From 1993 to 1997, researchers at the University of Missouri - Columbia, established a Rural Scholars Program and introduced curricular changes, including multidisciplinary opportunities for medical, nursing, and health services management students.
The project was part of the Robert Wood Johnson Foundation's (RWJF) national program Health of the Public: An Academic Challenge.
Missouri joined the Health of the Public program in 1990 with a project to improve long-term care for the frail elderly of rural Missouri.
In 1991, the medical school had revamped its curriculum, with a problem-based Introduction to Patient Care curriculum in the first two years, followed by a set of required clerkships in the third year.
Key Results: Under its second round of Health of the Public funding, the project reported the following results:
- The medical school introduced a required eight-week clerkship in family medicine for third-year students. Students spend four weeks in the family practice centers of the school's mid-Missouri residency program, and four weeks off-site in predominantly rural community practices.
- The school developed a Rural Medical Scholars program to promote primary care education and practice in rural communities.
The program identifies rural students predisposed to providing primary care in rural underserved parts of the state. Students can enter the program at one of three points:
- A preadmission program for rural college students.
- A summer preceptorship program for second year medical students.
- Participation in the rural training track for third year medical students.
Students can spend summer preceptorships in a rural community and can complete six months of their third-year curriculum in rural clinical training tracks in Rolla, St. Joseph, or Poplar Bluff, Mo.
- Two teaching practices about 25 miles from Columbia were added to provide community-based primary care experiences.
- In the multidisciplinary area, selected graduate students in medicine, nursing, and health services management worked together as a small group during two blocks of the Introduction to Patient Care curriculum covering psychosocial issues in health care and clinical epidemiology and prevention.
Each summer, students from the three disciplines also participated in the Health of the Public Rural Community Assessment Team, where they made home visits to elderly residents and evaluated demographic statistics and community-based resources.
Finally, the schools of nursing and medicine jointly established nurse practitioner teaching sites at an already existing rural physician practice. The joint practice works as a model for caring for rural nursing home residents and home-bound patients.
- The schools of medicine and nursing jointly published a bimonthly newsletter, Long-Term Links, distributed to more than 500 long-term care providers.
Regular features included news from the Division of Aging and the Missouri Association of Long-Term Care Physicians, population statistics on aging, a column on best practices, and a critical appraisal of current literature in long-term care.
- The project sponsored annual conferences, Caring for the Frail Elderly.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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