Partnerships to Establish and Sustain Rural GME: Q and A with Paulette Wehner, MD, FACC, FACCP, FAHA, FACP of the Marshall Community Health Consortium
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 platform, Learn at ACGME. Note: an account (free to create) is required to access most content in Learn at ACGME.
The Marshall Community Health Consortium was formed in 2014 to foster and promote the development of community-based rural residency programs. Its first residency was Holzer Family Medicine in the rural town of Gallipolis, Ohio. Today, the consortium proudly sponsors not only Holzer Family Medicine, but separately accredited rural residency programs in internal medicine, psychiatry, and general surgery (the nation’s first). By educating and training residents in rural areas, the consortium’s goal is to provide the same level of education and training offered in urban areas to these physicians and in turn, the same level of care to patients regardless of zip code. Dr. Paulette Wehner is the designated institutional official and vice dean of education at both the Marshall Community Health Consortium and the Marshall University School of Medicine. An interventional cardiologist by trade, she is also an advocate for rural patients.
ACGME: What drew you to academic medicine and to rural GME specifically?
Dr. Wehner: I have always been interested in teaching and providing care to those in need. Caring for patients created a career-long interest in medical education at all levels. I grew up in the rural town of Kingwood, West Virginia, which made me cognizant of the challenges of practicing rural medicine. As a medical student, resident, and fellow, I received teaching awards. I was later appointed as the cardiology fellowship program director at the Marshall University School of Medicine. Academic medicine allows me to combine both passions to train future rural physicians.
ACGME: Describe the rural GME experiences within your program (e.g., types of sites, structure, curriculum).
Wehner: We are fortunate to be at a medical school that has two Sponsoring Institutions that share the same graduate medical education (GME) support staff. Our consortium’s rural residencies have a “sister” program within the Marshall University School of Medicine Sponsoring Institution; this allows programs to collaborate while maintaining the features unique to each program and its participating sites. Programs are stronger and more cost-effective because of this relationship.
ACGME: How did your Sponsoring Institution and program become involved in establishing rural GME experiences?
Wehner: Since the inception of the consortium, the mission has always been to develop rural residency programs. Our institution’s goal is to train the unique resident who will practice in a rural area with confidence and dedication, which will help address the forecasted rural physician shortages in the coming years.
ACGME: Describe the internal and external partnerships that have been important in establishing and sustaining these experiences.
Wehner: It is imperative to have a local physician champion in each community who shares the same vision and goal that you do. These champions help recruit physicians and community leaders who can become team members in making things happen. We are fortunate to have the mayor of the City of Logan, West Virginia, and the support of the rural hospital as partners to help address several challenges with building a rural residency program. Issues such as housing, creating new resident spaces in existing clinics, and recruiting faculty members (some of whom may not have been previously involved in GME) have been hurdles in program development. Community leaders, such as county commissioners, state legislators, and local economic development staff members, have played key roles in the successful integration of our residents into the community.
ACGME: Describe the challenges you have experienced in developing and sustaining rural GME partnerships and experiences; and explain how you have overcome them.
Wehner: Establishing rural residency programs includes the same basic challenges as any new residency program. First, appropriate faculty members must be recruited, followed by enthusiastic program leadership, and successful accreditation. Once these hurdles are overcome, sustainability is the next puzzle piece. This includes gaining buy-in from the rural community, learning environment support, housing at both the urban and rural sites, and even such minutia as adequate technical support for didactic sessions and grand rounds. These challenges can only be overcome with strong institutional support and knowledge.
ACGME: Describe some of your program’s outcomes since establishing rural GME experiences, including the impact to the surrounding community.
Wehner: Our residents are actively engaged in their communities. They volunteer as much as their demanding education and training requirements allow. This has resulted in community acceptance of our residents and the rural residency programs. We are extremely proud that our associate program director of rural surgery, Jodi Cisco-Goff, MD, was named the 2024 West Virginia Rural Physician of the Year.
ACGME: What advice do you have for those interested in establishing rural GME experiences?
Wehner: Simply stated, don’t give up. If this was easy to do, every Sponsoring Institution would do it. It takes a dedicated Sponsoring Institution that can effectively engage community partners to not only create but sustain these rural residency programs, while also never forgetting that rural location is not an excuse to lessen the quality of the education and training or patient care.
ACGME: Describe the resources that have helped your program to establish rural GME experiences.
Wehner: The ACGME staff has been great at answering all our questions. We are also very appreciative of all the resources that the Health Resources and Services Administration (HRSA) and the Rural Residency Planning and Development (RRPD) grant Technical Assistance Center staffs have provided.
ACGME: Is there anything else you would like to add we haven’t asked about?
Wehner: We are very appreciative of the HRSA RRPD grants, as well as of our Teaching Health Center grant, which provided us with the start-up funds.
Email muap@acgme.org if you want to get in touch with Dr. Wehner. Is your Sponsoring Institution/program already providing rural GME experiences and would you like to be featured in a future post in this ACGME Blog series? Email muap@acgme.org to share what you’re doing. Visit the MUA/P web page to learn more about the ACGME’s efforts.