UNE’s Center for Health Innovation Forms a Pipeline to Franklin County to Address Healthcare Shortages

Students from the Franklin County rural health immersion pose for a photo on Wilson Lake the day after a Nor'Easter hits Maine and most of New England.

Students from the Franklin County rural health immersion pose for a photo on Wilson Lake the day after a Nor’Easter hits Maine and most of New England.

Fifteen healthcare students from UNE’s College of Osteopathic Medicine and Westbrook College of Health Professions Accelerated Bachelor of Science in Nursing (ABSN) program recently attended a weeklong rural health immersion in Franklin County. The experience, which is coordinated and funded by UNE’s Center for Excellence in Health Innovation and the Maine Area Health Education Center (AHEC), is a pipeline activity created to reduce healthcare provider shortages in rural Maine and to strengthen UNE’s relationships with healthcare centers around Maine. The weeklong rural health immersion experience was the second time that it has been offered to UNE students; last May a weeklong immersion was held in Maine’s northern most county, Aroostook County. The enormous amount of positive feedback from students and community members of last years 2016 immersion spurred two more immersions to be scheduled for 2017.

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, leading to poorer health outcomes. The locations for the immersion experiences are chosen based on the three AHEC centers strategically located around Maine in Aroostook, Franklin, and Penobscot counties, three of Maine’s most rural counties.

Franklin County, which ranked middle of the pack among Maine’s sixteen counties for health factors (8th) and health outcomes (7th), has been given less favorable ratings in quality of life (12th) and social & economic factors (10th), according to the Robert Wood Johnson Foundation’s 2016 county health rankings. It’s predicted that some of the health challenges that Franklin County faces would be improved if there were more providers in that area. According to the Robert Graham Center and the Nursing Workforce Forecast, Maine will need an additional 120 primary care physicians and 3,200 nurses in the next decade in order to maintain current rates of healthcare utilization. Research shows that students are more likely to practice rural medicine if they have a personal connection to a rural area, so, the rural health immersions aim to provide opportunities for students to connect to rural Maine and hopefully alleviate healthcare provider shortages.

Brad Gilbert, RN, talks to the students about his career path as a nurse and how he ended up in rural medicine

Brad Gilbert, RN, of Franklin Memorial Hospital in Farmington, ME, talks to the students about his career path as a nurse and how he ended up in rural medicine

The students who participated in the western Maine rural health immersion came from a broad array of backgrounds, some growing up throughout the country in areas like California and Oklahoma while about a third of the students had grown up in Maine or had spent time previously in rural Maine. Most students had some experience working with underserved populations in the past but, for some it was their first opportunity to experience rural underserved healthcare. One ABSN student, originally from Taiwan, Feng Cherng (Alex) Hsu, who was an economist before enrolling in UNE’s ABSN program, said he is already considering returning to Franklin County after graduating It would be my honor to be able to become one of the colleagues of Franklin Memorial Hospital because they have many professionals who contributed so many years in such working environment without many support and resources…We were constantly informed that [Franklin County] is and will be a great [place to] work under such a beautiful area. The working environment in Franklin County is great, people of Maine are very nice, and workers can enjoy all kinds of outdoor recreational activities all year long.”

The students experienced a variety of activities in underserved areas in Franklin County, such as meeting with providers of Franklin Memorial Hospital for a tour of the facility, meeting with a local pediatrician and nurse to discuss current strategies used to address population health, and meeting with a local EMS agency to discuss emergency medicine in rural Maine. There was also an overarching behavioral health theme during the trip and all of the students were exposed to topics within that field on multiple occasions, such as a panel discussion on the opioid epidemic in rural Maine with a public health professional, maternal child health nurse, and nurse practitioner who work in Franklin County. Later, they also attended a three-hour public seminar to discuss suicide prevention and strategies, which featured a well-known expert from Maine General and the director of the Maine Chapter of the National Alliance on Mental Illness. “There was great depth and breadth of exposures during the immersion that the students will be able to bring to future courses and clinical experiences”, says UNE clinical assistant professor, Judith Metcalf, APRN, BC, MS, FMGS, one of the faculty members who also attended the immersion.

The students also enjoyed having time to take in the natural beauty of the area, such as when they went snowshoeing under a full moon on Wilson Lake. They also got a taste of the local culture when they met with with Bill Roorbach and Tom Saviello. Roorbach, a nationally known author from Farmington, had lunch with the students and gave each of them a signed copy of one of his books. The next morning, Saviello, a Maine state Senator, talked with the students about economics and health policy in rural Maine.

Students wake up early to meet for breakfast and talk health policy with Maine state senator Tom Saviello

Students wake up early to meet for breakfast and talk health policy with Maine state senator Tom Saviello

Some of the week’s activities were canceled due to the March 14th blizzard that hit most of Maine and New England. There were a variety of clinical skills activities that were scheduled but had to be canceled due to the storm such as conducting health screenings at a senior citizens center in Farmington and Rangeley; collecting vitals and providing patient education at Edgewood Rehab in Farmington, and doing home visits with Androscoggin Home Health. Despite the wintery conditions, the students were determined to make the most of their rural health experience, and, after making a trip to the local Hannafords to stock up on food and water for the storm, the group hunkered down at the motel in Wilton to work on team-building exercises, as they collectively decided to cook dinner together and then self-facilitate an evening debrief.

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’s been very exciting to see medical and nursing students learn from, with, and about each other, and I found it very inspiring to learn from them.  They are truly an interprofessional team, as partly evidenced by how I couldn’t tell who is which profession.” Another UNE faculty member who participated in the immersion, Jen Van Deusen, Director of Curriculum in UNE’s College of Osteopathic Medicine, saw the tight bonds that had formed among the students as an opportunity to continue the interprofessional learning and extended an invitation to the nine nursing students to attend a panel session on addiction and substance use with the first year medical students the week after they returned from the immersion. “The rural health immersion leads to longstanding friendships and increases students’ value of interprofessional learning experiences, which is why I invited the nursing students to join our medical students in the March 24th training session”, says Van Deusen.

The full team of students who attended the Franklin County immersion included six medical students from UNE’s College of Ostepathic Medicine, Sean Bilodeau, Jessica Brancely, Kristina Carlson, Stephanie Czajkowski, Kristin Frisby, and Zachary Lane and nine nursing students from UNE’s Westbrook College of Health Professions Accelerated Bachelor of Science in Nursing program, Sheridan Aspinwall, Valerie Bedard, Ilija Bratina, Anika Gannon, Feng (Alex) Hsu, Kane Kunst, Cynthia Mosher, Sarah Rafferty, and Kali Waters. You can read more on each students experience here.

Lorri Brown and Tania Dawson, RN, talk to the students about substance misuse in Franklin County.

Lorri Brown and Tania Dawson, RN, talk to the students about substance misuse in Franklin County.

The majority of the planning and coordination for the trip was provided by Ian Imbert, MPH, project coordinator of a four year Josiah Macy Jr. Foundation grant and staff member in UNE’s Center for Excellence in Health Innovation. Jen Van Deusen, M.Ed., Director of Curriculum for UNE’s College of Osteopathic Medicine, and Judith Metcalf, APRN, BC, MS, FMGS, clinical assistant professor of nursing and coordinator, Upstream Practicums in Nursing Program, both 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 also attended the immersion.

The next weeklong immersion is scheduled for May 21st – 26th 2017 in the Midcoast region and will involve students from UNE’s College of Osteopathic Medicine, College of Dental Medicine, and College of Pharmacy.

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. Tania Dawson, director of the Western Maine AHEC was an essential resource in setting up connections with providers, community members, and hospitals in Franklin County. The Josiah Macy Jr. Foundation grant that also helped fund the experience is a four-year grant awarded to UNE in 2015 from the Josiah Macy Jr. Foundation and aims to improve health care and education in rural areas.

FMI: Contact Ian Imbert, MPH, (207-221-4625 or iimbert@une.edu)

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