A Sense of Community

RPAP students broaden their focus to tackle community health problems in Greater Minnesota.

By Erin Peterson

(Excerpted with permission from the Spring 2007 issue of Medical Bulletin. Full story available at http://www.mmf.umn.edu/bulletin/spring2007/.)

Over the years, the University of Minnesota's Rural Physician Associate Program (RPAP) has received accolades from numerous sources, including the Carnegie Foundation and the New England Journal of Medicine. And this year, the popular program has more participants than ever before. But like every good leader, RPAP Director Gwen Halaas raised the bar, demanding a bit more of the program and its students, knowing that both would benefit in the long run.

The state legislature launched RPAP in 1971 as a way to address the dire shortage of primary-care physicians in rural Minnesota. The idea was innovative yet simple: Third-year medical students would spend 36 weeks living, learning, and caring for patients in a rural Minnesota community. They’d work closely with rural physicians in a range of health-care settings, and if the program worked as planned (which it has), their experience would encourage them to return to a rural setting when they began their careers.

Among the oldest and largest programs of its kind, RPAP has now graduated 1,127 physicians—some 60 percent practice in rural communities, and about 80 percent provide primary care. RPAP has served as a model for programs in other states, including New York, Florida, and Alaska—and medical schools as far away as Australia have studied it. This year, 47 students are participating in RPAP communities— the largest group in the program's history.

Looking for a way to involve students more broadly in their host communities, Halaas revamped the program’s community health component after becoming RPAP director in 2004. The new community health assessment projects she initiated in 2005 require students to examine a health-care issue confronting their host community and to collaborate with local experts to seek solutions. Students may choose to investigate smoking cessation, teen pregnancy, depression in the elderly, obesity—any health-care issue of concern to the community.

“These projects are an opportunity for us to return something of value to the community for hosting and teaching our students,” says Halaas, who this spring became director of the Academic Health Center’s new Center for Interprofessional Education. “I really wanted students to go further than just the clinic or hospital they were working with—to learn from others in the community.”

The following is just one example of the community health assessment projects completed by RPAP students last year, which demonstrate what Halaas envisioned: students gaining a deeper understanding of community health; physicians and other health-care providers obtaining valuable information from the students’ research; and, ultimately, patients receiving better care.

Preventing falls in the elderly
Trip on a stair when you’re 20, and you might skin a knee. If you're 70, however, you might wind up with a broken bone, a hospital stay, and weeks or months of rehabilitation. Falls are the leading cause of injury among seniors nationwide, and an aging baby-boomer population makes finding ways to prevent them more crucial than ever.

Todd Johnson, a pharmacist at Lake Region Hospital in Fergus Falls (population 13,658), knows the scenario all too well. For 30 years, he has consulted at local nursing homes to make sure patients are getting the proper medications, paying particular attention to the charts of patients who have recently fallen. “Just today, I was looking at the medication of an elderly woman who fell after getting light-headed when she stood up,” says Johnson, who is also a faculty member in the University’s College of Pharmacy. The woman was fine, he notes, but many others in similar situations end up with broken hips and other serious complications.

When Heather Hamernick, class of 2007, chose to focus her RPAP community health assessment project last year on falls among the elderly, Johnson encouraged her to take a broad view and to seek solutions. Hamernick quickly discovered that dozens of factors contribute to the problem, including certain medications, arthritis, cluttered environments, and vision problems.

Her research paper described the scope of the problem and called for assembling teams of doctors, nurses, pharmacists, and others to help reduce the risks. “A pharmacist might look at what drugs contribute to drowsiness, but a physical therapist might say that doesn’t matter if the patient can’t get out of bed,” says Hamernick. “Everyone is trained to solve problems differently.”

She presented her findings and recommendations last spring to a team that has since launched a pilot program to help assess the risks of falls among elderly patients. Current RPAP student Mandy Hoffman worked on the Fergus Falls pilot project and says a more comprehensive fall-prevention program may be ready next year.

Hamernick, who is working in Uganda this spring as part of a global health rotation and will soon start her family practice residency at St. John’s Hospital in suburban Maplewood, says it was gratifying to complete a project that she knew was important to the local community. “There was a lot of excitement for this project, and it was great to see so many people who wanted to work on it,” she says.

Johnson concurs, describing the project as “a win for students and a win for the community.”