The financial value of services provided by a rural community health fair.

There has been little discussion in the literature regarding the financial value of the services provided to the participants in health fairs. This article examines the financial value of preventive services provided through a community health fair in an economically depressed area of southwest Virginia. Current Procedural Terminology codes were assigned to the services provided in order to estimate costs participants might incur for such services. An average 50-year-old man would have paid up to $320 to obtain commonly recommended preventive services available free at the fair. An average 50-year-old woman would have paid up to $495. Overall, over $58,000 in services were provided through the health fair. This community health fair provided preventive services that many participants otherwise might have found to be cost-prohibitive.

The Appalachian Preceptorship: over two decades of an integrated clinical-classroom experience of rural medicine and Appalachian culture.

There is a need to encourage careers in rural medicine and to prepare potential rural physicians for life in rural communities. The authors describe a program that addresses this need, the Appalachian Preceptorship Program, and report the program's experience from 1985 to 2004. The Appalachian Preceptorship is a four-week summer elective conducted by the Department of Family Medicine of East Tennessee State University (ETSU) that offers students clinical preceptorships in rural areas of southern Appalachia. By the conclusion of the 2004 preceptorships, the program had served 225 medical students from 95 medical schools across the country and abroad. The program combines an individual community-based preceptorship with an interactive group instructional block, emphasizes rural medicine, and provides students an understanding of the interface between culture and medicine in southern Appalachia. Follow-up of Appalachian Preceptorship students during the 18-year period studied demonstrates that 82% of the 157 participants who matched before 2004 had selected residencies in primary care, with 60% entering family medicine. Those completing the program were more than three times as likely to practice in a rural community compared with the national average. Fifty-six percent of their practice settings carry multiple rural or underserved designations. The program has helped transform a legislative mandate to train doctors for rural communities into an institutional culture leading to more extensive programs and a greater recognition of ETSU's rural mission. The authors encourage other medical schools to develop combined clinical/classroom electives that reflect their institutional priorities and that can address a wide variety of clinical interests.

A student-run outreach clinic for rural communities in Appalachia.

East Tennessee State University's Department of Family Medicine (DFM) implements a student-run outreach clinic series that addresses health care needs of communities in the southern Appalachians. Offered during the third-year family medicine clerkship, the clinics link academic family physicians and students with community health care providers. Services vary with each community's needs, but include history taking, physical examinations, patient education, and testing. The planning and implementation that begin with an annual meeting of faculty and community representatives include visits by DFM personnel to the rural communities and orientations of medical students conducted by faculty and community representatives. Students rate this experience highly because it provides them with useful hands-on experience, reasonable autonomy, collaboration with community providers, and understanding the needs of the underserved. Community hosts rate students highly in their respect for patients, sensitivity to confidentiality, and professionalism. Identified weaknesses are attributed to the fact that the outreach clinics were established in response to community needs and did not follow a careful curricular development. There was little attempt to standardize the procedures performed by each student or the amount of direct observation and feedback they received from their preceptors. Changes are underway that will strengthen the educational value of the outreach clinics. Participating students are provided a daylong orientation during which they practice full and focused physical examinations and review common medical problems such as diabetes, hypertension, and depression. Students also now document the patients encountered, their medical problems, and the clinical skills practiced.