Dr. Hana Hinkle and Dr. Michael Glasser explain the interprofessional approach to training future health care providers in the Rural Health Professions program, as well as the importance of collaboration and community engagement when equipping students for a career in rural health.
Featured researchers:
Hana Hinkle, PhD, MPH
Interim Director and Department Head, National Center for Rural Health Professions
Associate Director, Illinois Area Health Education Center Network Program Research
Assistant Professor, Department of Family and Community Medicine, University of Illinois College of Medicine Rockford
Michael Glasser, PhD (retired)
Former Director, National Center for Rural Health Professions
Associate Dean, Rural Health Professions Program
Research Professor, Medical Sociology and Dr. George T. & Mildred A. Mitchell Endowed Professor
University of Illinois College of Medicine Rockford
Learn about rural health training opportunities through the National Center for Rural Health Professions and Illinois AHEC.
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The University of Illinois at Chicago Center for Clinical and Translational Science is supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR002003. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
0:00 [Teaser Clip]
If you visited one rural community, you visited one rural community. I mean, they're so different in terms of the resources they have, in terms of the attitudes of the people, their understanding of what their own healthcare issues are, and they certainly are very appreciative of us coming in and working with them and learning from them.
0:33 [Voice Over Introduction]
Welcome to Collaborative Endeavors, a podcast about how scientists from different areas of research come together to tackle big health challenges, leading to better therapies and healthier communities.
In this episode, we meet Dr. Michael Glasser and Dr. Hana Hinkle who are at the helm of the National Center for Rural Health Professions at the University of Illinois College of Medicine Rockford. Since its inception in 2003, the center’s programs and collaborative partnerships have become successful models for education, service, research and policy related to rural health involving multiple health professions. Dr. Hinkle and Dr. Glasser spoke with me about their interprofessional approach to training future doctors, nurses, pharmacists and social workers as well as the importance of collaboration and community engagement when equipping these students for a career in rural health.
Dr. Glasser, who retired from the university this summer, was the former director of the National Center for Rural Health Professions, associate dean for rural health professions, a research professor of medical sociology and Dr. George T. & Mildred A. Mitchell endowed professor.
01:45 Dr. Glasser
My background happens to be in medical sociology and with an emphasis on patient- physician relationships and the need for health care in rural populations. And in terms of research, there is quite a bit of research that we do through the center. What I'm specifically focusing on really has to do with mental health, particularly the mental health of veterans and older populations looking at social support networks in rural communities. And increasingly, we're starting to look at issues in Hispanic and Latino Health in the rural sector.
02:28 [Voice Over]:
Currently leading the center is Dr. Hana Hinkle, interim director for the National Center for Rural Health Professions and research assistant professor in the department of family and community medicine at the University of Illinois College of Medicine Rockford campus. She also holds an affiliate appointment with the UIC School of Public Health division of community health sciences.
02:50 Dr. Hinkle
I am also serving as the associate director for our statewide Illinois AHEC (Area Health Education Center) network program that's HERSA funded. We have nine centers located throughout urban-underserved and rural-underserved communities with the idea that we will educate and train next pipeline or generation of quality- trained healthcare professionals and will populate those areas of workforce shortage areas across our state.
And then my PhD is in the health sciences really looking at interprofessional team-based care and how to improve health care delivery for disparate populations and underrepresented minority populations. I'm focused on culturally appropriate health care delivery as well in our work.
03:36 [Voice Over]:
Federal and state agencies, including the National Institutes of Health, have emphasized the need to reduce health disparities in rural America. More than 46 million Americans, or 15 percent of the U.S. population, live in rural areas as defined by the U.S. Census Bureau. Rural Americans are more likely to die from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke than their urban counterparts. Moreover, a CDC study found that children in rural areas with mental, behavioral, and developmental disorders face more community and family challenges than children in urban areas with the same disorders.
04:19 Dr. Glasser
When we first started the rural health medical education program, now almost 28 years ago, it was really because there was such health disparities and lack of health professionals in rural communities providing not only access to but quality care for rural populations- and actually this is backed up by NIH in many solicitations for grant proposals- we want to focus on minority underserved populations, not only say, including African American, Hispanic/Latino but they also say rural. I think there's been a greater recognition that rural in itself is a culture and that we need to have the expertise in working with not only rural people, but rural communities.
05:11 Dr. Hinkle
There's a lot of variation of how we define rural. In Illinois, for example, the Illinois Department of Public Health recognizes that counties that have a population size of sixty thousand or less are considered rural. Federally the Office of Management and Budget also defines rural by census tracks and how close a town is located in proximity to a metropolitan or non-metropolitan area as rural, so there's different variations. We tend to look at the spectrum of rural definitions based on a rural-urban commuting code- or RUCA code- which is by ZIP code population. Typically, acceptable is 49,999 or less is actually the definition of rural for RUCA. But we're really looking at where these communities are located and what their proximity Is to a metropolitan area.
06:04 Dr. Glasser
A lot of what we do is driven by, as Dr. Hinkle says, not only the Illinois Department of Public Health but through their Center for Rural Health. And they put out maps where they identify rural communities and determine whether or not- from the state perspective- they are considered underserved communities.
But the idea is you really do have to understand the rural populations. And it is different to experience mental health issues like depression in a rural community than in an urban area where you may have a number of psychiatrists or related mental health workers. In a rural community often it’s the primary care doctor who, at least initially, has to take on that role of not only meeting the needs physically of their patients but also the mental health needs of their patients.
06:57 Dr. Hinkle
From a practical standpoint as well, rural America continues to be where the economic drivers happen in terms of manufacturing and agriculture and other innovations that really help move the economy forward. And so when we're not investing in programs and services, that impact rural populations, it's really to a deficit of those living in urban and rural communities as well.
07:25 [Voice Over]:
The NCRHP is home to a variety of training programs, including Rural Health Professions the Illinois Area Health Education Centers Network (AHEC), Native American Pathways, and the Student Pipeline programs, which recruit and retain the next generation of rural health professionals. The center has had great success in its interdisciplinary approach to training. In fact, in spring 2021, the Rural Health Professions Program received the UIC Vice Chancellor for Health Affairs 2021 Interprofessional Teaching in Action Matters (ITEAM) award. Dr. Glasser explained the center’s origins and how it has evolved over time.
08:05 Dr. Glasser
Our rural initiative began with the founding and implementation of rural medical education in the RMED program on the Rockford campus, and that all came through discussions between our dean and state legislators, again, looking at the need for rural health care providers in the state of Illinois. There was a needs assessment that was done that determined how insufficient the physician workforce was- particularly related to primary care and family medicine in rural communities. Through this, we applied- and this was now about twenty eight years ago- applied for funding from the state to support the development of a program like this.
At the time there were three initiatives that the state decided that they would put money into. One was a Center for Rural Health through the Illinois Department of Public Health, which is mainly going to be used for grants and scholarships. The other was funding, that went to Southern Illinois University. The university there opted to use their money to support local communities in terms of projects that they might have. So if there was some sort of meeting program that was needed, or some transportation service that was needed in a rural community, each community could apply for funding from Southern Illinois University with this money that was allocated.
We went in a completely opposite direction and said- you know, after having looked at this we know that there's a need for primary care providers in our rural communities. And we want to put our funding, our resources, toward addressing that issue. Ours was perhaps the most complicated because now we're talking about education and not really being able to see a product of education until after going to medical school, going to residency and seeing where people would end up in terms of the actual practice.
We have been very successful, as it turns out, for a couple of reasons. I think mainly because of the recruitment for the RMED program, with a focus on “growing your own,” that is, identify young people from rural areas who are more likely to want to go back and practice in a small town in a rural community in Illinois.
It wasn't until the early 2000s that we were looking at the situation and saying, well, you know, it's good to be moving forward in terms of finding rural practitioners from medicine, but there's a lot of other needs out in the rural communities related to nursing, social work, public health, pharmacy to name a few. So that's when we came up with the idea of establishing our National Center for Rural Health Professions. We applied to the Illinois Board of Higher Education for approval of the center status and since that time on we've not only looked at medicine, but added these other professions to the mix.
I'd have to say having been with the program since its inception of rural programming that I’m really pleased with the amount of innovation that's gone into the different types of programs and the thought process for where we need to end up with our interprofessional programming. Hana can say more about this, but we do have a number of pipeline programs that really do put an emphasis on bringing health professions together and letting young people know at an early age that there's a possibility to go into a number of health professions in a rural community.
12:15 [Voice Over]:
The center’s interprofessional approach focuses on unique experiences that bring together both students and educators from different health arenas. The curriculum prepares graduates to be competent in their specific discipline, but students are also encouraged to understand the foundational concepts of public health and understand the persistent issues that lead to poor health outcomes.
12:37 Dr. Hinkle
I think initially we’re really trying to experiment with “how do you bring in multiple disciplines and multiple colleges together to have one shared vision and one common goal of education for different health professions students?” We're really able to manage that by bringing in unique experiences. So we train our students clinically but also non-clinically, as well try to understand what are those social determinant issues that create health disparities and poor health outcomes for rural populations, and that it's not all just based on maybe an access-to-care issue or that they there's not a physician existing in the community. It's a whole lot more in terms of that social piece.
Those unique experiences and unique disciplines come together when we're developing our curriculum, when we're developing experiences for our students, and when we're developing our own unique collaborative research projects as well. It’s really a testament to that work that helps create the success of our model.
13:38 Dr. Glasser
I think it's important to keep in mind that our focus has always been not only on getting students out into the clinical sector understanding what they need to do as clinicians working in rural hospitals, but also to truly understand the communities to which they will be returning to. To that end, in the fourth year of our students’ programming they spend sixteen weeks living in a rural community. And during that time they spend about seventy percent of their time on clinical work, and then they also are required to do- with the remaining 30% of their time- a community-oriented primary care project (COPC project) because, again, we want them to understand the context of care in the community in which they will be practicing.
This has really taken a nice turn for us a number of years ago when we really did engage full-time with pharmacy in terms of them developing a rural pharm track. And now, in a number of cases, we can have in that fourth year pharmacy students and medical students going to the same community for that 16 week period. So that has really, I think, been an eye-opener both in terms of team development and in terms of the impact that the rural community will experience when they have multiple providers who really understand each other's roles and understand how they can work together.
We have in our network over 30 collaborating hospitals in the State of Illinois for our programs. And actually now we've backed up in terms of third year for medical students and they have the opportunity now to go out and learn not only family medicine and, let's say, pediatrics in a rural community, but in general surgery and psychiatry and OB/Gyn. So we keep expanding that pipeline, the learning experience for the students, but with the ultimate goal to get our student to locate back into these rural communities, whether it's the community where they grew up or that's similar to where they grew up.
I think one thing in terms of translation and it is something that, again, we've learned through years of experience is that the laboratory for our students is out in the community. People have come to us and said, How do you get that started? How did you get that off the ground? How is it that you have all those collaborating hospitals and you have all these preceptors who are teaching your students and not charging you at all. We don't pay any of our external faculty. They all want to do this because they see this as something that benefits them, in a sense, because they learn from the students, but it also can benefit the community in the sense that if a student decides- I want to go back to Watseka or I want to go back to Princeton- their community benefits by having that person make their mind up based on their experience there for the 16 weeks. So, I think what we really want to continue to emphasize is that what needs to take place is something that's out there in the rural community. And the only way that you can get that off the ground is to go to those communities and work with people. Obviously through the pandemic there's a lot of things we couldn't do- as other people couldn't do- related to actually seeing patients or getting out into the community. And so, we had to rely on mechanisms like Zoom, but there's no substitute for actually being there, showing up at the door and establishing that relationship and trust with the hospital in terms of their CEOs, and the clinics in terms of the physicians and the preceptors, and the pharmacist preceptors, and the students- again- having that one-on-one face-to-face experience with patients in a setting that's going to be like where they intend to practice in in the future.
18:12 Dr. Hinkle
I think our faculty that are able to come train our students with their shared experiences our students are able to learn from those real-world examples of how to do consults with people from other disciplines/from other departments, what resources will be available, the social work component… that we’re continuing to build into our curriculum. I think its huge in terms of demonstrating the value-added when you have a social work department interacting specifically with the physician and pharmacy team for medication management, for long-term care planning, to improving readmissions rates for the hospital setting- which is tied into reimbursement. So, those are concepts that are not just concepts taught out of a textbook – it’s really demonstrated to students in their immersion experiences, through their faculty interactions, and then ultimately that will help improve their ability to understand their roles as leaders in their teams. But also understanding how valued each member of that team is to really promote the best experience for their patients long-term.
19:20 [Voice Over]:
The Rural Health Professionals Program utilizes principles of community engagement long examined by researchers and social scientists and applies them to an environment-specific training of future health care providers. Program leadership believe the relationship between education and community is a two-way street, and they have strived to engage the community in various aspects of their programming, from trainee field work and research to the way that they recruit new students.
19:49 Dr. Hinkle
First and foremost, our philosophy has always been there's no better classroom than a community. That's where you really understand the dynamic between a patient and provider and can understand, again, all those other issues that might be impacting outcomes related to that specific community population. So, although our students are recruited from rural backgrounds we're actually putting them in a position, in that fourth year especially but even starting their third year, they get the experience of training and various clerkships in rural communities really trying to put themselves in a physician-leader perspective rather than community member. Because we know that rural communities are not homogeneous, there's different needs and different influences surrounding individual rural communities in the state. We think that immersion experience is really important and not just in terms of the job shadowing opportunity but really being able to help support those providers in the system that those students are working and learning and training in. And then having that translational benefit of their community project where they're tasked to work with community leaders and stakeholders and trying to really understand- what are those priority health needs for that community? You can't necessarily get all the information you need to develop a real, true understanding and perspective of how to address these persistent and complicated issues unless you're on the ground in the community talking to people face-to-face and hearing the stories of the patients right in front of you.
21:18 Dr. Glasser
One of the more Innovative types of results that we have is we have what's called a recruitment and retention committee. Even at the time that we're looking for candidates to come into the RMED program, we're saying- this, this should not be academic exercise, we shouldn't be just in at a piece of paper that says- okay, here's their MCAT score, here's their GPA score, here's what the rating of the school that they went to comes out to be. We really want to pick the right people to go back into these communities. And so this committee, they are primary care doctors, nurses, social service workers- we even have a dairy farmer- but these people are the ones who interview the students and actually make the recommendation to us. And it's been wonderful. It's another way of being translational in the sense of identifying key people in the communities who we can work with, who are excited about the kind of things that we're doing to the extent- again- we don't pay them to do this, they want to do it.
22:31 [Voice Over]:
The center has a proven track record of success, but Dr. Glasser and Dr. Hinkle are not prepared to stop there. They shared their vision for expansion into additional health disciplines and efforts to replicate program outcomes throughout the country and the globe.
22:51 Dr. Glasser
I think this gets us back to the thoughts about innovation and expansion. We could have been satisfied with what was happening with the RMED program but then we recognized this really needs to be interprofessional, and if we're going to meet the multiple needs of these communities and these people in these rural areas, we need to be thinking beyond medicine alone. We could have stopped there. But I was actually part of a grant a few years ago through the Kellogg Foundation and in the context of the work we were doing there in terms of identifying priorities in rural populations- not only in Illinois but across the country. I was in a discussion with two people, one from Wyoming and one from Northern California, who were talking with me about- you know, this program you've got looks really good, but do you think it would work for Native Americans, as well? It seems like we have a lot of the same issues. So as a result of that, we're working with Wind River, Wyoming and with the Eastern Shoshone and the Northern Arapaho there to both send our students out who want to go in the fourth year for the 16 weeks to learn more about Native American health care. But also, at the same time, getting the message out to young people on the reservation there that it is possible for them to go to medical school or nursing school or pharmacy school and we will help do that. Not through scholarships because we don't have the money to do that, but through the mechanism that we have in place for the programming. Similar to that, in Northern California, we're working mainly with the Karuk and Hoopa tribes, which are outside of Arcata and Eureka. And so that is another step we can take. We had talked with people, for instance, from Jamaica, who are saying- wow, we have a lot of needs in our rural population, can you work with us to get a program started where we may be able to replicate not only the programs that you do but with the results and outcomes that you have with your program?
25:08 Dr. Hinkle
I think the future vision of the center is really exciting in terms of how we can expand these programs. Dr. Glasser mentioned this model we've developed has a lot of translational benefit even in a global health Community. The National Center for Rural Health Professions has been recognized as a collaborating center with the World Health Organization, and the Pan American Health Organization for helping to address medical resources globally. And we’re using our very same model of bringing together interprofessional teams of faculty, bringing together students who have an interest in developing the skills necessary to make a community impact, and to kind of have a level social accountability in the work that they're doing.
We started with these core disciplines that we've talked about today, but there's also discussions continually about how do we meaningfully bring in other disciplines that are in need in rural communities like dentistry, like having a more formalized focus in public health education and training, and really expanding that team model for students to train under, again, so that they're better prepared to be those champions for change in the rural communities that they will end up serving one day.
26: 23 Dr. Glasser
It’s just worked out in the most fantastic way in terms of the outcomes and I really do think, again, that's something that people need to learn from us if they want to make a difference in terms of the outcomes of the programs that they want to put forth that are designed to try to not only get people into rural communities but keep people in rural communities.
26:46 Dr. Hinkle
Our work continues to grow based on the needs of our community partners and we’re always looking to figure out better and innovative ways that we can achieve- ultimately again- improved health for people who typically have not had all the policy and all the focus around addressing their needs. And so programs like ours are really important to continue to advance health outcomes for people who again matter, and who matter in terms of what their communities bring to the fabric of America, really. So we're excited to see where this grows and continue our work.
27:28 Voice Over Outro
Collaborative Endeavors is produced by me, Lauren Rieger, on behalf of the Center for Clinical and Translational Science (AKA the CCTS) at the University of Illinois at Chicago.
To learn more about the research discussed in this episode, visit the links in our show notes.
The CCTS is supported by the National Institutes of Health’s National Center for Advancing Translational Science through their Clinical and Translational Science Award. The views expressed in this podcast are our own.
To learn more about how you can get involved in health research, visit ccts.uic.edu or follow us on Twitter @UIC_CCTS.