AHSC Students
Begin Rural Rotations
in the Far Reaches
of Arizona

Diana Hu, M.D., a pediatrician at the Tuba City Indian Hospital has agreed to be a preceptor, or mentor, to Denise Schweda, a first-year medical student and a pioneer in the Rural Health Professions Program, now in its inaugural year. Dr. Hu exudes enthusiasm and love for the Navajo and Hopi people she serves. When James E. Dalen, M.D., M.P.H., vice president for health sciences and dean of the College of Medicine, visited Dr. Hu, Schweda and several other preceptors and students in Flagstaff, Tuba City and Page, he clearly was impressed.

"Students are learning early how physicians think, what their life is like," Dr. Dalen says. "A university hospital is not the real world. This is the real world."

This summer, 15 UA medical students, four pharmacy and four nurse practitioner students worked in Page, Springerville, Nogales, Ganado, Flagstaff, Surprise and several other sites throughout the state. Each year, until graduation, these same students will return to spend four to six weeks in rural areas. And, with every incoming class of first-year medical students, 15 more will be selected to participate in the Rural Health Professions Program, first mandated by the Legislature in 1994. The program seeks to encourage more health professionals to live and work in the state's under-served regions. "We'll know it's a success in seven years when many of you are out there working in rural areas," Jay Smith, M.D., dean for academic affairs, told the group before they left Tucson to begin their first rotation last spring.

Today, as Dr. Hu meets Dr. Dalen for the first time, she quickly profiles the type of patient she frequently sees, reviews case histories and cites the prevalence of certain diseases, like diabetes, on the reservation. Clearly, a woman with a mission, Dr. Hu's excitement is contagious and the young medical student is smitten. Half Navajo, half Caucasian, Schweda has chosen to honor her Navajo heritage and has decided that she eventually will practice medicine on the reservation.

Schweda is a good example of the kind of student legislators had in mind when they provided funds to allow a number of medical, pharmacy and nursing students to complete a "rural rotation" as part of their regular education. And Dr. Hu is exactly the kind of preceptor College of Medicine faculty in Tucson knew was needed to make the program a success.

In the early '90s, in an effort to understand the health care needs of the state, the Joint Legislative Health Care Committee formed a study group, which visited several rural communities to learn firsthand what health care was lacking in less-populated areas. Legislators discovered that Arizona's rural communities are not unlike rural areas across the nation — doctors, nurses, pharmacists and other health professionals are in great need.

Although there is no shortage of doctors in the United States, most physicians tend to live and work in cities — just as most of the rest of the population. Although the UA Colleges of Medicine, Nursing and Pharmacy encouraged and sponsored opportunities for students to work in rural Arizona for many years, most chose to work in larger communities when their education was complete.

To further encourage and nourish health professionals in rural communities, legislators passed a law to require all students to complete a rural rotation as part of their medical education. Their rationale was that since ideal health care means better access to health professionals and the services they offer, why not make all Arizona medical students spend part of their training in rural areas as part of their education? Surely some would like the way of life and stay.

But the practicality of requiring all medical students to live and work in remote areas, as the Legislature first proposed, would prove to be an impossible request. Today's medical student is often a wife or a husband, a father or a mother, a person with responsibilities and long-held commitments that don't necessarily allow for time away from home. Further, medical accreditation requirements demand a high level of supervision. As in any profession, not all physicians automatically are qualified to be teachers. Legislators conceded their proposal needed to be tempered with practicality.

Over the next two years, AHSC lobbyist Janet Bingham, Ph.D., worked to explain the reality of complying with the legislative mandate while Nancy Koff, Ph.D., associate dean for curricular affairs, set about designing a curriculum and formulating a plan that would be acceptable to physicians, legislators, students and accreditation agencies. In 1996, an agreement was reached and the original bill was amended. Planning for the Rural Health Professions Program began in earnest.

Because medical students who have just completed their first year have no clinical skills, they would have to work closely with rural doctors, who would volunteer to teach them, to mentor them, to act as preceptors. Carol Galper, coordinator of the Commitment to Underserved People (CUP) program, was recruited to survey the state and identify physicians who were willing and qualified to work with medical students. In addition, she was charged with finding short-term, low-cost housing, negotiating her way through a myriad of complex problems.

In the spring of 1997 everything came together — revised legislation, funding to support the mandate, a well-designed curriculum, outstanding physician preceptors and an enthusiastic and committed group of students interested in rural medicine.

"This experience solidified our good relationships with our legislators," says Dr. Dalen. "The Rural Health Professions Program is a 'win-win' situation for everyone involved. If our students go into rural medicine after this experience, fine. If not, their experience will be an invaluable part of their medical education."

—By Nancy Guthrie

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