Clinical Clerkship Overview for Class of 2011 Oklahoma State University Center for Rural Health

1. Clinical Clerkship Overview for Class of 2011 Oklahoma State University Center for Rural Health William J. Pettit, D.O. Associate Dean for Rural Health and Course Coordinator November 17, 2008

2. Meet the Team William Pettit, D.O. Course Coordinator Vicky Pace, M.Ed. Clinical Training Coordinator Sherry Eastman Coordinator –Tulsa Office Dora Johnson Administrative Assistant II Not Available Kelby Owens SE Rural Coordinator Augelica Burrell SW Rural Coordinator Alexandra Bryant NE Rural Coordinator Morgan Farquharson Oklahoma AHEC Coordinator Note: NW Rural Coordinator to be announced

3. OSU-CRH Center for Rural Health Vision and Mission • Vision: To uniquely impact osteopathic physicians from the time they are students through the time they are practicing in rural communities by: • Training osteopathic students • Providing support services to osteopathic physicians and their rural practices • Strengthening the broader health care delivery systems in rural communities where they practice • Mission: To support the mission of OSU-CHS by seeking to improve health care in Oklahoma through • osteopathic student education and residency training, • research • program applications • advocacy and • alliances with others who share in our goals.

4. “…a greater emphasis on primary care can be expected to lower the costs of care, improve health through access to more appropriate services, and reduce the inequities in the population’s health.” (pg. 458-459) Source: Starfield, B., L. Shi, and J. Macinko. 2005. “Contribution of Primary Care to Health Systems and Health,” The Milbank Quarterly. 83(3): 457-502

5. Encouraging Rural & Primary Care PracticePre-Doctoral Training Grant • OSU Center for Rural Health Staffing Enhancements • Rural Medical Education Coordinator (Ph.D./Ed.D. level) • Four Regional Coordinators • Data Analyst • Rural Medical Education Curriculum • Perspectives for Rural Health (Spring 2009) • Rural Medical Care (Fall 2009) • Expanded Early Rural Experiences • Summer Rural Externship • Early Rural Experiences • Rural Health Student Organization

6. Perspectives in Rural Health (New: Spring 2009) • Introduction to Rural Health • Oklahoma’s State Office of Rural Health • Oklahoma’s Area Health Education Centers • Role of the Rural Preceptor and their Rural Lifestyle • Centers for Medicare and Medicaid & Oklahoma’s Policies and Politics • Rural Leadership Role and Local, State, and Federal Issues • Non-Physician Clinicians in Rural Practice • Rural Hospital: Not a Small Urban Model • Telemedicine and Rural Health Care • Medical Examiner’s Role in Oklahoma • Electronic Health Records • Introduction to Practice Management • Introduction to Billing and Coding

7. Rural Medical Care (New: Fall 2009) • Patient Education, Communication and Prevention of Disease • Rural Occupational Health: Accidents in the Rural Setting • Mental Health in the Rural Setting • Serving as the Team Physician • Neurology in Rural • Emergency Medicine in Rural ER • Review of the Geriatric Syndromes • Palliative Care and End of Life • Evaluation of Gait and Activities of Daily Living • Pediatric Practice in Rural • Obstetrics and Gynecology in the Rural Setting • Pediatric Cardiology for the Rural Physician

8. Encouraging Rural & Primary Care PracticeOsteopathic Residency and Internship Programs, 2008

9. OSU Physicians ClinicsExpanding into Rural and Underserved Areas • Michael Ogle, D.O. - Director, OSU Physicians Rural Clinic Services • Enid Clinic • Managed by OSU Center for Rural Health since 2007 • Staffed by 1 Physician Assistant – Certified • Country Club Gardens (Tulsa) • Managed by OSU Center for Rural Health since 2008 • Staffed by 1 Advanced Registered Nurse Practitioner • Exploring Future Sites • Okemah, Pawnee and others

10. Center for Rural Health’s Rotations • Summer Rural Externship for OMSI • 3 week volunteer summer rotation after first year • One month required rotations for OMSIII • Community Clinic, small clinics within 40-miles of Tulsa • Limited Oklahoma City sites are available for OKC students • Rural Clinic, clinics surrounding rural hubs • One month required rotations for OMSIV • Community Hospital 1 • Community Hospital II • Emergency Medicine

11. Encouraging Rural & Primary Care Practice Osteopathic Medical Students Completing Rural Clinical Rotations, Academic Year May 07 to May 08

12. Community Clinic Rotation • Clinics located within a 40-mile radius of Tulsa Bristow, Broken Arrow, Claremore, Cleveland, Drumright, Jenks, Mannford, Oologah, Owasso, Sand Springs, Sapulpa, Skiatook, Harrah (limited Oklahoma City options) • Orientation in Tulsa usually the first Friday of the month • Weekly didactics in Tulsa: • Rural Health Topics • Diabetic Treatment Standards • Variety of topics presented by rural physicians • Coding and Billing • Medical Curriculum Vita • “Hands-on” day with the Telemedicine Mobile Clinic (MTC) • Assignments include an interactive case presentation using distance learning techniques, evidence-based medicine, and presentation skills development.

13. Mobil Telemedicine Clinic

14. 2008 Community Clinic Rotation Sites

15. Rural Clinic Rotation Clinics located within approximately 50-mile radius of each hubsite Enid, Hennessey, Caldwell (KS), Alva, Miami, Grove, Jay, Joplin (MO), Poteau, Vian, Sallisaw, Stigler, Spiro, Idabel, Broken Bow, Elk City, Carnegie, Cordell, Hydro, Clinton, Altus, Hollis/Mangum, Ardmore Students are required to live in the rural community Orientations: Group orientation at the Center for Rural Health – first weekday of the month. Site orientation with preceptor first day at the site AHEC orientation – (date/time varies by location) to discuss community resources for Case Presentation, the AHEC Kids in Health Career event and other planned community activities Weekly didactic sessions presented by physicians at the hubsite Monthly interactive residency videoconference Assignments include an interactive case presentation

16. 2008 Rural Clinic Didactic Coordinators

17. Community Hospital Rotation Required to live in or close to the hospital Use distance learning for assignments Current sites include (limited sites): Ardmore, Claremore, Drumright, Durant, Elk City, Enid, Guymon, Lawton, McAlester, Miami, Okmulgee, Poteau, Sallisaw, Stillwater, Tahlequah NOTE: This rotation is to experience how small hospitals and their patients vary from large hospitals like Tulsa or OKC. Not everyone can be scheduled “close to Tulsa”. Spaces will be filled year around, only limited spots available for January through April. You will be notified if sites are added or removed.

18. 2008 Community Hospital Supervising Physicians

19. Emergency Medicine Rotation • Live in or close to the hospital • Use distance learning for assignments • Current sites include Tulsa, Oklahoma City, Enid, and Lawton (new)

20. Emergency Medicine Supervising Physicians

21. Center for Rural Health Rotations All information, forms, schedules, and handouts are located online. Visit the Rural Medical Education Website. http://ruralhealth.okstate.edu Click-on the “Rural Medical Education” link Contact the physician two weeks before the start of each new rotation Read the online syllabus at the beginning of the rotation Attend events outside of the office when appropriate Community meetings, hospital rounds, staff meetings, business meetings, conferences, school athletic events, nursing home visits, etc. Dress professional: wear white coats and identification Check e-mail often and answer messages promptly

22. For Additional Site Information • Visit our website http://ruralhealth.okstate.edu • Click on the “Rural Medical Education” link • Select the rotation at the top Example: “Community Hospital” • Click on the “Sites and Directory” • Click on any of the links for more information about the City, the Hospital, the Clinic, the Preceptor, or the rotation • Updates over the next few months

23. Center for Rural Health Rotations • 100% Attendance is required • Students that miss a day at the clinic or hospital • Must get the preceptors approval. Preceptor may require student to make-up time missed • After three absences students must notify the Center for Rural Health and may be required to make-up time missed. • Students that miss an event or assignment • Must notify the Center for Rural Health and may be required to make-up work missed. • Online Site Evaluations are due at the end of the month • Verify the Center for Rural Health’s office has all paperwork before the 7th of the following month • After the 7th it is considered late and points will be deducted from the final grade.

24. Distance Learning • Polycom Equipment (usually located in the local hospital) • Used for Interactive Residency Video Lectures and the Case Presentations • Maintenance and support may be through the hospital and/or OSU-Telemedicine/Distance Learning • On site Computers (hospital, physician’s office, or house/apartment) • Used to connect to the Internet to check OSU email, do assignments, and access the OSU-Medical Library. Availability varies based on the site. • Flash Drives (1GB) • Distributed during Community Clinic or Rural Clinic Orientation • Must complete the online Student Information Form to receive • Keep and use for all Center for Rural Health Case Presentations • Interactive Laptop Computers checked out to students at remote sites to • Access the Internet to connect to OSU-COM • Use for interactive participation of selected didactics and Residency Video Lectures • Increase safety, decrease time away from physician’s office, and save money by reducing travel

25. Housing for Students on Rural Rotations Housing is a courtesy that Encourages you to stay in the rural area during the rotation Expands students’ training options across the state Decreases travel time for students from their site to the hubsites Provides off time to explore the local lifestyle, scenery, and events Saves student money and weekend travel time Housing provides A secure place to keep your personal items A place for you to prepare meals, work on assignments and sleep Housing may be A room in the hospital An house, apartment, or mobile home shared with several students A room in the home of an area resident Students Have the option of staying with family (if located close) Must let us know if you will NOT be using provided housing May chose to select and pay for your own housing if you wish to bring spouse, children, and/or pets

26. Center for Rural Health Coordinators OSU-CHS Rural Coordinators are your local OSU contact and may assist with Locating and scheduling housing for the student Orienting students to an area Identifying community resources in the area Processing required documents Selecting Electives Rural Coordinators Sherry Eastman, Tulsa Area, Main Office, 918-584-4375 Alexandra Bryant, NE Area, Tahlequah Office, TBA Kelby Owens, SE Area, Durant Office, TBA Augelica Burrell, SW Area, Lawton Office, TBA TBA, NW Area, Enid Office,

27. Area Health Education Center Coordinators AHEC may assist with Locating and scheduling housing for the student Orienting students to the area Identifying community resources in the area Assignments, didactic scheduling, videoconferencing Clinical Coordinators Morgan Farquharson, Oklahoma AHEC Program Office in Tulsa, 918-584-4368 Dianne Bostic, NE Area, Tulsa Office, 918-595-8403 Jennifer Billingsley, SE Area, Poteau Office, 918-647-8611 Teresa Mitchell, NW Area, Enid Office, 580-213-3166 Jenny Breeden, SW Area, Lawton Office, 580-581-2792

28. Thank You • We know you will have some great experiences. • We look forward to working with you! • Contact us if you have questions