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Building the Future of Rural Care
Rural and frontier communities have a harder time accessing care due to long distances and a shortage of medical resources in their own communities. The leaders of the Rural & Underserved Utah Training Experience (RUUTE) program, Kylie Christensen (medical school) and Sri Koduri (residency programs/GME), share what they’ve learned about improving access for rural communities now and into the future.
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ccessing health care is a challenge for individuals living in Utah’s rural counties, often requiring hours of travel (or even days if a hotel is required for an early or late appointment). The state of Utah is ranked 49th in the nation for access to primary care—and it is worse for indiviudals living in rural communities. 

Within our own system, many of our patients travel 100 miles or more to receive care. These patients inspired us to take action to decrease the burden of seeking health care for rural communities by creating the Rural & Underserved Utah Training Experience (RUUTE) program

Through this program we are focused on improving access to care for rural patients by placing medical students and residents into their communities. Since 2017, we have received state funding to support the travel, housing, and salaries for medical students and residents in rural clinical rotations in underserved populations.

The program has offered us new insights into the benefits of rural medical training, not just for the community, but for medical students and residents, too. While these principles were learned in a rural setting, we think they apply to any program that is hoping to work within a community that is underserved in health care.

What we’ve learned

#1 Foster relationships

People who practice in a rural setting have to have a strong relationship with rural communities, or a strong passion or concern for them. That’s why health care providers from rural areas may be more likely to return home or practice in other rural areas in the future. However, many rural students have less exposure to professionals in health care. They may not know about their career options within medicine.

An integral part of the RUUTE program is to foster relationships with young people in rural and frontier communities to pique their interest in health care careers. Our team has developed curricula and presentations to connect with elementary, middle, and high school students and get them engaged with the health sciences. Our interactions with young people help open their eyes to career options in medicine, nursing and other health related fields. 

#2 Build cultural competency

Most of the medical students and residents who participate in the rural rotations through RUUTE may not go on to practice in rural care. However, the rotation can change the way they provide care in the future by increasing their understanding of the unique challenges of living in rural communities.

Exposure to rural communities increases empathy for patients and the struggles they face to receive care. It helps our future providers understand barriers to care, such as transportation, and offer more compassionate care in the future. Even if they choose not to practice in rural or underserved areas, they gain deep, firsthand knowledge of the social determinants of health, from education level to job opportunities, as well as the unique needs of rural patients.

Across the country, programs like ours have shown that the more you place future providers in rural and underserved areas and life, the better off those communities are, whether they receive temporary or permanent access to that provider. Programs like RUUTE foster a culture of education, and can be used as a recruitment tool. A medical student or resident might not know if they want to provide care in a rural setting if they have never been to a rural community. If a community, hospital, or preceptor can provide a medical student or resident with an exceptional learning opportunity, that medical student or resident may be more likely to practice care in that community someday. 

#3 Make the effort mutually beneficial

Anytime we can provide a patient with high-quality care closer to home, we improve their quality of life. By placing medical students and residents in rural places, we extend the support for local health care providers, enable future physicians to be well versed in caring for the patients—in person or through telemedicine. If retention happens, then we help create access to health care, thereby reducing patient travel, and the lost opportunity costs (e.g., missed school, work). 

Increasingly, rural providers now see the benefit of having third- and fourth-year medical students in their practice. Though these students cannot prescribe medicines or perform procedures unsupervised, they can take patient histories and perform other duties to save the physician time. On the other hand, medical residents often serve as physician extenders through rotations, enabling experiential learning. The Resident As Teacher (RAT) initiative also provides us opportunities to pair a medical resident with a student to act as a trainer. Wherever the RAT program is implemented, it takes an even bigger burden off the rural provider. 

Medical students and residents benefit from the program, too. Our program offers wellness support, housing, and other resources, and many residents report feeling less stressed on their rural rotations. They can move at a slower pace than urban rotations and feel more empowered to provide care. 

By building on these principles, we’ve been able to use the RUUTE program to fulfill the needs of rural communities, not just now, but into the future. 

RUUTE participants pictured above

  • Top left: Whitney Moss, MS4 completed her family medicine clerkship in Price Utah (pictured with her preceptor Dr. Shane Gagon).
  • Bottom left: Addie Langner, MS4 completed her family medicine clerkship in Beaver Utah.
  • Middle and top right: Tiana Tu, MS4 completed her family medicine clerkship in Panguitch Utah.
  • Bottom right: Nicholas Henrie, MS4 completed his general surgery clerkship in St. George (pictured with his preceptor Dr. Ryan Lewis).
Contributors

Kylie Chirstensen

Director of RUUTE & Regional Affairs, University of Utah School of Medicine

Sri Koduri

Director, Strategy and Workforce Planning (GME), University of Utah Health