Impact Over 3 Years of a Family Medicine-led Addiction Medicine Curriculum for Medical Students.

BACKGROUND AND OBJECTIVES: Innovations in medical school training are essential for family physicians to enter practice confident in addressing the opioid epidemic and substance use disorders. The objective of this study was to evaluate the effectiveness of a distance-learning addiction medicine curriculum led by family medicine physicians for third-year medical students. METHODS: Our prospective cohort study of third-year medical students compared our educational model to a traditional curriculum. Our distance-learning collaboration employed videoconferencing and community experts to engage students across Minnesota in an addiction medicine curriculum. Students in a family medicine-focused 9-month longitudinal integrated curriculum (LIC) participated in this 16-session curriculum while embedded in a rural or urban underserved community for their core third-year clerkships. We evaluated program effectiveness through a knowledge and attitude self-assessment survey of student participants before and after the program compared to students in a traditional curriculum. RESULTS: The pre- and postsurvey response rates, respectively, were 22.8% for the control group and 98.4% for the ECHO (Extension for Community Healthcare Outcomes) group. Compared to classmates in a traditional curriculum, program participants reported significantly higher self-perceived ability managing addiction concerns upon completing this curriculum (mean score of 3.2 vs 2.2 on a 5-point Likert scale, P<.001). CONCLUSIONS: Data from our LIC showed promise that the model can be effective in building confidence in students' abilities to practice addiction medicine. Because of its broad reach and low cost, this form of medical education may be a key model for medical schools to respond to the opioid epidemic and better serve our patients.

Factors Associated With Health Care Professionals' Choice to Practice in Rural Minnesota.

Importance: Rural health inequities are due in part to a shortage of health care professionals in these areas. Objective: To determine the factors associated with health care professionals' decisions about where to practice. Design, Setting, and Participants: This prospective, cross-sectional survey study of health care professionals in Minnesota was administered by the Minnesota Department of Health from October 18, 2021, to July 25, 2022. Advanced practice registered nurses (APRNs), physicians, physician assistants (PAs), and registered nurses (RNs) renewing their professional licenses were eligible. Exposures: Individuals' ratings on survey items related to their choice of practice location. Main Outcomes and Measures: Rural or urban practice location as defined by the US Department of Agriculture's Rural-Urban Commuting Area typology. Results: A total of 32 086 respondents were included in the analysis (mean [SD] age, 44.4 [12.2] years; 22 728 identified as female [70.8%]). Response rates were 60.2% for APRNs (n = 2174), 97.7% for PAs (n = 2210), 95.1% for physicians (n = 11 019), and 61.6% for RNs (n = 16 663). The mean (SD) age of APRNs was 45.0 (10.3) years (1833 [84.3%] female); PAs, 39.0 (9.4) years (1648 [74.6%] female); physicians, 48.0 (11.9) years (4455 [40.4%] female); and RNs, 42.6 (12.3) years (14 792 [88.8%] female). Most respondents worked in urban (29 456 [91.8%]) vs rural (2630 [8.2%]) areas. Bivariate analysis suggested that family considerations are the most important determinant of practice location. Multivariate analysis revealed that having grown up in a rural area was the strongest factor associated with rural practice (odds ratio [OR] for APRNs, 3.44 [95% CI, 2.68-4.42]; OR for PAs, 3.75 [95% CI, 2.81-5.00]; OR for physicians, 2.44 [95% CI, 2.18-2.73]; OR for RNs, 3.77 [95% CI, 3.44-4.15]). When controlling for rural background, other associated factors included the availability of loan forgiveness (OR for APRNs, 1.42 [95% CI, 1.19-1.69]; OR for PAs, 1.60 [95% CI, 1.31-1.94]; OR for physicians, 1.54 [95% CI, 1.38-1.71]; OR for RNs, 1.20 [95% CI, 1.12-1.28]) and an educational program that prepared for rural practice (OR for APRNs, 1.44 [95% CI, 1.18-1.76]; OR for PAs. 1.70 [95% CI, 1.34-2.15]; OR for physicians, 1.31 [95% CI, 1.17-1.47]; OR for RNs, 1.23 [95% CI, 1.15-1.31]). Autonomy in one's work (OR for APRNs, 1.42 [95% CI, 1.08-1.86]; OR for PAs, 1.18 [95% CI, 0.89-1.58]; OR for physicians, 1.53 [95% CI, 1.31-1.78]; OR for RNs, 1.16 [95% CI, 1.07-1.25]) and a broad scope of practice (OR for APRNs, 1.46 [95% CI, 1.15-1.86]; OR for PAs, 0.96 [95% CI, 0.74-1.24]; OR for physicians, 1.62 [95% CI, 1.40-1.87]; OR for RNs, 0.96 [95% CI, 0.89-1.03]) were important factors associated with rural practice. Lifestyle and area considerations were not associated with rural practice; family considerations were associated with rural practice for RNs only (OR for APRNs, 0.97 [95% CI, 0.90-1.06]; OR for PAs, 0.95 [95% CI, 0.87-1.04]; OR for physicians, 0.92 [95% CI, 0.88-0.96]; OR for RNs, 1.05 [95% CI, 1.02-1.07]). Conclusions and Relevance: Understanding the interconnected factors involved in rural practice requires modeling relevant factors. The findings of this survey study suggest that loan forgiveness, rural training, autonomy, and a broad scope of practice are factors associated with rural practice for most health care professionals. Other factors associated with rural practice vary by profession, suggesting that there may not be a one-size-fits-all approach to recruitment of rural health care professionals.

Characteristics of International Rotations for Undergraduate Medical Education at United States Medical Schools: A National Study.

Objective: Medical education is criticized that it does not prepare students to serve in an increasingly globalized society. Evidence that global educational experiences can alleviate these concerns have contributed to the rise in international medical education experiences. This study explores surrounding characteristics and institutional support for international rotations across medical schools in the US. Methods: The authors conducted a sequential mixed methods exploratory national survey of international rotation coordinators at 185 US medical schools and 15 semi-structured interviews in fall 2018. Quantitative data were analyzed with descriptive statistics and qualitative data were coded and analyzed using interpretive description to identify themes across data. Results: There were 57 responses to the survey for an overall response rate of 31%, with 77% percent of respondents (n = 44) indicating that their medical school offered international rotations. Fifteen individuals representing 13 medical schools were identified as interviewees for the second stage of the study. International rotation coordinators described components of international rotations, including partnerships with host communities, use of third-party organizations, and supporting administrative and academic structures. Conclusion: Although international rotations are common in medical education, they are not positioned as core academic programming within medical schools. This leads to challenges in planning, implementation, and evaluation, and immense variation in rotation components across medical programs. Future research should explore best practices for pre-departure preparation, post-travel debriefing, and evaluation of student activity as well as impact on the host site. Additional research should include exploration of unique benefits of international versus domestic sites, and aspects of sustainable partnerships between medical schools and host communities.

Perceived Influence of Medical Students' Community Health Assessment Projects.

BACKGROUND AND OBJECTIVES: To achieve overall health, physicians must understand how community and population health impacts individual health. Although several US medical schools have incorporated community health assessment project requirements into traditional curricula, examples in longitudinal integrated clerkships are unknown. This study was designed to assess alumni perceptions of the influence of community health assessment projects, a core component of the University of Minnesota Rural and Metropolitan Physician Associate Program's (RPAP/MetroPAP) 9-month longitudinal integrated curriculum. METHODS: This 2018 study consisted of a descriptive cross-sectional survey of 480 RPAP/MetroPAP alumni who completed 457 community health assessment projects between 2004/2005 and 2016/2017. The authors administered a 14-item survey requesting date and location of RPAP/MetroPAP 9-month placement, name of project, source of project idea, and perception of project influence on professional activities. Quantitative data were collected using 4-point Likert scales. We collected qualitative data with open text boxes. RESULTS: The survey response rate was 42.29% (203/480). A key finding was alumni perceived project ideas arising from community partners had greater impact on their acquisition of several community engagement skills. One-half reported projects influenced their professional activities, evidenced by ongoing community engagement, interest and participation in public health and preventive health initiatives, efforts to learn about specific health issues, social determinants of health and patient advocacy. CONCLUSIONS: This exploratory study suggests medical student community health assessment projects enhance community engagement and soliciting project ideas from community partners increases student acquisition of community engagement skills.

Conceptual Framework of Mentoring in Low- and Middle-Income Countries to Advance Global Health.

Although mentoring is not a common practice in low- and middle-income countries (LMICs), there is a strong need for it. Conceptual frameworks provide the structure to design, study, and problem-solve complex phenomena. Following four workshops in South America, Asia, and Africa, and borrowing on theoretical models from higher education, this article proposes two conceptual frameworks of mentoring in LMICs. In the first model, we propose to focus the mentor-mentee relationship and interactions, and in the second, we look at mentoring activities from a mentees' perspective. Our models emphasize the importance of an ongoing dynamic between the mentor and mentee that is mutually beneficial. It also emphasizes the need for institutions to create enabling environments that encourage mentorship. We expect that these frameworks will help LMIC institutions to design new mentoring programs, clarify expectations, and analyze problems with existing mentoring programs. Our models, while being framed in the context of global health, have the potential for wider application geographically and across disciplines.