Integrated Residency helps retain students in a regional campus residency program

David L. Bramm, MD;  Paula Clawson

Family Medicine Integrated Residency (IR) at the UAB School of Medicine Integrated Residency (IR) at the UABSchool of Medicine,Huntsville Regional Medicine Campus is designed to attract rural students and to fully prepare them for Family Medicine Residency. It also provides a recruiting method for the residency to retain in-state medical school graduates. The 2017-18 pilot year had 5fourth year medical students enrolled and they all matched in the Huntsville residency.

Since 2005, only 32.2% of the UAB Huntsville Family Medicine Residency has been filled with graduates of Alabama medical schools.  This is concerning because in Alabama, 74.7% of physicians who do both their undergraduate and graduate medical training in-state set up practice in Alabama.  This residency program accepts 12 interns per year. It is housed in the Huntsville Regional Medical Campus of the UAB School of Medicine (HRMC).

The HRMC teaches clinical skills to a cohort of third and fourth year students, approximately 35 in each class. Included in these classes are a special track of Rural Medicine Program (RMP) students who grew up in rural Alabama, expressed an interest in rural family medicine, and have been exposed to a special rural curriculum. EvenRMP students, who would seem likely to train in-state, tend to go elsewhere for residency.The entire UAB medical school graduates about 175medical students annually.

Additionally, 72students graduate from the University of South Alabama College of Medicine. Though it would seem that the Huntsville residency could attract a majority of its intern class from in-state graduates, that has not been the case as of late. It is hard to quantify why in-state students do not choose the Huntsville residency. Perhaps the reason is the successful recruiting the program does at the regional and national level; RMP students may see this as an opportunity to spread their wings outside of Alabama before returning home to set up practice(to date, 96% of the RMP graduates set up practice in Alabama).

In an effort to increase in-state intern numbers and to further cement RMP students in Alabama, the Family Medicine Residency and RMP launched an Integrated Residency (IR) in 2017-18. The IR combines the requirements of fourth year medical school with intern experiences. Although IR students are not obligated to choose the Huntsville Family Medicine residency, all of the IR students matched in this residency in its pilot year. The IR is fashioned after a similar program at the University of Missouri School of Medicine. The Missouri program has operated since 1992and every participant has chosen to match in to their residency.

The Integrated Residency is open to HRMC students from rural Alabama. The rural background requirement is because the funding source is specific to creating rural physicians for Alabama. It is well documented that students most likely to enter rural Family Medicine are those who were raised in a rural area, intend rural practice, intend primary care, and participate in a rural program.5Applications are submitted in the spring of the third year with the interview and selection process duplicating the regular residency selection process.

Selected IR students are notified in May and may begin some IR activities that fit in their schedule prior to the fourth year, which starts in late June. IRs engage in a more rigorous fourth year schedule, which includes a pulmonary medicine/critical care rotation designed specifically for IR students, a family medicine acting internship in UAB’s Huntsville Family Medicine Clinician required rotations in normal fourth year elective offerings of anesthesia, nephrology, emergency medicine, and cardiology.  The fourth-year specialty preceptors in Huntsville are community preceptors which were informed of the Integrated Residency goals. These preceptors expressed enthusiasm for working with students whom they expected to stay in Huntsville for residency.Even with these required rotations, students have time to take some additional electives of their choosing.These students had an acting internship in rural family medicine in the third year, and we hope to add a fourth rural rotation for IR students.

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