Indiana Sexual Assault Nurse Examiner Training Initiative: Positive Impacts for Medical Forensic Care.

BACKGROUND: Indiana ranks among the highest in the nation for child abuse and neglect reports. Already facing a persistent shortage of sexual assault nurse examiners (SANEs) to serve patients across the life span, residents with medical forensic needs were often being referred to other hospitals across the state for care or simply were not receiving medical forensic examinations because of lack of access to trained examiners. The Indiana SANE Training Project was established to evaluate the forensic nursing workforce throughout Indiana and work to expand access to qualified SANEs through training and collaboration with stakeholders, with a focus on rural and underserved areas of the state. METHODS: The Project gathered information from nurses who participated in activities during the first Project year. This information was evaluated for service gaps and ongoing training needs. The project coordinator then convened a workgroup of stakeholders and subject matter experts to evaluate and respond to the most immediate need-limited access to pediatric medical forensic providers. RESULTS: From September 2018 to December 2019, nurses were trained by the Project ( n = 160). Of those, 86% indicated that their hospital did not provide medical forensic examinations to pediatric patients. The Pediatric SANE Intensive was launched in October 2020 and trained pediatric SANEs ( n = 28). Upon completion, participants reported 47% increase in confidence and 56% increase in competence related to caring for pediatric patients. DISCUSSION: Statewide collaboration is a critical component of establishing a consistent approach to care, strengthening multidisciplinary partnerships, increasing access to medical forensic services across the life span and in rural and underserved areas, and promoting the Indiana Guidelines for Medical Forensic Examination of Pediatric Sexual Abuse Patients.

Using the AHEC Scholars Program to Enhance Health Professions Learners' Self-Efficacy for Practice Transformation.

The Indiana Area Health Education Centers Scholars program is a 2-year leadership program designed to supplement health professions students' academic training and enhance practice readiness around 6 core topic areas including practice transformation. The study was a retrospective cohort study assessing learners' reported level of self-efficacy on a set of 6 competencies around practice transformation and quality improvement. A total of 68 students graduating in the first cohort responded to the competency questions. Area Health Education Center Scholars reported a significant increase in self-efficacy on the competencies Identify issues emerging in health care delivery such as accountable care organizations, medical homes, and health insurance exchanges; understand how to practice effectively within the organization and culture of the interprofessional team, practice setting, and local health care system, and use an electronic health record to retrieve relevant information and to document care. This study found that learners reported a significant increase in self-efficacy related to implementing practiced transformation.

From pipeline to practice: Utilizing tracking mechanisms for longitudinal evaluation of physician recruitment across the health workforce continuum.

PURPOSE: Area Health Education Centers work with community partners to prepare a diverse, primary care workforce particularly among rural and underserved communities. We set out to assess our impact on the physician workforce across a multitude of short-term, intermediate, and long-term benchmarks METHOD: We used a comprehensive evaluation scaffolding to assess benchmarks of success across the workforce pipeline including short-term (i.e. pre-medical intent to pursue a health career or medical students' intent to practice in primary care), intermediate (college matriculation and primary care residency match rates) and longterm measures (licensure and medical practice location of program participants). RESULTS: We identified significant findings in each part of the AHEC program continuum. Among our alumni, we found a significant increase in the pre-medical learner's intent to pursue a health care career. Among medical students, we found a significant increase in intent to practice in primary care, rural areas, and medically underserved communities and a high rate of primary care residency match (compared to peers). Approximately one-third of licensed physicians are now practicing medicine serve in an underserved community CONCLUSIONS: Our findings confirm the value of longitudinal evaluation on confirming that participation in an AHEC supported program strengthen the physician workforce development.

Using area health education centers to promote interest in rural practice.

INTRODUCTON: In the USA, area health education centers (AHECs) work to recruit and educate students to serve in medically underserved communities, primary care, and rural settings. One important aspect of their work is connecting students with rural clinical experiences. Within these experiences, AHECs incorporate a community health/socioeconomic experience within the family medicine clerkship that may not be as prevalent in the standard family medicine clerkship experiences. The purpose of the study was to assess the relationship between AHEC-sponsored family medicine clerkships with a self-reported intent to practice in a rural setting upon graduation. METHODS: The study compared third-year medical students with the Indiana University School of Medicine, which participated in AHEC-sponsored family medicine clerkships to the standard family medicine clerkship. Following the 4-week clerkship, students were asked to report their intent to work in a rural setting using a five-point Likert scale. A χ2 test was used to determine the association of AHEC sponsorship, clerkship site location (rural/urban) and intent to practice in a rural setting. RESULTS: The study consisted of 587 students. There was a statistically significant association between self-reported intent and rural clerkship site, χ2 (1, N=587)=6.542, p=0.01. Furthermore, 21.6% (n=25) of students with a rural clerkship experience reported a greater intent compared to 12.3% (n=58) of students with non-rural clerkship experience. CONCLUSIONS: The study confirmed a significantly positive association between participation in medical clerkship experiences in a rural primary care setting and the intent to practice in a rural setting upon graduation. The results also support the potential value-added benefits through academic-community partnerships with AHECs, family medical and other primary care specialty clerkship programs may perhaps succeed in increasing student interest in pursuing a practice serving in rural communities upon graduation.