Rural Opportunities in Medical Education (ROME) ROME is seven-month interdisciplinary, continuity

1. Full credit for Family Medicine & Surgery, Half credit IM, Peds, OB/Gyn IM Peds OB/ Gyn Psychiatry Performance Outcomes for Students in a Rural Immersion ExperienceRoger Schauer, M.D., and Dean Schieve, Ph.D.Office of Medical Education University of North Dakota School of Medicine & Health Sciences Williston Minot Devils Lake Grand Forks Results Standardized tests allow for measuring and comparing learning outcomes. T-test analysis shows no statistically significant difference in MCAT scores, NBME Step I scores, clinical shelf exam scores, or Step II scores for ROME students vs. traditional curriculum students. Mean scores sorted by ROME/Traditional Results: t-test analysis shows no statistically significant difference in MCAT scores, NBME Step I scores, clinical shelf exam scores, or Step II scores. Fargo Minnesota Bismarck Jamestown Hettinger ROME sites are starred. Campus sites are underlined. MCAT Scores Rural Opportunities in Medical Education (ROME) ROME is seven-month interdisciplinary, continuity experience in a rural primary care setting, available to Third-year medical students (MS3) at the University of North Dakota School of Medicine and Health Sciences (UNDSM&HS). ROME was developed to provide UNDSM&HS students an opportunity to experience and learn about rural health care and rural living. Five months of year 03 are spent in traditional clinical clerkships on one of two third year campuses. Goals are to provide the student with a comprehensive, broad-based primary care medical education while providing an opportunity to experience the lifestyle of rural health care providers. Students learn patient assessment, patient management, resources, and barriers to care commonly encountered in primary care.  Comments about exams: “…In my opinion, standardized testing has likely the most to do with the amount of independent study done and how well you are at ‘test taking.’ On the other hand, independence with clinical decision making and helping to understand your transition into the role of a physician were significant benefits of the ROME program. I certainly do not think the ROME program was a detriment to my shelf and USMLE scores.” Shelf Exam Scores ROME Students MS3 Rural setting, 7 months Traditional campus, 5 months MS3 follow-up comments about the ROME experience: “…Independence was a strength that translated well into my intern year. The one-on-one interactions with attending/supervising MDs was a strength. The OB portion was quite good, in that we were able to follow patients on a longitudinal basis as well as be present when they delivered was quite helpful.” “…I would repeat the experience in a heartbeat with great enthusiasm.” “…Working directly with the attending (my first experience with working with residents was when I was a resident!), the number of patients I saw in the ambulatory setting has made that transition from residency (a lot of hospital work) to practice (not very much hospital work) very easy. I also liked the freedom I had to attend any procedure, delivery, surgery that I wanted through the days/nights/weekends, as I saw more things spontaneously. A lot of my experience is attributable to the people in Devils Lake (ROME site) as they were very supportive of the program.” “…Now with my internal medicine residency completed, I realize the importance of the internists in that rural community. They function as consultants in many subspecialty areas that would have subspecialty consults in larger medical settings.” Traditional Students: 6 rotations MS3 Pediatrics Obstetrics Gynecology Surgery Psychiatry Family Medicine Internal Medicine Conclusion Students who take part in an extended rural immersion clinical training program perform as well in examinations as those students in a traditional third year clerkship program. Based on the provided sample of student comments, the benefits of the ROME experience extend beyond exams, beyond year 03, into residency, and possibly into practice. The statement “…I would repeat the experience in a heartbeat with great enthusiasm” has been repeated and echoed by virtually every student who has completed ROME. Problem – Initially there were warranted concerns about student outcomes because of less structured curriculum delivery opportunities at rural compared to traditional campus clerkships. We wondered whether ROME students would perform as well on third year clerkship shelf exams and the USMLE Step II exam as do traditional clinical curriculum students. NBME Step 1 and 2 Scores • Research Design • Study group: students in five medical school classes from 1999 to 2003 • N = 288 traditional third-year clerkship students and 35 ROME students • Performance outcomes variable: USMLE Step II scores and NBME shelf exams in the following areas: • Pediatrics Internal Medicine • Surgery Obstetrics and Gynecology • Variables to control for academic achievement/ ability prior to entering the third year experience: • MCAT (Physical Sciences, Biological Sciences, and Verbal Reasoning components) • NBME Step I scores (1st time takers prior to beginning year 03) • Class rank is not considered in approving ROME participation. Rural Opportunities in Medical Education was developed, established, and funded with the assistance of grants from HRSA, Bureau of Health Professions, Academic Administrative Units Grant Program