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.
The Wisconsin Collaborative for Rural Graduate Medical Education (WCRGME) works to address the shortage of rural primary care physicians through the expansion of rural GME. It is a network of 20 rural GME programs and several partners (i.e., hospitals, programs, stakeholders) looking to expand rural education and training experiences. While WCRGME doesn’t directly sponsor residency programs, it provides technical assistance and support to both existing and developing rural programs, as well as rural hospitals looking to educate and train residents. Ms. Lori Rodefeld serves as the Director of WCRGME, leading a team that supports rural GME development and technical assistance for their partner programs and sites. Her team offers educational events, professional development for faculty members and coordinators, and outreach to medical students interested in rural education and training. Ms. Rodefeld also serves as the Manager of Medical Education at SSM Monroe Hospital.
ACGME: What drew you to academic medicine and to rural GME specifically?
Ms. Rodefeld: My background prior to GME includes work in rural workforce development at a two-year college. I worked at a rural branch campus where I was able to support the development of new programs that would meet workforce needs in the local community. After eight years at the college, I had the opportunity to set up new GME programs at the hospital in my community. While I had limited knowledge of GME, I was fortunate to work with a CMO [chief medical officer] who was a former residency program director. Together we built new medical education programs that have supported workforce needs of the state and region. These two experiences have solidified my interest in rural workforce development, not only in Wisconsin but across the country.
ACGME: Describe the rural GME experiences within Wisconsin.
Ms. Rodefeld: The rural programs in Wisconsin vary in the types of experiences offered. We have both rural track programs (RTPs) and rurally located programs. The rural track programs vary in curriculum with several of the family medicine RTPs set up in the 1+2 model, where residents will spend one year in an urban location followed by two years at a rural hospital. In procedural-based specialties like surgery and obstetrics and gynecology, residents will spend more time in the urban location while completing several months of rural education and training at partner hospital sites over the course of their residency. WCRGME supports development of these rural training sites, identifying locations where there are both sufficient volumes and strong rural physician mentors. Rurally located programs operate almost entirely at one location and may utilize outside education and training at urban sites to supplement curricular experiences.
ACGME: How did WCRGME become involved in helping establish rural GME experiences?
Ms. Rodefeld: WCRGME was founded in 2012 to support the growth of rural GME in Wisconsin. At the time WCRGME was created, there was a small presence of rurally located and 1+2 RTPs. The organization was founded to create an infrastructure and support system to not only grow new programs but also expand rural education and training sites. WCRMGE is supported by grant funding that was established at the state level following a landmark report from the Wisconsin Hospital Association anticipating a shortage of 100 physicians a year through 2030. Since that time, the state has added additional funding for program development and expansion. This has led to creation of several new programs, including rural family medicine residencies, rural psychiatry residencies, rural surgery residencies, and the first rural obstetrics and gynecology residency program in the nation.
ACGME: Describe the internal and external partnerships that have been important in establishing and sustaining these experiences.
Ms. Rodefeld: WCRGME regularly collaborates with statewide partners, including the Rural Wisconsin Health Collaborative, Wisconsin Office of Rural Health, Medical College of Wisconsin, University of Wisconsin, Wisconsin Academy of Family Physicians, the Wisconsin Northern & Central GME Consortium (WiNC), and the Wisconsin Council on Medical Education and Workforce, to name a few. Many stakeholders are invested in the growth of rural GME as we look for strategies to increase our physician workforce. At the national level, we have a strong partnership with the RTT Collaborative, as they provide support to our programs through consulting, educational events, and recruitment activities, and through networking with other rural programs. WCRGME has also been a partner in the work of both the Rural Residency Planning and Development and Teaching Health Center GME Planning and Development Technical Assistance Centers.
ACGME: Describe the challenges you have experienced in developing and sustaining rural GME partnerships and experiences; and explain how you have overcome them.
Ms. Rodefeld: Recruitment of rural faculty members continues to be a challenge for rural programs, whether it is recruiting a new faculty member to a program or identifying a physician to mentor a resident on a rural rotation. WCRGME has partnered with WiNC to develop a Rural GME Leadership Academy as a method of ‘growing our own’ faculty members. Earlier this year, we established the first cohort, and 27 rural physician faculty members joined our six-month program. These included community rotation faculty members, new faculty members, and rural program directors in a variety of specialties. We are planning a follow-up session in 2023 and to continue to support the work of our rural faculty members educating and training residents.
Another challenge rural programs face is retention of a program coordinator. The loss of a coordinator can negatively impact the continuity of a program without strong support. Staff members at WCRGME have developed not only a rural coordinator bootcamp to support training of new coordinators but are also working to establish a rural coordinator leadership academy that will begin in 2023. These efforts support the professional growth and leadership of rural coordinators not only in Wisconsin but across the country.
ACGME: Describe some of WCRGME’s outcomes, including the impact to the surrounding community.
Ms. Rodefeld: WCRGME has grown from a group of eight hospitals and GME programs in 2012 to more than 40 partners in 2022. We anticipate adding at least two new rural GME programs in 2023 and have other partners interested in GME development. The total number of rural GME positions has grown 51 percent in the last 10 years from 25 residents in 2012 to 51 residents in 2022. Last year, 65 percent of our rural residency graduates chose rural practice. While we are still preparing for additional shortages in the physician workforce, our programs are making an impact by placing graduates into rural communities throughout the state.
ACGME: What advice do you have for those interested in establishing rural GME experiences?
Ms. Rodefeld: The resources provided by the Rural Training Track Collaborative (RTTC) and RuralGME.org both offer an excellent starting point for those looking to start rural GME programs. The RTTC has an annual meeting held in each spring, which provides not only educational sessions but networking opportunities. The RTTC website has an extensive directory of rural programs in various specialties. RuralGME.org has free tools and resources, including webinars and an extensive toolbox with resources on program development and sustainability.
ACGME: Describe the resources that have helped WCRGME.
Ms. Rodefeld: State grant funding was the primary catalyst to establish WCRGME back in 2012. The legislature realized the need to place physicians in rural settings and allocated funds to support the Wisconsin Rural Physician Residency Assistance Program (WRPRAP). This allowed for the creation of WCRGME and supported development of new programs, as well as rural GME sites and rotations. Since that time, additional Medicaid GME funding through state grants have been established to support program development and expansion. This has allowed for growth in both rural programs and the total number of rural GME positions.
Email muap@acgme.org if you want to get in touch with Lori. 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.