Medical Education Feature - February 2010
Tex Med. 2010;106(2):43-48.
By Ken Ortolon
In 2001, a chance encounter at a Texas Medical Association meeting between Crockett general surgeon J. Patrick Walker, MD, and a first-year medical student at the Texas College of Osteopathic Medicine (TCOM) led to an invitation for the student to do a two-week rotation with Dr. Walker and his partner, Ray Morrison, DO.
That two-week rotation turned into six weeks, Dr. Morrison says, and when the student, Paula Rossi, returned to TCOM, she offered to talk with other students about doing rotations with the two Crockett general surgeons.
"Every year at that time between the freshman and sophomore years, they would have to do at least a two-week rotation somewhere," Dr. Morrison said. "We told them we will do it for a month. The students came down and just really gave us a love for teaching."
When TCOM launched its Rural Osteopathic Medical Education (ROME) program in 2006, Crockett became one of about a dozen sites where students interested in careers in rural medicine could train in surgery, internal medicine, and obstetrics.
With support from community leaders and the Houston County Hospital District, Crockett has become something of a hotbed for rural medical education. The community showed its growing commitment to medical education earlier this year when it launched construction of a Rural Physicians Education Center to provide housing for TCOM students and family medicine residents from the Texas A&M Health Science Center doing one- to two-month rotations in the East Texas community of about 7,000.
Officials from both TCOM and A&M say the facility could be a model for rural medical education efforts elsewhere in Texas and the nation.
"I think Dr. Walker, Dr. Morrison, and the community of Crockett have really stepped up," said John Bowling, DO, assistant dean for rural education at TCOM. "We really want to use this as a template and a model for other rural communities in our program."
Added Dr. Walker, "We think this is a model where we can move a significant degree of medical education away from the big cities into the rural areas and, therefore, acquaint physicians with a rural component early in their career. We're dying for rural docs."
Creating a Model
The Rural Physicians Education Center opened in July. It was formally dedicated Nov. 23 at ceremonies featuring Gov. Rick Perry, state Rep. Chuck Hopson (R-Jacksonville), and other elected officials.
The facility was the brainchild of Drs. Morrison and Walker, who saw a need for more comfortable accommodations for residents and students training in Crockett.
Both Dr. Bowling and David A. McClellan, MD, assistant professor and director of the Family Medicine Residency Program at Texas A&M's College of Medicine, say finding places for students and residents to live during rural rotations is an ongoing problem.
"We have always left it up to the community to find housing," Dr. Bowling said.
Ms. Rossi - now Dr. Rossi and a practicing emergency physician in McAllen - lived in a patient room at East Texas Medical Center (ETMC) when she did her rotation in Crockett. Other students lived with Dr. Morrison and his family during their rotations.
But as more students and residents went to Crockett for training, it became clear the community needed other solutions. Drs. Morrison and Walker approached the Houston County Hospital District, which agreed to donate land for the facility behind ETMC, which the district owns, and financed construction of the 2,800-square-foot facility.
The center, which cost a little more than $200,000, can house up to seven students or residents in four bedroom suites. The building also includes a common kitchen and sitting area.
In addition, the facility has state-of-the-art teleconferencing equipment to allow the students to connect to TCOM and A&M for lectures or other didactic learning experiences.
Dr. Morrison says ETMC also uses the facilities for meetings and educational opportunities for its staff.
Finding a Home
Residents and students who have stayed at the Rural Physicians Education Center say the facility is "amazing," compared with other housing they've had during rural rotations.
Third-year TCOM student Ashley Thomas, who was on a surgical rotation in Crockett at the time of the dedication, says she stayed with a local family during an earlier rotation in Giddings. While the family was "very welcoming," she says the household was always very busy because of activities in which the family was involved.
"There was not really any opportunity to have some down time and get some studying done," she said.
Katie Fuller, another third-year TCOM student on a rotation in Crockett in November, lived for two months in a hospital during one rotation and for two months in a children's home during another.
"I stayed in a patient room," Ms. Fuller said. "It was on a more isolated hallway so there weren't always people coming and going, but the helipad was right outside my window."
After that experience, she says, the housing situation in Crockett was like winning the lottery.
A&M second-year family medicine residents Brad Faglie, MD, and Kurt Davis, MD, also stayed in the new facility. They say the accommodations enhanced their experience in Crockett.
"I don't want to knock any other rotations, but this was far above anywhere we've been," Dr. Faglie said.
"We really appreciate the effort they put forth making us comfortable while we were here," Dr. Davis added. "I've been in other places where they've put us in hotels or other not-as-nice amenities. So this was really good to be in close proximity to the hospital."
Setting an Example
Dr. Walker says the new housing facility is just another step in Crockett's commitment to train physicians for rural practice. He has been training medical students and residents throughout his 23-year career in Crockett, often with students from The University of Texas Medical Branch or the UT Health Science Center at Houston.
It was only after he and Dr. Morrison began training TCOM students that the arrangement became formalized.
"As they needed more places to train, they developed the ROME program," he said. "It was a natural step for them to come here."
Dr. Morrison says he and Dr. Walker assured TCOM officials that they could offer a full two-month surgery rotation with exposure not only to general surgery, but also to ophthalmology and orthopedics, and more in cooperation with other local physicians or visiting surgeons.
"We told them we could provide everything that you do in a core surgery rotation and give them that experience," Dr. Morrison said. "So we made a formal agreement."
They started out with two students from the ROME program doing their surgery rotations in Crockett in 2007, then four in 2008.
"This year we'll get all eight of the ROME students in the third-year class," Dr. Morrison said.
In addition to the TCOM students, Drs. Walker and Morrison also help train the A&M family medicine residents. Dr. McClellan says A&M began sending residents to Crockett to train with local family physicians, but Drs. Walker and Morrison soon got involved, particularly in training the residents in endoscopy and hands-on surgical experience.
"Our residents were getting such a great experience, particularly with the rural surgeons and the family physicians, that we ended up making this a required rotation for all our residents," Dr. McClellan said.
Now, all second-year residents from the A&M program do a one-month block rotation in Crockett.
Both Drs. Bowling and McClellan say the new Rural Physicians Education Center can enhance efforts to train physicians who want to work and live in rural Texas. The facility is a "shining example" of Crockett's commitment to that effort, and it should be a model for other communities involved in rural medical education, Dr. McClellan says.
"I think this shows the commitment and vision they have for how a rural community can participate in quality medical education," he said.
What does a community like Crockett get out of putting their resources behind training physicians? For one, Dr. Walker says it gains them recognition as a teaching center. For another, it makes the physicians doing the teaching better doctors, he says.
"Virtually anybody will tell you that when you teach students or residents, you do better quality medicine," he said. "When you teach, you perform at a better level."
Lastly, there's the promise that maybe one or more of those students or residents trained in Crockett will one day set up their practice there.
"For any community, it's cheaper to build a facility such as this than to pay a physician's salary for a year or two and then have him or her leave."
Ken Ortolon can be reached by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by e-mail at Ken Ortolon .
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