Attracting healthcare professionals to rural and underserved communities has been a national priority for several years and a particular issue for Maine partly due to the fact that, according to the 2010 Census Data, Maine was the most rural state in the United States. Rural terrain can lead to long commutes for patients seeking basic healthcare services and can exacerbate provider shortages. Maine isn’t only rural; it also holds the title for being the oldest state. Healthcare utilization will continue to increase as Maine’s aging population is growing and will likely further stress the already burdened rural health system in Maine. According to the Robert Graham Center, Maine will need an additional 120 primary care physicians in the next decade in order to maintain current rates of healthcare utilization. Moreover, the Maine Department of Labor projects a shortage of 170 dentists.
To increase the number of students interested in practicing rural medicine healthcare educators have starting thinking outside the box. Research shows that students are more likely to practice rural medicine if they have a personal connection to a rural area, so, the Center for Excellence in Health Innovation at UNE decided to organize a group of healthcare students and immerse them into the culture of rural Northern Maine. The trip was termed a rural health immersion and fifteen graduate healthcare students traveled to Aroostook County during the last week of May as part of a pipeline for building rural health competencies and gaining student interest in practicing rural medicine. During the immersion, the students conducted a variety of skill-based, observational, and community activities which are described in more detail below.
The clinical skills activities included providing fluoride varnishes at an elementary school in Van Buren; conducting health screenings at a senior citizens center in Madawaska; participating in a daylong interprofessional airway training at The Aroostook Medical Center; attending ophthalmology grand rounds at TAMC; and visiting with a variety of other rural health professionals across Aroostook county.
The community activities included included a dinner with Cathie Pelletier, a nationally known author from Allagash, and each student received one of her signed books. The students also had breakfast with Rep. John Martin and Sen. Judy Paradis and discussed the Franco-American culture in that area.
When the students weren’t building professional relationships they were relaxing among the rural culture of Aroostook County. An impromptu moonlit kayak trip on the Aroostook River kicked off the trip and was followed up throughout the week by a variety of other activities such as a campfire under the stars, eating homemade ice cream at Houlton Farms Dairy, and trying baked goods at the Amish store in Easton. One group of students was fortunate enough to see the Northern Lights one evening and everyone saw several moose.
Dora Anne Mills, MD, MPH, FAAP, and Vice President for Clinical Affairs and director of UNE’s Center for Health Innovation attended the immersion and had this to say of the students experiences “It was extremely gratifying to witness the students articulating their new insights about the strong sense of community and culture in rural areas, about each other’s professions, about how rural health systems are different, and about rural population health and health care challenges. It is also clear this group of 15 have bonded and will stay in touch, as they were already asking us what other inter professional activities they could participate in, together. And, most importantly, virtually all of them expressed a strong interest in returning for some of their clinical training time to rural Maine or other rural areas. So, the overall goal of this brief immersion serving as a pipeline to rural inter professional and other clinical clerkships/rotations seems to have been preliminarily accomplished.”
The trip was graciously supported by Maine’s Area Health Education Center (AHEC) and the Josiah Macy Jr. Foundation. The Maine AHEC has continued to prioritize experiential learning in rural communities for graduate healthcare students and their commitment to the rural health immersion proved to be invaluable for the success of the trip. Leah Buck, director of the Northern Maine AHEC was an essential resource in setting up connections with providers, community members, and hospitals in Aroostook County. A four-year grant awarded to UNE in 2015 from the Josiah Macy Jr. Foundation aims to improve health care and education in rural areas.
The enormous amount of positive feedback from students and community members of Aroostook County has spurred initial discussions of future immersions. One unique feature of a large state like Maine is socio-cultural differences that can vary greatly between major geographic locations. For example, when asked to self-report health status, residents of Aroostook County have a higher perceived mental health status but a lower perceived physical health status than Maine’s mid-coast region. Substance abuse and addiction is a statewide health issue in Maine and particularly prevalent in Maine’s mid-coast region. Behavioral health is addressed in the curricula of all of UNE’s healthcare professions and has been proposed as a theme for a future immersion.
The full team of students who attended the Aroostook immersion included six medical students from UNE’s College of Ostepathic Medicine, Samuel Wood, Andrew Vetter, Ellen Clark, Nicole Rainville, Tara Formisano, and Danielle Beard; five pharmacy students from UNE’s College of Pharmacy, Casey Hutchinson, Kelly Frazier, Jhoana Meza, Marina Izzi, and Ian Greenstien; and four dental students, from UNE’s College of Dental Medicine, Tyler Gagnon, Christopher Parent, Alexandra Hensen, and Sarah Georgeson. Each night the students who attended were asked to write a reflection of the events that occurred that day. You can read more here.
The majority of the planning and mentorship was provided by Jennifer Gunderman-King, MPH, faculty member in UNE’s Westbrook College of Health Professions. Jen Van Deusen, M.Ed., and Director of Curriculum for UNE’s College of Osteopathic Medicine, also attended and provided expertise and mentorship during the trip. Dora Anne Mills, MD, MPH, FAAP, Vice President of Clinical Affairs at UNE and director of UNE’s Center for Health Innovation, and Ian Imbert, MPH, project coordinator for clinical interprofessional education at UNE’s Center for Health Innovation, also attended portions of the immersion.
FMI: Contact Ian Imbert, MPH, (207-221-4625 or firstname.lastname@example.org)