Partnerships to Establish and Sustain Rural GME: Q and A with Dr. Heather Kovich of the UNM Shiprock Family Medicine
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 University of New Mexico (UNM) Shiprock family medicine residency program in the federal Indian Health Service (IHS) is the only program on Navajo Nation (Diné Bikéyah). Residents spend their PGY-1 in Albuquerque at UNM, and their PGY-2 and -3 at the Northern Navajo Medical Center in the small town of Shiprock, New Mexico. Accredited since 2021, the program has two residents per class. Heather Kovich, MD is the founding program director.
ACGME: What drew you to academic medicine and to rural GME specifically?
Dr. Kovich: Coming out of family medicine residency in 2008, I wanted to maintain all my clinical skills. I wanted to deliver babies, and work in a hospital and in an outpatient clinic. I wanted to work where I was needed and be part of the local community. I enjoy spending time outside. This what drew me to rural medicine.
I have always enjoyed academic medicine. When I started working in Shiprock, I continued writing, speaking at conferences, and teaching visiting students and residents. When the University of New Mexico reached out to explore a rural track program at our site, I was eager to be part of it.
ACGME: Describe the rural GME experiences within your program (e.g., types of sites, structure, curriculum).
Kovich: We have a “1+2” family medicine residency. Our Sponsoring Institution is UNM, and our residents spend their PGY-1 in Albuquerque at UNM’s tertiary care hospital and clinics. Then they move to our rural site in Shiprock, New Mexico, three-and-a-half hours away. The PGY-2 and -3 take place on Dine’ Bikeyah, the Navajo Nation. Residents work in our inpatient and outpatient settings, and out in our community. They work on our street medicine service, in our school-based clinics, at local sporting events, and do home visits. They facilitate community meetings about health care. The community teaches the residents how to be excellent physicians, and also how to butcher a sheep.
In addition to our accredited program, our hospital supports residents from other GME programs around the country who want to visit for an elective month.
ACGME: How did your Sponsoring Institution and program become involved in establishing rural GME experiences?
Kovich: UNM develops health care workers for all of New Mexico. It already had a rural track program in Santa Fe and was interested in expanding to additional sites. Because of our work with visiting residents, they knew we were dedicated to teaching, and that our hospital has the patient volume and variety to be a robust site for a residency program. On our end, we recognized that residents who train for two years are likely to stay in the area, and that a residency program would give our community a voice in how doctors are trained. The community has a lot of knowledge to share with learners, but this relationship takes time and consistency.
ACGME: Describe the internal and external partnerships that have been important in establishing and sustaining these experiences.
Kovich: UNM and the IHS have worked in partnership to build this program. These are two large institutions, and I’ve been impressed with how they’ve been able to problem-solve and be flexible as we’ve developed this program.
ACGME: Describe the challenges you have experienced in developing and sustaining rural GME partnerships and experiences; and explain how you have overcome them.
Kovich: It’s hard to recruit students to rural family medicine. We’ve found that having student rotations has been one of our best recruiting tools. Our visiting students often want to come back, and they spread the word to others.
There are also challenges inherent to training residents at a small hospital. We don’t have a large variety of specialists, and when one teaching physician leaves there is an outsized impact on the program. These are challenges that our patients have experienced for decades. We’ve worked with surrounding hospitals and with our Sponsoring Institution so that our residents have the experiences they need.
ACGME: Describe some of your program’s outcomes since establishing rural GME experiences, including the impact to the surrounding community.
Kovich: Our family medicine department is fully staffed for the first time in the 16 years I’ve worked here. We have hired some of our residents and we’ve recruited other faculty members who are excited by the opportunity to teach in this unique environment.
In addition, the ACGME accreditation requirements have nudged our hospital to develop programs that we’ve wanted to have for a long time. Our Patient Advisory Committee was developed to meet the Program Requirements for Family Medicine, but it’s been one of the most meaningful experiences of my tenure here. I look forward to the bimonthly meetings and always leave with renewed energy and optimism.
ACGME: What advice do you have for those interested in establishing rural GME experiences?
Kovich: Develop rural GME experiences at sites that have already shown dedication to teaching and academic inquiry. The rural site should drive the development of these programs, with support from academic centers.
ACGME: Describe the resources that have helped your program to establish rural GME experiences.
Kovich: HRSA [Health Resources and Services Administration] grant funding covered five years of start-up costs, which was crucial to the development of our program; UNM poured time, energy, and expertise into developing this program—we couldn’t have done it without partners who already had so much knowledge and experience in GME.
Email underserved@acgme.org if you want to get in touch with Dr. Kovich. 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 underserved@acgme.org to share what you’re doing. Visit the Rural and Underserved GME web page to learn more about the ACGME’s efforts.