Rural Primary Care
The East Tennessee State University Rural Primary Care Track (RPCT) is a 4-year community-based experiential curriculum whose core goals emphasize community, rural culture, interdisciplinary team interactions and leadership development. Rural Medicine is at the very heart of the mission of the Quillen College of Medicine at East Tennessee State University.
Rural primary care and the Quillen College of Medicine go hand in hand. Created over 20 years ago, the RPCT provides a specilized educational experience for students interested in careers in rural primary care. Beginning in the 1st year, RPCT students work at one of two rural sites, either Mountain City or Rogersville. On site, students work with community physicians to learn and understand the practice of rural medicine.
Rogersville
The Rogersville Academic Center, located at 948 West Broadway, is the home to Rural Primary Care Track students in their first three years of medical school at Quillen College of Medicine. Rogersville is a small community located about 50 miles south of ETSU. It began in 1994 as the “Kellogg Program” and has continued providing “hands-on” education to medical students in Rogersville, TN ever since.
The purpose of the program is to provide clinical and community-based education. Two doctors from Rogersville are the assistant professors for these medical students, Dr. Jose Velasco and Dr. Mark Dalle-Ave. For more information, contact the coordinator, Jeanie Parrott atparrotsh@etsu.edu
The camaraderie that the students have amongst their peers and mentors in the rural setting speaks for itself. There is so much one on one with your faculty who are compassionate, caring for their students. They get to know you as a person, not a number. Students are treated like family and if you chose not to go into primary care, it is ok, you are not looked down on, RPCT just wants you to succeed. In Rural track you see the value of a physician in the community and you are so welcomed. As a first and second year, you spend about one day a week in the rural sites doing your Community Oriented learning in the morning and then you apply what you learn with your faculty in the afternoon. You are also involved in a rural research project, developing a poster to present to local or national conferences. As a third year, you are immerged in the rural community for 3 months seeing patients and putting your clinical skills to use. As a fourth year, you have 4 to 8 weeks of rural rotation electives of your choice which includes international rotations. Our Rural programs are consistently ranked in the top 10 by U.S. News and World Report.
Curriculum
1st Year
Rural Case oriented Learning and Preceptorship (Fall Semester)
Students develop an understanding of their personal lifelong education process by addressing learning issues identified from encounters with rural patients. Students will explore issues of health and disease in context of their patients’ lives, families and communities. Emphasis is placed on the case-oriented learning process using real patients in rural communities. The course is comprised of team building and clinical experiences, complemented with group discussion, review of clinical encounters and self-directed information acquisition. Topics correlate closely with material from the basic medical sciences curriculum.
Communication Skills for Health Professionals (Fall Semester)
Required of all first-year medical students. This interdisciplinary course addresses basic communication skills that are utilized by health professionals. The course focuses on data gathering skills, development of rapport, listening skills, and empathic and facilitative responses. Principles of interpersonal, family, group and interdisciplinary communication strategies are addressed. Students begin to address ways to reconcile differences in expectations between patients and health care providers.
Rural Case Oriented Learning and Preceptorship (Spring Semester)
A continuation of Rural Case Oriented Learning and Preceptorship I, this course continues to emphasize personal life-long education by addressing learning issues identified from rural community and clinical patient encounters. Students explore issues of health promotion and disease prevention. Emphasis is placed on the case oriented learning process as well as disease management in rural communities. The course includes clinical experiences coupled with in-depth evaluation of rural patients with common diseases. Clinical experiences are reviewed with peers and faculty through group discussion and self-directed information acquisition. Topics complement material covered in the basic medical sciences curriculum.
Rural Health and Research Practice (Spring Semester)
This interdisciplinary course with nursing, medicine and public health students is the first of a two semester series of courses which allows students to develop an understanding of the practical application of community based and participatory research methodology and theory relevant to health sciences by developing proposals for community health projects and specific plans to assess achievement of objectives. Students develop an understanding of interdisciplinary working relationships among health professional disciplines. Students will develop an understanding of issues associated with research involving human subjects and receive IRB Training. They attain an understanding of data collection methods for research and evaluation purposes and develop data collection instrument(s) as necessary to analyze health status indicators using appropriate technology. The course includes an online component on theory and research methodologies using community experience as part of assessment/research activity.
2nd Year
The Practice of Rural Medicine I (Fall Semester)
The Practice of Rural Medicine I is a concentrated experience occurring both at a selected rural site and on campus which familiarizes students with the community and provides a foundation for later coursework and clinical experience. The main objective is the integration, review, and application of basic science pathophysiology through an introduction to clinical medicine with attention to the rural community. This occurs within the context of rural clinical and community experiences as well as case-oriented learning encounters. Students use their knowledge base to build differential diagnoses and learn advanced interviewing and physical exam skills. Additionally, students are introduced to evidence-based medicine and how to use the resources available to them. Basic interpretation of electrocardiograms, lab data, and diagnostic imaging studies is also presented. Experiential learning activities include preparticipation physical examinations for community school students and Division of Transportation (DOT) Health Evaluations as well as community clinical preceptorship experiences. Rural community patients, standardized patients, small group attending physician sessions, and simulation lab workshops are used to facilitate the course. Students are expected to approach this course in a self-directed learning format with active participation expected.
Rural Community Based Health Projects
In this course nursing, medical and public health students work in interdisciplinary teams to develop a community-based health proposal in collaboration with their rural community partners. Through implementing and evaluating the proposed community-based project, students gain hands-on experience in using participatory methods to promote the health of a selected rural population. Students enhance their formal presentation skills through presenting the results of their community-based health project. This is a writing-intensive course. This is an oral-intensive course. The purpose of the Rural Community-based Health Projects course is to provide students with the opportunity to work in interdisciplinary teams with a rural community partner to plan, implement, and evaluate a community-based project.
Clinical Preceptorship II
Clinical Preceptorship II is offered the second week of October. Students may select to do an international rotation, Remote Area Medical (RAM) or select a Rural Preceptor. Click here to view a video about RAM.
The Practice of Rural Medicine II (Spring Semester)
A continuation of The Practice of Rural Medicine I, this course is part of the Rural Primary Care track. A concentrated experience occurring both at a selected rural site and on campus familiarizes students with the community and provides a foundation for later coursework and clinical experience. The main objective is the integration, review, and application of basic science pathophysiology through an introduction to clinical medicine with attention to the rural community. Focusing on real world experiences in rural communities, students use their knowledge base to build differential diagnoses and learn advanced interviewing and physical exam skills. Additionally, students are introduced to evidence-based medicine and how to use the resources available to them. Basic interpretation of electrocardiograms, lab data, and diagnostic imaging studies is also presented. Students receive experience in the human patient simulation laboratory through a series of exercises which allow students to receive recertification in BLS training and certification in ACLS. Rural community patients, standardized patients, small group attending physician sessions, and simulation lab workshops are used to facilitate the course. Students are expected to approach this course in a self-directed learning format with active participation expected.
3rd and 4th Year
Third year in Rural Track is the beauty of RPCT. You are submerged in the rural area of either Mt. City or Rogersville for 12 weeks. You are there mainly to see patients and spend time in the clinic or hospital, which is why you are in medical school correct? You are spending one on one time with one of the best preceptors in the state. You are not competing for their time amongst other residents, because there are only medical students at the sites. Students also follow patients in community non-ambulatory care settings such as in the hospital or nursing home. In addition students are responsible for completing a community project of their choice that benefit both the student and the community. Students have ½ day a week to work on the project. There is housing provided at both sites to live in the community or students can commute. Rural track is family and pet friendly so we strive to always meet your needs and become flexible when needed. During down time, after hours, there are many outdoor activities the students can become involved in, hiking, biking, Downhill snow skiing, running/walking in the park, working out at a local gym and the local events in the area. Lots of fun things to do. You will not want to leave after living in the beauty of either site after living in the area for 3 months.
Mountain City
Johnson County is the most easterly county in Tennessee and its county seat is Mountain City. Traveling around beautiful Watauga Lake, Johnson County is approximately one hour from Johnson City. Mountain City is the largest town in Johnson County and the highest town in Tennessee. Other communities in Johnson County include Butler (“the town that wouldn’t drown”), Trade (the oldest community in Tennessee), Laurel Bloomery (home of the Old Time Fiddlers’ Convention), and Shady Valley (location of the unique Southern Appalachian Mountain Bog habitat).
Students at the Mountain City site work out of the Johnson County Academic Health Center as well as in the Johnson County Memorial Hospital and several outpatient clinics.
The Johnson County Community Hospital is the smallest hospital in Tennessee with two in-patient beds. However, the hospital offers a full range of health services from the Johnson County Medical Group, ETSU College of Nursing’s Mountain City Extended Hours Center, assorted specialty clinics, and the Emergency Room with access via air to trauma centers in Johnson City & Boone, NC.
Dr. Florence works closely with the rural programs at ETSU, which include the medical school's Rural Primary Care Track - community partnerships program, Rural Health Fairs, and the Rural Family Practice Fellowship. Since 1983, Dr. Florence has been training medical students, family practice residents, and other health care professionals including nurse practitioners, paramedics, and physician's assistants in an effort to prepare them for practicing in rural, underserved areas. Dr. Florence grew up in Virginia, completing a Bachelor's degree in Chemistry and Religion at Duke University and a Masters degree in Biology prior to medical school at the Medical College of Virginia. After completing his family practice residency at Roanoke Memorial Hospitals in Roanoke, Virginia, he practiced as a National Health Service Corps doctor in Central Appalachia, in and around Hazard, Kentucky. During this time he worked as Medical Director of the SE Kentucky Area Health Education Center. In 1991, Dr. Florence accepted a full-time position with the University of Kentucky to help develop the East Kentucky Family Practice Residency Program.
As Program Director of this rural training program, his duties also included directing clinical programs at the UK Center for Rural Health, which in 2000, received honors from the National Rural Health Association as the Outstanding Rural Health Program in the United States. Dr. Florence was also a member of the faculty of the Appalachian Osteopthic Postgraduate Training Institute Consortium. Early in 2002, Dr. Florence was appointed Vice-Chair of the Department of Family Practice at the University of Kentucky. During his tenure he had the distinction of being the first medical director of the East Kentucky Veteran's Center, a recently opened long-term care facility serving the veterans of Central Appalachia. Dr. Florence's scholarly interests include rural health, public policy, diabetes, advanced cardiac life support and the use of technology to enhance rural health. Dr. Florence's e-mail address is: florencj@etsu.edu
Faculty
Dr. Joseph Florence - Director, Rural Programs
florencj at mail.etsu.edu
