Partnerships to Establish and Sustain Rural GME: Q and A with Joseph Weigel, MD, MACP of Lake Cumberland Regional Hospital
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.
Lake Cumberland Regional Hospital is a community hospital that serves as the Sponsoring Institution of both an internal medicine and a family medicine residency program. The internal medicine program has 21 residents, and the family medicine program has 18 residents. Lake Cumberland also has 20 full-time medical students. Both residency programs are a decade old. Lake Cumberland is in south central Kentucky in the foothills of Appalachia. Dr. Joseph Weigel is a board-certified internist who practiced traditional inpatient and outpatient internal medicine at Lake Cumberland for 28 years before becoming the founding internal medicine residency program director there in 2013.
ACGME: What drew you to academic medicine and to rural GME specifically?
Dr. Weigel: I have always enjoyed teaching as a way to practice better medicine. I have been an active member of the American College of Physicians (ACP), which has always encouraged lifelong learning. It was a straightforward transition for me when the opportunity arose.
ACGME: Describe the rural GME experiences within your program (e.g., types of sites, structure, curriculum, etc.).
Dr. Weigel: We are a secondary medical center with a large, rural referral base and with nearly every medical subspecialty represented. We have an open ICU [intensive care unit] model and emphasize critical care and procedural expertise to meet our mission of generating rural physicians.
ACGME: How did your Sponsoring Institution/program become involved in establishing rural GME experiences?
Dr. Weigel: Both [residency] programs are about what it is like to practice in a rural area daily. We have combined our continuity clinic into a single entity to mimic what it is like for generalists to practice together.
ACGME: Describe the internal and external partnerships that have been important in establishing and sustaining these experiences.
Dr. Weigel: The primary partnership is between the two [residency] programs. We have found this strengthens both. We have university-based affiliation agreements for subspecialty rotations as needed.
ACGME: Describe the challenges you have experienced in developing and sustaining rural GME partnerships and experiences; and explain how you have overcome them.
Dr. Weigel: Our primary challenge is and has always been having sufficient faculty membership. It is, I think, the primary ongoing problem for all rural GME programs.
ACGME: Describe some of your program’s outcomes since establishing rural GME experiences, including the impact to the surrounding community.
Dr. Weigel: We have now placed nearly 40 outpatient, hospitalist, and subspecialty practicing clinicians within a 50-mile radius of our institution in the past decade. We will add two more next year.
ACGME: What advice do you have for those interested in establishing rural GME experiences?
Dr. Weigel: Be prepared to roll with the punches. Sell yourself relentlessly to [your institutional] administration and potential teachers. Eschew mediocrity, and convince your learners that excellence is the only goal worth pursuing.
ACGME: Describe the resources that have helped your program to establish rural GME experiences.
Dr. Weigel: Our Sponsoring Institution has been willing to expend sufficient financial resources. Our program coordinators/administrators were smart and have been totally committed from the start. We have had good community recognition and support.
ACGME: Is there anything else you would like to add we haven’t asked about?
Dr. Weigel: Both program directors love their work and consider it the capstone of their practice careers. Nothing is more invigorating in medicine than to teach motivated, passionate students. It is a true gift to be able to improve the nature of care available by educating our own. Finally, a vigorous relationship with nearby medical schools is crucial.
Email muap@acgme.org if you want to get in touch with Dr. Weigel. 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.