While treating patients, medical students evaluate area health needs and design service projects to meet them as part of the Rural Medicine Internship.
BY KATIE SANDERS | PHOTOS BY HARISH RAO
When most people think of medical school, images from movies or TV come to mind: classrooms, labs and hospitals. Students at The University of Alabama School of Medicine go beyond these scenes into the rural communities of Alabama.
All third-year medical students in UA’s College of Community Health Sciences, which
functions as the School of Medicine’s Tuscaloosa Regional Campus, are required to complete the Rural Medicine Internship, which places each student with a physician in a rural community for up to eight weeks.
In addition to treating patients, each student conducts an assessment of the community’s
health needs and develops a service project in response to one of those needs. “The clerkship involves walking into town and looking at the current system to determine the possible health outcomes,” said Lea Yerby, assistant professor of community and rural medicine and an internship director. “It’s like community health or public health 101. Every future physician should have this experience and knowledge.”
Each year, approximately 32 students participate in the Rural Medicine Internship, which began as a course at UA around 1970. Since 2005, students have completed more than 300 health-related service projects in rural communities across Alabama.
Recent service projects have addressed obesity in children and adults, diabetes, smoking, health literacy, teen pregnancy, substance abuse, shortages in mental-health resources and transportation challenges.
Russell Allinder, who completed his Rural Medicine Internship in Reform, Ala., in Fall 2013, said he encountered many patients who had questions about their illnesses and treatments and relied solely on infrequent doctor visits to have these questions answered.
“With the current trend in technology, the days of pamphlets and handouts are being phased out and are being replaced with websites and phone apps,” Allinder said. But the Internet can be a daunting place for certain individuals, he continued, and many rural residents do not have access to it. “If we as health-care providers do not address patients accessing quality information, many questions will either go unanswered or be answered with bad information,” he said.
For his service project, Allinder created a survey exploring Reform residents’ health-information resource preferences and whether an educational experience utilizing a computer with Internet access at a primary-care clinic would help overcome barriers.
Nearly 30 percent of those surveyed do not have access to the Internet within their homes, and 52 percent of those responders stated they would utilize a computer within a clinic to access health information through the Internet. Of the 42 percent who do not use the Internet for health information, many stated they would rather talk to a doctor or do not trust the information. “This is why I think it is crucial to get patients to go to credible sources from trusted websites, which a computer within a clinic would be able to provide,” Allinder said.
The results of his study are being used to determine the best means of communicating health information to residents of Reform and other Alabama towns of similar size.
Medical students’ service is particularly valuable in light of a primary-care-physician shortage that is especially dire in Alabama. According to the Alabama Department of Public Health, the ratio of primary-care doctors to Alabama citizens is 1:1,641, compared to the national average of approximately 1:1,253. In rural areas, the shortage is much greater. In Alabama’s Black Belt, a string of counties named for their rich soil and known nationally for their high poverty rates, the ratio ranges from 1:2,818 to 1:15,736.
During the Rural Medicine Internship, students visit schools, government agencies and community organizations, conduct inhome health visits and tour farms and industry sites, noting occupational hazards and warning signs of disease in employees. “Students get out of the clinic and into the community,” said Dr. Pamela Payne Foster, deputy director for UA’s Institute for Rural Health Research and a director of the internship. “We don’t want students to have a narrow definition of health. We want their experience to include working in health departments, law-enforcement offices and mayors’ offices.”
Medical student Erica Young spent May and June of 2013 in Alabaster, a city in Shelby County. “In my time in Shelby County, I saw problems with access to care for minority populations, especially the Hispanic population finding affordable preventative care and care providers who spoke Spanish,” Young said.
She also noticed health consequences of cigarette smoking were prevalent. The goal of her service project was to decrease cigarette smoking in the community and prevent youth from starting smoking. She talked with patients to learn about their smoking history and cessation habits and educated and encouraged those who were trying to quit. She also interviewed school-age children about smoking and discussed its effects with them.
Young said her biggest takeaway from the internship was realizing there are pockets of underserved individuals among the prosperous community. “Proper, preventative medicine is still a luxury for most Alabamians,” Young said. “Primary-care physicians are needed in almost every part of Alabama and also physicians who are willing to serve patients on Medicaid.”
Some medical students choose to serve a community concurrently with another student or to carry forward the service projects of previous interns.
After realizing transportation challenges were hindering access to medical care for many Pickens County residents, students Shweta Patel and Kelly Roszcynialski investigated area transportation needs during Summer 2013 and presented their findings to the community. “One of the best ways to implement change in any small or rural community is to get the community members involved in the process instead of having an outsider come in to try to set things straight and leave as soon as the job is done,” Patel said. “Getting the community members involved allows personal motivation for success and continuity for progress in the future.”
Patel and Roszcynialski found that although two transportation services existed in Pickens County, they were not adequate to meet the community’s needs. They devised proposals for improving transportation access and discussed them with area church leaders. Future interns have the opportunity to work with church leaders to implement the plans.
Medical students complete eight clerkships or rotations. The Rural Medicine Internship is devoted to community and rural medicine and partners with the family medicine rotation. Students attend classroom sessions, which feature lecture topics including the social determinants of health, health disparities and policy and the discovery and application of health data.
At the end of the course, each student gives a presentation on the community he or she served as well as a literature review of articles and journals that could be applied to the community.
Goals of the internship are to teach students the value of primary care as an integral part of any health-care system, how to manage chronic illnesses commonly seen in an office setting and the underlying factors of these illnesses in rural and underserved communities.
Yerby said another objective is to show future physicians the needs they could fill in rural Alabama. “We hope this program provides exposure to students and possibly increases the number of primary-care doctors in underserved areas of Alabama,” she said.
To learn more about the Rural Medicine Internship, contact Lea Yerby at firstname.lastname@example.org or 205/348-4693.