Partnerships to Establish and Sustain Rural GME: Q and A with Dr. Kevin O’Connell of the Wisconsin Northern and Central (WiNC) GME 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 Wisconsin Northern and Central (WiNC) GME Consortium is an ACGME-accredited Sponsoring Institution that supports residency and fellowship programs across northern and central Wisconsin, with a focus on strengthening the regional physician workforce in largely rural communities. The consortium’s membership includes health systems, medical schools, and community partners working together to provide high-quality GME. Kevin O’Connell, MD serves as the designated institutional official (DIO).
ACGME: What drew you to academic medicine and to rural GME specifically?
Dr. O’Connell: As a 14-year-old high school freshman, having spent a great deal of time in the health system as a patient and growing up in a very rural part of western Wisconsin on a small dairy farm, it became my goal to be a small-town rural family doctor. Medical school, unfortunately, almost beat that out of me. But my family medicine residency in Wausau, Wisconsin, with a program director who became my mentor, my colleague, and my friend, showed me that rural academic medicine, if done right, can be so uplifting and affirming.
ACGME: Describe the rural GME experiences within your Sponsoring Institution.
O’Connell: WiNC sponsors multiple family medicine residencies, a psychiatry program, and an American Board of Physician Specialties-accredited emergency medicine fellowship located across northern and central Wisconsin. Consortium sponsorship centralizes institutional oversight (Graduate Medical Education Committee (GMEC), Board of Directors, DIO), while each program retains local program directors, associate program directors, and coordinators. The consortium provides shared resources (Human Resources, legal, payroll, benefits, faculty development, learning resources, and cross‑program learning and rotations). Each program has autonomy to meet accreditation standards. WiNC offers the opportunity for shared cross-program didactics, and shared curricula are being rolled out yearly. This approach offers learners autonomy to pursue their areas of interest within a small rural program. Ongoing faculty development attracts new and develops existing faculty members, and develops current and future GME leaders via a Leadership Academy.
ACGME: How did your Sponsoring Institution become involved in establishing rural GME experiences?
O’Connell: Our mission is “Together, create the best regional physician workforce in the country.” That mission statement was developed as the guiding principle for WiNC, bringing together our many stakeholders to collaborate on forming rural GME as the means to that end.
ACGME: Describe the internal and external partnerships that have been important in establishing and sustaining these experiences.
O’Connell: Internally, program directors, the GMEC, Board of Directors, and institutional coordinators have been important partners. The newly created Center of Excellence coordinates curriculum and faculty development and enables collaboration between programs. Externally, affiliations with two Wisconsin medical schools (University of Wisconsin SMPH, Medical College of Wisconsin), regional health systems, local hospitals, community organizations, and state and national GME have been important to establishing and sustaining these experiences.
ACGME: Describe the challenges you have experienced in developing and sustaining rural GME partnerships and experiences; and explain how you have overcome them.
O’Connell: One challenge was accreditation and compliance complexity. WiNC received citations during Initial Accreditation cycles; addressing them required coordinated GMEC action, Board oversight, and targeted remediation. The consortium later achieved Continued Accreditation with no new citations. Another challenge was program transitions and closures. The Prevea Eau Claire program closed due to a hospital closure, for which WiNC worked to reassign residents and preserve training continuity. We also had to deal with geographic dispersion and resource variability. This was overcome by centralizing shared resources, creating the Center of Excellence, facilitating cross‑program workshops and funding, or other mechanisms to support program needs. Lastly, we faced program director and coordinator turnover. The typical length of service for a program director nationally is three years. In Academic Year (AY) 2023-2024, WiNC replaced four of five program directors, leaving the most experienced director with under five years of experience. Simultaneously, multiple program coordinators left as well. While not outside the norm for the industry, this level of turnover in short order, combined with the other challenges, was exceptional. Through support and leadership, the programs have now stabilized, are in the process of optimizing, and are able to plan for expansion and innovation.
ACGME: Describe some of your Sponsoring Institution’s outcomes since establishing rural GME experiences, including the impact to the surrounding community.
O’Connell: At the start of AY 2024‑2025, WiNC had 64 residents and two fellows, and the consortium achieved a 100% percent primary fill rate in the 2024 [National Residency Matching Program] Match. Over half of the 2025 graduates (approximately 53%) are practicing in Wisconsin, demonstrating local retention and community impact. The average over WiNC’s five-year history of physicians practicing in Wisconsin is 63%. Resident Survey results improved markedly from AY 2023‑2024 to AY 2024‑2025 (residents’ overall positive evaluation rose from 71% to 89%), and faculty evaluations remained highly positive. These improvements reflect programmatic changes, policy updates, and targeted remediation. Through the use of the American Medical Association’s Organization Biopsy and ResZ burnout tool, WiNC identified it has higher wellness scores than the national average for residency programs due to its ongoing commitment and action to building the skills of leaders and faculty members that create the learning culture. WiNC led the engagement of five competitive health systems to work together to improve patient safety and quality improvement in their systems through utilization of GME learners. This improves the current and future care of patients beyond residents’ or fellows’ time in training and shows communities that health systems can work together to better health care for all. This has had a positive impact on the community, as graduates practicing locally increases access to primary care and specialty services in rural and underserved populations and communities.
ACGME: What advice do you have for those interested in establishing rural GME experiences?
O’Connell: Build collaborative governance early: Create a clear institutional sponsor structure and formal affiliation agreements with clinical sites. Invest in shared infrastructure: Create a central information sharing site for cross‑program sharing. Reduce duplication by sharing intellectual resources across programs and sites (such as aligning didactic days to create time for collaboration). Prioritize resident support and community integration: Design curricula that reflect rural practice scope specific to your area, emphasize continuity, and include community stakeholders to ensure training meets local needs. Create learning opportunities at the intersection of learner interest and community need (like lifestyle medicine or addiction medicine). Plan for accreditation rigor: Expect iterative work to meet ACGME (or some other national best practice) standards, even if you sponsor non-accredited programs. Use the GMEC and external partners to remediate challenges and document improvements.
ACGME: Describe the resources that have helped your program to establish rural GME experiences.
O’Connell: Giving program leaders ease of access to institutional leadership for support, coaching, and connections to other programs to support minimally resourced programs has been essential. Additionally, adoption of a Learning Management System to centralize faculty development and resident resources, and establishing and coordinating the sharing of specialized curricula to make them accessible to all programs has had a significant impact. Creating processes to share resources between programs with awareness of time limitations and the academic calendar demands is an important consideration. Finally, we have created specialty support for opportunities and challenges to help programs thrive and survive based on their needs. WiNC has a DIO discretionary fund for educational innovations or learning opportunities that programs may not be able to take advantage of without some help. Similarly, external learner and leader support is contracted to help programs face learner or program challenges. This extra third-party support provides programs with a little extra resource and the confidence that we are here for them when times are tough. Some pre-planning on the part of the institution to set these funds aside can help programs feel both valued and buoyed in trying times.
Email underserved@acgme.org if you want to get in touch with Dr. O’Connell. 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.