Interdisciplinary Program Designed to Prepare Student Health Professionals for the Cultural Aspects Affecting Medical Service Develivery in Rural Areas

A Peer Reviewed Publication of the College of Allied Health & Nursing at Nova Southeastern University Dedicated to allied health professional practice and education http://ijahsp.nova.edu Vol. 2 No. 4 ISSN 1540-580X Interdisciplinary Program Designed to Prepare Student Health Professionals for the Cultural Aspects Affecting Medical Service Delivery in Rural Areas Denise G. Bender, JD, PT, GCS Brett R. Braziel, SPT University of Oklahoma Health Sciences Center, College of Allied Health, Oklahoma City Citation: Bender, DG., Braziel, BR. Interdisciplinary Program Designed to Prepare Student Health Professionals for the Cultural Aspects Affecting Medical Service Delivery in Rural Areas. The Internet Journal of Allied Health Sciences and Practice. October 2004. Volume 2 Number 4. ABSTRACT Minorities are significantly underrepresented in the medical professions as compared to the US population as a whole. This discrepancy highlights the need to prepare students to practice in a culturally competent manner. This is especially true for those students who plan to practice in rural areas. Rural practice requires not only the skill of cultural competence, but also the ability to work with other disciplines as part of a team, due to the shortage of health professionals. This article outlines a monthlong clinical rotation developed by the health professions programs in Oklahoma and funded through a grant to Oklahoma’s Area Health Education Centers. This funded program combines mentoring, clinical experience, and didactic information on cultural awareness to prepare students to work together to provide care for members of the Choctaw Nation. INTRODUCTION The geographical distribution of health care providers is currently inadequate to meet the health care needs of rural America. The result of the disparity in health services between rural and urban areas is illustrated by examining the health status of a geographically large mid-western state. Oklahoma faces unique issues in health service delivery due to having both a high number of rural residents and a high percentage of persons of American Indian descent. Approximately 81% (63 out of 77) of the counties in Oklahoma are classified as rural.1 In 2000, 39.2% of the state’s population lived in these non-metropolitan counties.1 Census figures report that 11.2% of the population in Oklahoma is either completely or partially of American Indian descent.2 These two factors introduce cultural and geographic considerations that affect the provision of health care. The state’s recent health report card showed a dismal rating of its overall health and wellness when compared to the level enjoyed by residents living in other states.3 Seventeen indicators of health were graded. Oklahoma earned eight grades of “F” and only two of the remaining indicators received grades higher than a “C.” Consequently, Oklahoma ranks 45th out of the 50 U.S. states for the overall health of its citizens.4 These results indicate a critical need for improvement of accessibility and availability of health care resources, especially in the rural portions of the state. The Health Resources and Services Administration’s (HRSA) Bureau of Health Professions has established health professional shortage areas (HPSA) and medically underserved areas (MUA) in response to this problem. In addition to providing federal grants for medical clinics to these designated areas, HRSA has also developed the Area Health Education Centers (AHEC). The AHECs serve as a link between the universities and surrounding communities by developing educational programs for recruitment, support, and retention of rural practitioners.5 The AHECs offer educational opportunities for current practitioners and for students who may potentially become rural health providers. The universities participate by modifying the traditional curriculum to allow students of all disciplines to participate in rural health educational experiences. © The Internet Journal of Allied Health Sciences and Practice, 2004 Interdisciplinary Program Designed to Prepare Student Health Professionals for the Cultural Aspects Affecting Medical Service Delivery in Rural Areas 2 The Talihina Project at the Choctaw Nation Health Care Center (CNHCC) The health professions educational programs in Oklahoma have a strong interest in improving the availability of health care services throughout the state. Faculty and administrators believe that involving student health practitioners in opportunities to provide care to traditionally underserved areas and populations might increase the likelihood that these students will enter rural practice after graduation.6 Achievement of this outcome could significantly improve the quality and quantity of healthcare available for persons living in rural areas. In 2002, a three-year Quentin N. Burdick grant for $423,876 was awarded to the AHEC sponsored by the Oklahoma State University College of Osteopathic Medicine. The grant provided funding for Rural Interdisciplinary Training Programs. The state’s AHEC program used the monies to develop interdisciplinary educational experiences throughout the state. These programs pair health professions students with mentors who can provide opportunities to work with and understand the underserved populations in rural areas.7 The AHEC programs offer on-going educational experiences that familiarize students with the issues affecting delivery of culturally sensitive health services in rural parts of the state. Clinical and academic faculty work closely with the AHEC staff and rural clinician-mentors to train teams of medical, nursing, occupational therapist, physical therapist, physician assistant, dental, optometry, social work, dietetics and pharmacy students from five universities throughout Oklahoma and Illinois.8 These universities are the University of Oklahoma, Oklahoma State University, Southwestern State University, Northeastern State University, and Midwestern University in Chicago. Healthcare students from these disciplines participate in month-long projects that offer patient-centered and interdisciplinary care in the rural northeastern, northwestern, southeastern and southwestern areas of Oklahoma. The grant makes it possible to fund not only the administrative costs, but also pays for student housing, mileage, and a generous stipend. These benefits act to aid in recruitment of interested students by removing any potential financial hardship that otherwise might be associated with a clinical rotation at a rural site.5, 9 The first clinical rotation was sponsored at Choctaw Nation Health Care Center (CNHCC) in Talihina, located in southeastern Oklahoma. The CNHCC provides healthcare services only to American Indians identified as eligible for services.10 Eligibility is established by meeting two criteria. First, the patient must provide proof of membership in one of the tribes recognized by the federal government. 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