This interview is part of a series featuring Sponsoring Institutions and programs providing rural graduate medical education (GME) experiences. The series was initiated following the 2022 ACGME Annual Educational Conference presentation on Medically Underserved Areas/Populations: Partnerships to Establish and Sustain Rural GME, available in the ACGME’s digital learning portal, Learn at ACGME. Note: an account (free to create) is required to access most content in Learn at ACGME.
Rhonda Edison, DO and Ms. Trinity Turner are the site director and program coordinator, respectively, for the Central Washington family medicine residency program’s rural participating site located in Ellensburg, Washington. This participating site is sponsored by Community Health of Central Washington, a Federally Qualified Health Center (FQHC), and is affiliated with the University of Washington Family Medicine Residency Network. This rural site was established in 2012 and founded on the belief that the best preparation for rural practice is rural training. It is a three-year training site, with residents doing most of their education and training in Ellensburg and part in Yakima, Washington at the program’s primary clinical site, just 35 miles from Ellensburg. The rural track matches two slots each year for a total of six residents in Ellensburg. They provide full spectrum family medicine education and training, including obstetrics, integrated behavioral health, osteopathic medicine, procedural training, and inpatient pediatric and adult medicine. Since its establishment, the rural track has graduated 15 residents, the majority of whom have gone into rural/underserved medicine and several staying to practice in Ellensburg or neighboring counties.
ACGME: What drew you to academic medicine and to rural GME specifically?
Dr. Edison: In Latin, doctor means teacher. While much of the time, this refers to educating patients as to the role they play in their own health care, it is also training within the health care institution. I have done this now for many years, from elementary school through founding and teaching at an osteopathic medical college, working with medical assistants, nurses, and new physicians. Having been in private practice for more than a decade, I was twice the town doctor in a rural setting. I did enjoy the aspect of community associated with this setting, which always leads to best care, as patients are seen throughout their lives, giving better understanding of their situational health.
Ms. Turner: My path to GME had some twists and turns in it! After graduating with my Bachelor of Science degree in geography a few years ago, I started working in health care administration and found I really enjoyed it. I had always had a strong interest in education as well, so when the opportunity arose to join the GME team here, I was excited to join the field. Having lived and worked in Ellensburg for several years, I knew all too well the challenges faced by this rural community when it comes to physician recruitment, and the lack of health care access for patients. Our rural residency program is having a direct impact on improving the health and well-being of this community, and I am proud to be a part of it.
ACGME: Describe the rural GME experiences within your program (e.g., types of sites, structure, curriculum).
Dr. Edison/Ms. Turner: What sets us apart is that our Ellensburg rural site is located close enough to the core program in Yakima to make it possible to spend three years in the rural setting, while also maintaining a close relationship with the core program, and working on the larger hospital service in Yakima throughout residency. Ellensburg is located in Central Washington and home to Central Washington University. Ellensburg offers many amenities not often found in smaller communities, but it is still very much a rural area. We like to say that we are “rural, but not remote.” Some of the experiences unique to our program include rodeo medicine opportunities, sports medicine experiences at the university and high school, a fully integrated primary care behavioral health program, a strong obstetrics program, and opportunities for training in medication-assisted treatment for Opioid Use Disorder.
ACGME: How did your program become involved in establishing rural GME experiences?
Dr. Edison/Ms. Turner: Throughout the US, and especially in some areas of the western US, access to physicians is limited. Prior work from the Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) workforce center has noted that eastern Washington state has fewer physicians per 100,000 population than Wyoming, Alaska, Montana, or Idaho. In the early 2000s, our residency had an opportunity to explore development of a rural residency track. At the time, we could not find financing to support the expansion, yet this concept remained part of our strategic plan. In 2005, our residency program separated from its hospital sponsorship and became an FQHC look-a-like and then an FQHC. This provided access to capital funding that allowed us to build the first community health clinic in Kittitas County. At the time we designed the building with a residency in mind and included resident and faculty space. Then, in 2010 with passage of the Affordable Care Act, we were able to apply for and receive Teaching Health Center funding for a rural track. This novel track started residents in their first year with a continuity panel and experiences with community physicians in a rural setting. Our focus was on family medicine as those physicians can provide a rural community with inpatient, pediatric, obstetric, and ambulatory care.
ACGME: Describe the internal and external partnerships that have been important in establishing and sustaining these experiences.
Dr. Edison/Ms. Turner: A critical aspect in starting the program was that the community wanted us. They saw the value of an FQHC and residency to serve patients and grow the workforce. Kittitas Valley Healthcare (KVH), our public hospital district, has been an invaluable partner in both establishing and sustaining our rural residency site. Our residents do a significant portion of their education and training at KVH Hospital and their outpatient specialty clinics. We are able to provide local, rurally focused rotations in cardiology, general and vascular surgery, orthopaedics, pediatrics, obstetrics and gynecology, neurology, and many other specialties because of the hard work that has been done by our local hospital district to bring high-quality specialty service lines to our community.
Another valuable partnership we have is with our local and regional medical schools, Pacific Northwest University of Health Sciences College of Osteopathic Medicine, Washington State University Elson S. Floyd College of Medicine, University of Washington School of Medicine, and Idaho College of Osteopathic Medicine, which provides us the opportunity to train and recruit medical students who are passionate about rural health care and often want to remain here in the community after medical school. We attend regular, recurring meetings with the medical schools and KVH to ensure that we are all effectively collaborating when it comes to rotation scheduling opportunities, faculty development, and other opportunities to share resources.
Additionally, our membership in the WWAMI Family Medicine Residency Network (FMRN) provides us with an incredible network of knowledge and learning to make our program stronger, and provides us with opportunities for our faculty members, residents, and administrators to collaborate, learn, and network with other family medicine residencies in our region.
ACGME: Describe the challenges you have experienced in developing and sustaining rural GME partnerships and experiences; and explain how you have overcome them.
Dr. Edison/Ms. Turner: One of our biggest challenges has been the ongoing need to maintain strong relationships with community attendings and recruit quality faculty members to our area. We are incredibly thankful for our core faculty members and partnerships with community attendings. However, rural graduate medical education is still fairly new in Ellensburg, and transitions in personnel both in the community and our own organization, coupled with the disruptions from the COVID-19 pandemic, created a significant challenge for us as a program to maintain these relationships and keep residency training at the forefront of people’s minds. We have found that one-on-one relationship building to ensure buy-in from community attendings and other stakeholders has been an invaluable step taken to overcome this challenge.
ACGME: Describe some of your program’s outcomes since establishing rural GME experiences, including the impact to the surrounding community.
Dr. Edison/Ms. Turner: One of the most significant impacts rural GME has had in our community has been the improved patient access to physicians. Our residents’ appointments make up a significant number of the total visits in our rural clinic. We have also had several of our graduates stay in Ellensburg to continue practicing, both at our own clinic and residency and with other organizations in the community.
ACGME: What advice do you have for those interested in establishing rural GME experiences?
Dr. Edison/Ms. Turner: Taking the time to build and maintain relationships with our community attendings and other stakeholders is one of the most important things we have done to both establish and maintain our rural GME program. We could not do what we do without the help and support of those around us. Especially in smaller communities like Ellensburg, where resources can be scarce, it is paramount that we cultivate a spirit of collaboration and knowledge sharing.
ACGME: Describe the resources that have helped your program/Sponsoring Institution to establish rural GME experiences.
Dr. Edison/Ms. Turner: A strong relationship with our local critical access hospital and community attendings has been invaluable to the success of our rural site. We also have strong support from our core site in Yakima and our Sponsoring Institution, which have provided us with the administrative and leadership support we need to continue doing the work that we care about so much as rural medical educators.
ACGME: Is there anything else you would like to add we haven’t asked about?
Dr. Edison/Ms. Turner: We would like to thank Dr. Russell Maier for his input on this blog post with regard to the history and initial development of our rural residency site. He served as our program director from 2005-2018 and played an integral role in the creation of our rural site. He is now the Associate Dean for Graduate Medical Education at Pacific Northwest University of Health Sciences, and the WWAMI FMRN Regional Associate for Program Development and Support.
Email firstname.lastname@example.org if you want to get in touch with Dr. Edison and/or Ms. Turner. Is your Sponsoring Institution/program already providing rural GME experiences and want to be featured in a future post in this ACGME Blog series? Respond to this short questionnaire to share what you’re doing and provide input on how the ACGME can engage stakeholders in this important work. Visit the MUA/P web page to learn more about the ACGME’s efforts.