Native villages and communities
were suffering from inadequate care. From this
Creighton University Entry Level Distance Occupational
Therapy Doctorate Program–Alaska (OTD Program) was
Utilizing a unique hybrid distance education program,
residents of Alaska can earn a degree from the comfort of
home. Creighton University develops the curriculum and
content for the courses and distributes it through video
conferencing technology to students. Clinical adjunct
faculty in Alaska serve as mentors in the field and
assist the Nebraska faculty by teaching the lab and
experiential components of the program. The goals,
objectives and core content are identical to that of
Creighton University's on-campus pathway.
"Equipment, space and cost of starting, running
and sustaining a program can be a costly
endeavor," said Dr. Alfred Bracciano,
coordinator of the OTD Program. "An independent
program was not feasible."
An average of 10 students are admitted to the program
each year. Bracciano said that the program numbers could
fluctuate based on the needs of the community.
Creighton University, a private institution, and UAA, a
state institution, each brings its own expertise to the
partnership. Creighton has a long history of distance
education programs in the health sciences. In fact, it
had the first distance pharmacy program in the country,
so it had the infrastructure in place to develop other
distance education programs. UAA also had an
infrastructure available due to its array of disciplines
that had implemented distance education.
Students who wish to apply to the program are required to
demonstrate that they are prepared to enter a hybrid
program and show a particular interest for practicing OT
in Alaska. Alaska residents are given first preference
for this program, but non-residents can apply if they
wish to relocate to the greater Anchorage area since all
labs are facilitated at UAA.
One such student is Karianna Gallagher, who grew up in
Alaska and wanted to practice her chosen field in the
place that she loved. "I knew that I planned to
stay and work as an OT in Alaska after
graduation," Gallagher said.
"Therefore, I thought it was important to plan
my internships and network with the Alaskan OT community.
The Creighton distance program allowed me to do
Tuition is set at a mutually decided rate between the
institutions, including technology and lab fees. Students
can apply for scholarships to ease their financial
The sheer distance between the institutions and their
distinct regional nuances pose some challenges, which is
why communication is so vital for the well-being of the
"We must appreciate and respect the cultural
differences as we navigate and negotiate a completely
different system in Alaska," Bracciano said.
The program has proven itself successful by the number of
graduates who have remained to practice in the state. Two
graduates have even gone on to serve on the Alaska
Occupational Therapy Association's Board of Directors.
Physician Assistants (PAs) are helping fill the gap in
healthcare coverage in rural communities, particularly
for rural Medicare beneficiaries.
An innovative program in North Dakota addresses that
need, making healthcare in rural areas of the state a
University of North Dakota Department of Physician
Assistant Studies Program (UND PA Program) is a
hybrid distance-on-site program that aims to increase the
number of PAs in the state. Preference for admission is
given to students applying from rural, North Dakota
areas; however, students from other locations are still
encouraged to apply.
There are currently 306 licensed PAs in North Dakota. The
UND PA Program (the only PA program in the state) has
graduated approximately 50 percent of them.
This 90-credit program practices "sequential
growth" where students learn concepts and
skills in a series of alternating online courses,
didactic periods on campus, and clinical experiences, in
order to develop and apply primary care knowledge and
skills on an individualized basis.
"This format works well for our students as it
promotes sequential application of concepts shortly after
didactic instruction, which promotes retention of
content," said Dr. Jeanie McHugo, chair of the
UND PA Program.
During their clinicals, students pair up with licensed
physicians and/or PAs, who serve as clinical preceptors,
in medical facilities.
This model allows professionals in rural areas to teach
students firsthand how they practice and run their
clinics in hopes that it will make students want to
"It is a 'grow your own' mentality,"
This approach has worked well, as 82 percent of graduates
reside in the same city or town where they trained. This
means that nearly 46 percent of graduates practice in
A total of 1,721 graduates have completed the UND PA
program. This is good news, as the
Bureau of Labor Statistics projects that national
employment for PAs is expected to increase 38 percent
through the year 2022.
The UND program is funded through appropriated state
dollars and a Health Resources and Services
Administration (HRSA) grant for curriculum development,
which focuses specifically on rural healthcare needs.
Students are able to receive financial assistance through
two internal scholarships and a scholarship offered
through the North Dakota Academy of Physician Assistants.
McHugo said some local communities also have donated
money in the past to provide students with the funds to
complete the program, provided they return to work at
that particular healthcare facility.
The University of Missouri-Kansas City has created a
RN-BSN Rural Nursing Initiative (RNI) to address the
hardships that rural licensed nurses often face when they
go back to school. The program is one of the only ones in
the nation with a virtual practicum, allowing students to
attend while in their hometowns.
The program's inception was made possible by a HRSA
grant, which enabled the program to be entirely online.
It has since grown to be a self-sustaining
university-funded program. This set-up has helped rural
distance students receive the same quality education as
on-campus students, without an extra burden on them.
.JoAnn Klaassen, clinical associate professor at the UMKC
School of Nursing and RNI director, said rural nurses who
enter the program come in as a jack-of-all-trades,
whereas urban nurses tend to be more specialized in a
particular area. By allowing these groups to interact and
team up, Klaassen said, students are able to play off of
each other's skills to ultimately design programs that
benefit rural areas during a yearlong practicum
experience at the end of the program.
According to Klaassen, the program expands the view of
what's possible within the nursing profession and allows
students to form a new perspective on how they can use
what they know to impact and engage with their
"This initiative creates an authentic
engagement with rural communities," Klaassen
said. "Students feel like they are doing
something that makes a difference."
Around 300 students currently are enrolled in the program
and roughly 600 students have graduated from it.
Klaassen is excited about expanding the program globally
by offering practice experiences that apply to different
areas of the world. The program currently works with
rural hospital nurses in Ethiopia and has recently
started working with nurses in Liberia. "As
long as we have connections, we can go anywhere in the
world," she said.
In addition, the program is aiming to enhance
interprofessional experiences through future
collaborations with other medical fields like dentistry
and physical therapy. The program already collaborates
with social workers, pastors, educators, and the UMKC
graphic design department, in helping to create more
thorough practicum projects.
Students are among the program's biggest boosters.
Virginia Slaughter has recruited many students for the
program since she graduated from it. "This is a
well-organized program with tremendous faculty and
staff," she said. (For more, seeMissouri
RN Earns BS Nursing Degree Online)
WWAMI study found that the top concerns of rural
nursing professionals considering a distance education
program include difficulty relocating, commuting, limited
training opportunities in rural areas and the
affordability of distance education. Klaassen said she
believes technology can help alleviate these worries.
"We can do so much in the virtual
world," Klaassen said.