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Rural Medical Education


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Rural Medical Education

University of Wisconsin

School of Medicine and Public Health

Wisconsin Rural Health Development Council January 12, 2012


SMPH Continuum of Rural Educational


• Premedical • AHEC • RUSCH • Medical

• Third year required Primary Care Clerkship (8 weeks) • Fourth year required Preceptorship (6 weeks)

• Elective rural Family Medicine rotations (4 weeks) • Longitudinal Rural Rotation (5 months)

• Wisconsin Academy for Rural Medicine (WARM) • GME

• Department of Family Medicine State-wide Residencies • Baraboo Rural Training Track



The Wisconsin Academy for Rural Medicine (WARM) is a program at the University of Wisconsin Medical School dedicated to improving the supply of physicians in rural Wisconsin and improving the health of rural Wisconsin


This will be accomplished through a comprehensive rural medical education program combining a focused

admissions process with an educational program designed to prepare students for rural practice and providing


Strategic Initiatives Grant is awarded Collaboration Planning Grant is awarded Wisconsin Rural Medical Education Advisory Committee begins planning WARM 7/09: First cohort of WARM students relocate to Marshfield/ Rice Lake WARM receives approval from the Academic Planning Committee 8/06

Wisconsin Academy for Rural



7/2010: Second cohort of WARM students relocates to La Crosse and Marshfield 5/2011: First cohort of WARM students graduates from UW SMPH 2004 2005 2006 2007 2008 2009 2010 2011 7/07: WARM receives funding from the Wisconsin Partnership Fund 8/07: First cohort of WARM students enters medical school 7/2011: Green Bay hosts its first group of WARM students


WARM Admissions Process

• Targeted admissions process to identify applicants who

are likely to practice rural medicine

• Rural background/connectedness • Community engagement

• Specialty orientation • Academic success

• First full class of 25 began


WARM Admissions Data

2007 2008 2009 2010 2011 2012 Applications 12 27 40 40 55 61 Interviews 12 27 40 29 48 51 Offers 6 14 21 21 26 Admits 5 13 18 21 23 Ave GPA 3.79 3.65 3.62 3.65 3.57 Ave MCAT 26 30 28 28 29


2011 WARM Evaluation

Year-end GPAs, Step 1 Board scores, clerkship subject exam scores and YEPSA scores for WARM students are similar to those of typical UWSMPH students.

In short, in spite of the some incoming WARM students’

lower MCAT scores, WARM students’ performance in

medical school has essentially equaled that of their peers, and their performance on written tests and

clinical exams has been neither helped nor harmed by their participation in the WARM program.


UW SMPH Matriculating Student Questionnaire

Year 10K to 50K (not a suburb) Less than 10K Rural/ unincorp Total 2006 5.2 2.6 3.5 11.3 2007 3.0 2.0 8.1 13.1 2008 2.8 5.6 5.6 14.0 2009 4.6 9.2 2.6 16.4 2010 5.7 7.0 8.9 21.6 2011 7.8 8.5 2.6 18.9 Percentage of students indicating their plans to work in various size communities after their medical education.


WARM Curriculum

Yrs. 1 and 2

GPP assignments in rural clinics

Mineral Point, Belleville, Spring Green, etc.

Rural Health Interest Group

Overview of Rural Health Elective

Summer Externships


WARM Evaluation

Shadowing or working alongside a rural physician—as most

WARM students have done in the GPP or summer externships and all will be doing in 3rd and 4th year clerkships and

preceptorships—was the most influential rural health experience these students experienced.

Not surprisingly given the focus of the program, WARM students

enter the program with a very high level of interest in being physicians in rural underserved areas, and at the end of the 1st

and 2nd year, that interest level remains very high for most

students. In short, the impact of the past year on WARM

students’ confidence in their rural health skills is about twice as big as the impact on their desire to work in rural areas.


Years three and four—

• Live in assigned regional/rural learning


• Fulfill required core clerkships,

• Take electives


Student Comments

“I saw that medicine is a team approach, and you

get advice from other people and…you're working

with medical assistants, PA's, and everyone is

involved in the patient care as an active team

member. I think that is the biggest thing that I've

taken away…[In rural practices] there's only a few

of us, and so we have to be a strong team in


Student Comments - Challenges

Travel burden

Lack of interaction with traditional students

Rural faculty not accustom to teaching and SMPH

policies and grading

Some course specific challenges

From WARM Evaluation:

“There were also some drawbacks to being the only student on a rotation, although both WARM students felt the benefits outweighed the drawbacks.“


Student Progression Issues

• 4 WARM students did not pass USMLE Part 1 on the first


• 2 WARM students have been excused from the programs

regional/rural requirements during the 3rd and 4th years

• 3 WARM students have been reconsidering their

commitment to rural practice

• 2 WARM students have withdrawn from medical school

• 2 traditional students have transferred into WARM


Specialty Interests

2007 (5) 2008 (13) 2009 (18) 2010 (21) Fam Med FM/Psych 1 7 11 1 12 Int Med Med/Peds 1 1 Peds 1 1 1 Surg 1 1 Ortho 1 1 Ob Gyn 1 ER 1 3 2 Undecided/ other 2 1 3


WARM Student Awards

Third- and Fourth-Year Scholarship and Awards 2010-2011

• Carla Bouwkamp: Lora L. Marshall Scholarship

• Michelle Clark-Forsting: Robert F. and Irma K. Korbitz

Endowed Scholarship and the Ted Lefco Rural Medicine Scholarship

• Gena Cooper: Dr. H. James Sallach Scholarship and the

Dr. Paul and Alice Bishop Memorial Award

• Henry Clay Dean: Compassion in Action National

Community Health Award; Charles Russell Bardeen, Founding Dean, Fourth Year Student Award


WARM Student Awards

First- and Second-Year Scholarship and Awards 2010-2011

Jeffrey Clark: Dr. Anthony J. Kisley Scholarship

Karyn Laursen: Dr. Anthony J. Kisley Scholarship

Michael Otte: Lora L. Marshall Scholarship

Trista Stankowski-Drengler: Student Leadership and Service Book Award

Jasmine Wiley: Student Leadership and Service Book Award

Gabriel Berendes: Peter G. Hanson Scholarship

David Rebedew: Student Leadership and Service Book Award

Ian Stormont: Molly and Louis Hinshaw Medical School Scholarship;

McGovern-Tracy Scholars Award; Wisconsin Medical Alumni Association Student Scholarship



• Wisconsin Medical Society

• Robert T. Cooney, MD Scholarship

• Paul and Alice Bishop Scholarship

• Dr. Bishop was a primary care physician in Louisiana and Sauk

Prairie who loved practicing medicine

• Ted Lefco Rural Scholarship

• 1941 graduate of UW-Madison whose life work was as a


• Wisconsin Rural Opportunities Foundation


Next Steps

• WARM Strategic Plan process – initiated fall 2011

• Address course specific issues and continue faculty


• Enhance rural community engagement

• Help lead the clinical public health curricular transformation



 Byron Crouse, MD

Associate Dean for Rural and Community Health



 Alison Klein, MPA

Assistant Director, WARM





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