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All right, folks. Well, welcome. Welcome to the Phoenix Bioscience Corps and thank you for coming either here in person to you all or virtually. We're excited for this workshop today. It's the second in our series of five workshops that we're offering this year that are all supported by the Arizona Biomedical Research Center and brought to you by Nau, Center for Health Equity Research. My name is Steve Palmer, and I'm a Professor of Health Sciences at Nau and one of the co leads along with Dr. Bob Trotter who is outside. He'll be in shortly. We want to start by thanking John Garcia from the ABRC who is here today. John. Thank you and the ABRC for supporting this and the series of education workshops. Yeah, thank you, John. I'd also like to thank Nick Beckett, who is really he's just the guy that keeps pushing these things through. Where is he? Nick is back behind Nick. Nick is taking care of all the details and he's amazing. Thank you, Nick, Before I introduce the leaders for today's workshop, I'd like to mention the upcoming events in this series. March 25, we're offering a workshop on health messaging culture and the pandemic response. This is a collaborative offering between Nu College of Health and Human Services. The Department of Health Sciences share Arizona State University's Cite, School of Journalism and Mass Communication. Let's see, May 18, we're bringing a workshop on whole school and community collaboration for school health. Both of these events will take place in Flagstaff, but also in a hybrid format. Let's see here then, of course, May 25, we're going to return to Yuma for the fifth annual. For the fifth annual forum, Collaborative partnerships, translating research to practice, which is led by Amanda Geary who is here today. Thank you very much, and we hope to see at these upcoming events and please get the word out there. There are amazing things we're going to be learning and covering today. We're proud to offer this conference focusing on developing a diverse rural healthcare workforce. Although only 14% of Americans live in rural communities. These rural communities, they represent nearly two thirds of health professional shortage areas. While Arizona averages about 230 physicians per 100,000 population, the rural areas have only about 70. And that's just one example of that short. Six of the eight highest needed primary care care areas are in regions, tribal areas. And really the areas with the greatest need include those rural communities and border regions. Today we're going to hear about strategies for recruiting, retaining, and supporting healthcare providers in these rural and underserved areas. This is a joint offering from Any Use College of Health and Human Service and we're fortunate to have our colleagues from Texas Tech University their health sciences center. I'd like to introduce the leads for this and the brains behind this workshop. We wouldn't be here without these amazing folks without Dr. Oakley Rogers and Dr. David Trader. Dr. Rogers, she's currently Associate Dean in the Nau College of Health and Human Services. She's an occupational Therapist and past chair of the Occupational Therapy department. Dr. David Trotter. He's an Associate Professor in the Department of Family Medicine, Community Medicine and Medical Education. And he's currently serving as Assistant Dean for Student Affairs at Texas Tech University. These two have brought some amazing professionals and panelists together today. Thank you to Dr. Rogers and Dr. Trotter for putting this together. We're excited for what the day will bring and I'm going to turn it over to you to thank you. I just want to start by thanking you all for having the Texas contingent here. Many of you may not know actually grew up in Flagstaff and went to the University of Arizona. This is a little like returning home. For me, it's pretty exciting and thinking about how to introduce today's topic, I've been thinking a lot about a dear colleague of mine who retires at the end of this month. A physician by the name of Kit Linton, Dr. Linton has practiced in rural West Texas for 42 years. She has delivered well north of 3,000 babies and has been a through force of good in our community. For those of you who know Dr. Litton, she has lots of very quotable saying, some of which are a little edgy, but I'll share one of them with you. It's how she describes the practice of family medicine. She says family medicine is from sperm to worm wound to Tom. What she means by that, right, is that it is that health care should be accessible and it should include everything that we need before we're born and should continue to care for us and our family after we pass. Right. And she has certainly lived that in her 42 years, delivering babies, surgical OB in rural West Texas, and being the Medical director of several of our Nursing homes and I've been thinking a lot about that. Because what we're trying to do here is also really discuss that life traject developmental trajectory of our learners. When we think about our learners, when we think about placing healthcare providers into rural communities. We need to be thinking beyond what we do with them when they step through our door and what we do with them when they walk across that stage and get their diploma. We need to be thinking more broadly, what do we do with them as they're leading up to their matriculation with us? And then how do we help them launch them into a community? That's been our goal throughout this is to try describe that whole lifespan of a student. We've got professionals from both NU and from TTUHSC to talk about really some of the amazing work that they're doing across that lifespan of a Students are really excited to share that with you today. I'll turn it over to Dr. Rogers to build on what Dr. Trotter just said. You're going to hear from several amazing speakers today really as the goal, to give you a brief snapshot of the different areas from recruitment to admission to then graduation. And how do we get these grads into that clinical practice. There's going to be several speakers. We joke that it was almost like speed dating a little bit. You're going to get to hear from a little bit of everybody. So to that end we are not going to read everybody's full bio. We want to give that dedicated time to the speaker so that way you can hear from them. But please note that all the bios are listed in the program. You can read that in there. The other thing we do want to acknowledge our friends on zoom all throughout the nation. Welcome, Zoom land. We're so happy that you are here. And so anytime that we have questions or work in conversation, we'll make sure that we use the microphone so everyone can hear. Also, we do have speakers who will join us from zoom, so just be patient if we have some technology issues with that, I will go ahead and get started with our first speaker. I am privileged to present Dr. Lian Smith, the Dean for the College of Health and Human Services at Northern Arizona University. Welcome Dean Smith. The key things that we do forward and backward, sometimes standing still. Hi, I'm Lilian Smith. I am a new Dean in the College of Health and Human Services at Nau. Started back in, I think, mid June, along with my colleague who's also in the room, Dr. Janina Johnson, who's our new Executive Director for Nursing. We have a lot of new in our leadership here at Nau, working in a great space of building around a new roadmap called Elevating Excellence. This is directly tied to where we are in the northern part of Arizona. We are in the northern part and it's almost like we have two states in the state, Arizona. We have a very large metropolitan area of Phoenix, which is in fact has more population than the entire state from which I'm from, South Carolina. And so when I come to here, I'm like, this is the entire population of my entire state. And then we leave the greater Phoenix area and we are in a whole nother landscape, right? And so Northern Arizona University is also serving that more rural Northern part of the state. But we're also all over, I'll show a little bit about what that looks like. We are in fact part of that, we're called the Mountain Campus. And so when we come down from the mountain, I actually did put on a nicer suit of wear today or something akin to that. It's a completely different environment for us as it is when you get into rural areas, in any state in which we go. And so even though my little state was so small, anyway, when you're in the city, it's one thing. But where I grew up, count of 700 was another. And I also was from an area that's called the Corridor Shame, the United States. An area that is grossly neglected and also has huge differences in socioeconomic and all sorts of resources. This is where I grew up and it for me is a passion of mine to make sure that we have equitable access to education and the things the drivers that are going to make a difference in people's lives. So for us here in Arizona, we had the Mountain campus. You can see there's our map and it is again, like two different areas. So I've got 3 ft of snow in my front yard. Right. Okay. And here we are. And I'm like, I what am I going to wear when I come down here? But we also have locations in North Valley, which is a little bit above Phoenix, and then in Yuma and in Tucson, And actually about in 20 different locations across the state. We are offering different programs. And our mission is very much tied to what it is that we are doing in distributed areas across the state. When I talk about elevating excellence, we have a new president. He's been there. He just got installed in the fall. So for, he's been there though about a year, year and a half now. Okay. And our entire strategy, our elevating excellence roadmap is about becoming the vehicle of economic mobility and driver of social impact, delivering equitable postsecondary education. And so we are really, this is our mission, these are our values. And our whole strategic roadmap is centered around how do we do this? And with that, we were able to get the topic of my talk today will be mostly about what this new economy initiative is and what we're doing with that. Our board of regents who direct us here, the higher education system in Arizona made a huge investment in what's called the New Economy Initiative. How do we get people across the state able to participate in a vibrant economy? We see so much job growth, we see so much opportunity here in the valley, here in this greater area. And then we get out into a rural area. And again, it's like another state. How do we get ourselves where people across the state actually participate in this environment, in our economy and the importance of that. You have $22 million that have been put into a program. That's what attracted me to come down here and work at this university to build this program. With this huge initiative, right, 22 million to increase educational access in advance Arizona's future healthcare and behavioral health workforce. 20 million of that came to my college. Came to health and human human resources. And we'll talk a little bit about how that got distributed. But the reason it's pretty clear, we did a huge study. Our board of Regents did a huge study. Thank you. Oakland Oakley's been working on as a Provost Fellow, and actually leading up the university wide presentation of our and work for the new economy initiative. But when we looked at what this investment might do for us, they looked at it purely by the numbers, okay? We're going to get 22 million. What's the return on investment? Is it worth it? And that's how it got sold for the state of Arizona. Okay. We're talking about increasing about 7,000 jobs in the first ten years, doubling that to about 19,000 jobs in 20 years. We're talking about a total of almost 130 billion, 130 billion in economic output over the next 20 years. 60 billion in labor income. So these are people out there working, bringing home checks to people that live in Arizona. And also that is generating then a tax base that is coming back into the state can then reinvest in our people. Okay? When we have traveling, PTs, traveling nurses, traveling, we're paying them an incredibly high dollar and they are paying their state taxes to another state. So not only is it hard and not a good business plan for the healthcare systems, it's not a good business plan for the states. Okay? We're losing out on tax income and I honestly, this is the best way to sell something like this in any state at the moment, right? What are we doing with this? We have in our College of Health and Human Services, we have a number of programs. The ones that are highlighted in yellow are the ones that have received the initial investment that we have. Communication science disorders, occupational therapy or nursing, PT, physical therapy is getting money, not athletic training at the moment, sorry, highlighted that in our physician assistant studies as well. Now I'm going to talk to a little bit about what that looks like in each of the programs in the communication sciences and disorders. We're getting a lot of money for them, but they're actually starting a program on our Yuma camp. And all that. We're going down and we're starting a program and that will actually launch June. We got it fully accredited already. And we're also doing a culturally and linguistically responsive practice in speech language pathology with curriculum that's being developed as well as clinical rotations that will be utilizing the curriculum and will be tied in with clinical education as well. Then also in nursing, which is probably the biggest area of need, as well as expansion opportunity here in the state, we are having several different programs. So we have a new psychiatric mental health nurse practitioner program emphasis that will begin fall of 2023. And then we have two accelerated BSN. We have the traditional accelerated BSN where you get a degree and you're coming back in and you're working for 12 months to get that. Your nursing degree, your nursing credential, That's one piece. But thanks to Dr. Johnson, we have a very innovative new accelerated program, which is about a 16 month program where people who have some actual coursework are able to get into the accelerated program and in 16 months get their initial degree in nursing. Okay. And with both of those programs, the State of Arizona has also doubled down in another area where Dr. Johnson has also been able to get Us 6.4 million for scholarships. That will be for the accelerated program. For students that are in the accelerated program, if they stay in the state of Arizona for four years post graduation, when they're out there working, they'll have loan forgiveness. They'll have tuition forgiveness for the, for all that tuition. Okay. So again, we're starting to see that not only are we creating more set, we're creating more innovative opportunity to keep people here. And so what we'll be looking at is how do we now partner with systems Starlet, like your system, how can we partner with our systems across the state if we can get placements with you? What we're talking about is now having nurses that will be staying on site there. They need to be working now for four years here in the state. They aren't going to get swept away by the traveling nurse epidemic. We have more opportunity to actually keep them here working with our systems in the state of Arizona. Okay, Again, we're bringing a little something to the table for our systems, as well as helping our students and our population not have that loan debt here. And they're working and being supported and also supporting their families and the state and our fellows. I'm really excited about these new programs. We're looking to also figure out how do we get those. That same type of scholarship funding now for our other program. Okay, so we don't want to just do this for nursing, we want to be doing this across the board right now. We've got a really good funnel with our state entity that's providing funding for that. So we're looking at other creative ways to actually figure out how to do that In occupational therapy, we're increasing seats and also access by having a weekend program. So if we have people who are out there working, they can come in and get a better degree. Hopefully be more promotable and be able to earn more as well through a weekend program. They don't have to leave, their job, can come in and actually get it done here in Phoenix. Then in physical therapy, we have ADPT Right now, we already have two programs that are ones on the Flag campus. Ones here at PBC. We have about 45, 50 seats in each of those programs. We're increasing both of those existing campus based programs to 66. We're increasing seats in those programs. Now the really big news for us is that we've just hired I think 12 DPT faculty who were in another institution who got closed down, that we had another institution, we're able to bring all 12 of them on to start our hybrid competency based DPT program. And we were able to get that done in about eight weeks. Yeah. Like why Wacom? But because we had the money for the investment in place, the DPT program, the hybrid program was planned and promised already for the state. So we were just having trouble hiring folks. This gave us an opportunity to come in and get this whole group of people who had already been working together, already had a curriculum that was ready to go, had already gotten the nod from their accreditors as being innovative in a wonderful way to do competency based education. And we're able to actually pull all those folks in together. Okay. We'll be launching that now. Spring of 24. And so this gets us to those individual programs are all great, right? We're increasing seats. Huge problem. As we all know when it comes to clinical education and all of our accreditation, we have to increase seats one thing, but we also have systems that are in desperate need of help repair innovation and change. One of the things I do want to do a shout out for is for the Center for Health Equity Research. They are helping in so many different ways and programs in actually doing work. How are we actually creating and helping with community health workers, community representatives according to where we are across the state? How are we actually creating pipe lines in those areas? Pipe lines from high school, middle school, high school into our colleges. Then also across, and I'm sorry, also the research in the workshops, just like this, are going to help us all learn and grow together. We're adjusting the high school core requirements. So we had about 17% of the high schools, mostly in rural areas. They did not offer the courses that were required to get into our universities. So our students didn't have access to prerequisite courses to get into our universities. Our president changed that. Okay, Then we have access to excellence. If you make $65,000 or less in the state of Arizona and you have a student that can get into our university, come on free tuition. Then we also have a new initiative as well, a plus plus Arizona Attainment Alliance, which is where we are working with the ten, with the ten community college systems and Arizona. I always forget this. Let's see. Arizona Commerce Authority in a, in how we can create systems for Steamlus transfer. If you get accepted into a community college in the state, we'll already have a seat for you and nau, once you finish that program, it will just come right over. There's a lot of work around that with how we share data, all those fun things that keep us from being able to really work well together. We have additional investments in clinical placement personnel. We're also working in 100% career ready to make sure that our students are ready to go when they come in. But that's really, all of us are having to work across our curriculum to make sure that that happens. Pathways. We have rural and indigenous health programs and fellowships building that capacity in our rural areas. Then I don't know what the future is going to hole. We're in a very agile space right now. In space of innovation, we are co creating a future with our rural partners and our agencies across the state. And I look forward to hearing from all of you to see what things we can beg bar and steal from your ideas to make our programs better, richer for people here in Arizona. Thank you. So, thank you, Dr. Smith was that was really great to hear. I'm jealous of some of the programs you all are launching. Next, I'd like to introduce my colleague and mentor Dr. Betsy Jones. Dr. Jones is a professor in the Department of Family and Community Medicine And well, really medical education where she's the founding chair. And she has developed some really innovative programs at our School of Medicine. So I'm excited to hear her. Thank you. Okay, I'm so honored to have been asked to come and it's true. I've known David since he was a graduate student. In those of you who are chemists, biochemists by training, and I suspect there's some in here, you know the concept of a catalyst. And David was absolutely a catalyst when he joined us as a graduate student with a job on a Hrsa grant that we had. And he made a lot of sparks happen. And it's been a real pleasure to watch him grow and mature as a faculty member and as an administrator, and certainly as a friend and colleague. I'm really honored to be here in his home state. A few apologies or just beginning comments first of all. I am preaching to the choir. Not only am I preaching to the choir, I am talking to people who know all the words to the hymn, who know all the music, who know all the instrumental parts, and the minute I sit down can sing it better. I'm going to tell all of you a lot of things that you already know. I'm also going to take a step backward, or maybe take a step up, fly over here. Because I'm going to show you a lot of map. What I'm going to talk about really is the background, really, of why we care about healthcare in rural settings. But I'm also talking to you as a medical educator. Part of what I feel like we have the obligation to, especially where we are in West Texas, Texas Tech, is to really build that healthcare workforce in the part of the state that we care about. I don't know how much you know about another apology. I'm going to give a lot of examples of Texas, Arizona, and those of you on zoom who are from other states. I apologize that I'm leaving you out of the conversation. Fill in the gap, your own head, But here's what you need to know about Texas Tech Health Science Center. First of all, Texas has 254 counties. We, at Texas Tech Health Scienceusenter, have a catchment area of 108 of them. They're all over on the west side of the state. And that doesn't include our catchment area of Eastern New Mexico. We pretty much, we're about an hour and a half drive from Eastern New Mexico. Any time you walk into family medicine service in the hospital, you're going to have probably a big chunk of Eastern New Mexico folks patients who are on our service. Okay. So I'm really going to talk about the health care, the health professions workforce from the perspective of what we teach our medical students. Okay, Medical educator, we've got session objectives. So I'm going to talk about some trends in rural health and rural United States. Talk about social determinants of health. Because let's be honest, that's really why this matters. We're talking about some of the challenges that we all see. And then I'll give you a little bit of a preview about some of the strategies we use a tech, but you're going to hear more about that from some other of our test. This is a slide that I use with my student. My first year medical student. First year medical students are beginning to wear their Dr. Hat. Your patient comes to you and what you see are her health conditions. You see her diabetes, her hypertension. You know that she has neuropathy. She complains about that. You can tell that she's probably not getting enough exercise. You worry about her diet, her cholesterol numbers are high. She's a tobacco user, she's a breast cancer survivor. You as a provider are very focused on all of those things that she comes to you. But we got to be cognizant of what the context is for Rachel. She comes to you with a lot more than just those health conditions. So she grew up in poverty. Absolutely essential to keep in mind and continues to live in poverty. She immigrated from Mexico at age 19. She was widowed at 35. Spanish is her preferred language. She doesn't have health insurance. She doesn't have a driver's license. She lives in rural Texas. Could be New Mexico, could be, Arizona, could be anyway. So the perspective that Rachel brings to you and the barriers that present with her to allow you to do the things that you need to do to address her health conditions absolutely cannot overlook. We all know the definition of social determinants of health. This particular one comes from the World Health Organization. The conditions in which people are born, grow, live work and age. They're shaped by a lot of external forces. Distribution of money, power resources. Certainly globally, we worry about social determinant of health. We see that every day on the news. When we hear about what's going on in Syria and Turkey. When we hear about what's going on in Ukraine, what's going on in other places in the world, but those are the things that are mostly responsible for health inequity. So here's another way to look at social determinants. Or again, think about Rachel, She grew up in poverty, has to do with economic security. By the way, these are really the domains of social determinant. She immigrated to Mexico that has to do with her community and social contexts. Her language, the role of the healthcare system, the fact that she can't really access it because her insurance is poor or nonexistent. The fact that she doesn't drive, she's dependent on friends or public transportation. And then her access to healthy information or healthy food, really all of that drives her health outcomes. The impact of these factors on the risk of premature death. What I really hope our students can understand is all of these things, maybe less genetics, but I wouldn't leave that out completely. All of these things are drivers of function. Her individual behavior, but even her individual behavior is a function of her social determinants, but certainly the social and environmental factors and her excess ability to access the healthcare system. I think the other thing that I'm feeling more and more committed to helping our students understand is the role of climate change on health. Ii think that's a little bit of an uphill battle. Maybe especially in a place like rural Texas and in west Texas. But I think we absolutely need to get our students to understand that. I was at a conference in medical school conference back in November and heard a presentation where the quote that really rings in my head, I don't know what the source of this is. Maybe some of you do, being the choir, that you are a third of, preventable death in the United States can be linked to climate change. When you think about all these reasons why that would be, guys in Arizona know about wildfires, you know about heat, extreme cold storms, floods, vector board disease, all of these things that, in one way or another, either a direct line or a gutted line, get you back to climate change. I feel like we absolutely need to get our students ready to understand what those challenges are. This is another slide that I show my students because they really recognize this. Our students are going to be thinking about heart attacks, about stroke, about cancers. Yes, those are responsible for a lot of deaths. But deaths due to social factors, education, segregation, low social individual, poverty, area of poverty, income inequality. If you really are talking about causes of disease, this is obviously a no flood. Think about what has been a real driver of the last three years, deaths due to Covid. Even if you think about what the drivers are of deaths through the Covid, it's taking you right back to that list of things that are social factors. Whether it's access, whether it's communication issues, all the way that Covid has really been challenged by some of these social factors. Where do you find concentrations of all this stuff? You find it in rural America. The top picture is in Arizona. The bottom picture is the West Texas. What you're looking at there are the health professions shortage areas. I'm going to talk quite a bit about that. First of all, if you look at how these data are driven and what some of the definitions are, you'll see that we use both the term rural and the non metro. The Office of Management and Budget has a definition of that really al they're thinking about 2,500 people or less. Non metro is 50,000 or less, but that's 50,000 or less area. That's not also linked directly to a metro area. Just to clarify what those definitions are, we also talk a lot about frontier counties in West Texas. Here's where we are, that 108 counties is really that part of Texas, and you can see that we have a lot of frontier counties, where we are, that's counties with a density of fewer than seven people per square mile. But all of the frontier counties are really in the part of the United States where I suspect mostly live and work and do our work. Lots of distance, lots of counties without very many people, lots of healthcare challenges. And I'm going to talk more about this, but these are just some examples. Provider of population ratio, as we talk about hips or a health profession shortage area, the calculation has several things in it, provider to population ratio, the percentage of people below the poverty level and that, as you know, is calculated every year, recalculated every year. And then distance, the distance to get to healthcare. Just a few things. The availability of physician specialists. David talks about form to worm wom Tom, he's really talking about family medicine and certainly primary care. We are bending the curve, we think toward primary care in our part of the state, but sometimes you need a specialist and the ability to access those is very limited in those places. Higher suicide rate, higher motor vehicle accidents compared with just the percentage of population uninsured. Again, look at all of that, dark green and that is where we live. Texas a state that has chosen not to expand Medicaid? I don't know about Arizona. Arizona expanded Medicaid or not. Yes, go Arizona and probably are not going to do. If you read our headlines. Let's talk about hips, Again, health profession shortage areas and these are really calculated at the county level or in the census level. So again, look at all that dark blue. So everything in dark blue is, and this particular primary care health profession shortage area, interestingly, Arizona doesn't have as much dark blue. And I think that's probably has to do with kind of the clustering of your population. I'm just kind of guessing on that. If anybody's got an explanation about how many counties do you have in Arizona? Big counties, right? Right. Nothing is white. Everything has got some, at least partial, but you don't have as much dark blue as we do. Okay? This actually shows the same thing, but, and this probably is a little bit of the point here. You can have a hips in a metro area, so you can have a big city that has hips inside of it. This is Arizona, again, a close up of that. And you can see you've got a couple of counties that are in fact the whole county or hips. This is Texas. Interestingly, those counties are really interesting outliers. Basically the rich counties, Williamson County, Rockwell County, that little tiny one that you can see up there by Dallas. Tiny tiny county. Fort Bend County. The richest county in Texas. Most everything else you're going to see lots of blue. This is another view of the primary care. What I want you to notice on that is the difference between the green and the blue is the difference between rural and urban. Those counties that are primarily rural are the green and those that are primarily urban are blue, but they're all his primary care hips. I don't know what's going on in Nebraska. Nebraska mental health shortage areas. And again, you can see some of the differences between rural and urban. This is dental and this is surprising to me. I would have thought there would be a lot more dental shortage areas. I think we definitely see that in West Texas. You can see there's lots of green in our areas in West Texas. But the ability to get good dental care is something we want our students to understand. Is that, yeah, you're not a dentist, but if you don't understand what dentition, oral health lots of carries are going to do for your patient's ability to follow your instructions, you're going to not be successful. Teen birth rate by county. We are right up there. Even though we're an urban county, we've got lots of blue male life expectancy. You'll see that guy, you guys are that light green, which means less than 75 years for many of you. There's again, our part of the state. But female life expectancy, we get darker colors. Women, lots of rural hospital closures. And we've spent a lot of time talking to our students about this as part of their understanding of the health system. There have been 186 rural hospital closures since 2,005.143 since 2,010.24 of them in Texas. So the biggest number in Texas. Lots of critical access care hospitals, and many of those have transitioned to this new rural emergency hospital. It, some of you guys are very familiar with the way that works, but it's essentially no stay hospitals. It's really just to deal with emergency issues. Adults without a usual source of healthcare. Diabetes prevalence, much higher, rural communities, poor fair health, much worse in rural communities. Okay. I love this one. This actually comes from Texas Texas Rural Health. This is the state report card. Reds, bad yellows in the middle. Green is good. Arizona. Don't get cocky, You guys are 35, but that's just one better than 36 where we are in Texas. This shows you all the states and how they're graded, Arizona and Texas. D minus this contrasts with the states that are at the top. And I'll be happy to share this with you guys because this is really fascinating. Massachusetts and New Hampshire are numbers 1.2 There is a little bit of good news, Interestingly, good news that is driven by the pandemic. This is probably not a big shock to anybody here, which is suddenly people are moving back to the rural communities and non metro site. You can see population goes down and then in the last, in about 18 months pops up there at the end, really driven by outmigration during the pandemic. The growth in labor opportunities are really healthcare and social assistance. Healthcare with quotation marks. A lot of times that means home health and long term care. Back to bad news. Very non diverse workforce. This shows you what the difference between rural and metro counties there. And then mortality is, again, taking us back to our social determinant. There's some real disparities there with racial differences. Okay, so this is a picture of Tech Tech, our area. We talk about food, fuel and fiber can't show very well. I'm sorry about that, you're going to hear more about. These are some of the things that we are trying to do. Really trying to get our students understand about the role of social determinants. We do a lot of small group discussions around things like hospital closures and some of the healthcare systems issues. We have rural health electives for preclinical students and for our clinical students care of the underserved. We have a program of distinction in that Hispanic Center of Excellence, really out of our permanent basin campus. We have a family accelerated track, which I will happy to talk about later. We are rural tracks, and then we have a Rural health Institute. These are some pictures from that. Again, our patient, Rachel. The things that we would want our students to understand. You've got to have proactive preventive care, helping her out with access resources, culturally sensitive interactions. You've got to deal with her with humility and patients. But most of all, you've got to advocate for her and we want our physician leaders to be able to lots of useful resources, which I am happy to share with that. I am probably right at the end of it. Thank you, Dr. Johnson. It's good to know that we've got another state with us and all of the issues that we face. Not the happiest club to be a part of, but don't feel alone. Next, I want to introduce Dr. Sarah Stringer. Dr. Stringer comes from our PA program which is in Midland, Texas. It's about 2 H south of Lubbock. And she's going to be talking about some of the psychological factors that are going to predict healthcare providers willingness to work in rural communities. So thank you very much for coming everybody. I'm excited to be here with you all and share some of the things that we're doing in our program. Hopefully that can be of a help to you guys in speaking about the psychology of rural health. I guess how I came about to be interested in this. I'm a physician assistant by training. My clinical background has primarily been in psychiatry and addiction medicine. So I've always just been bent and oriented to finding better ways to serve underserved populations and also how to galvanize other people into that interest. I am an assistant professor at my program. I've been there for about three years. Also the admission chair, we're going to take a really admission oriented lens today looking at all of this. And I would like to give you guy some practical tools hopefully today, before you go with some of the things we're doing, our program. Why do some people want to stay in rural areas while others perhaps not once again, psychiatry oriented? So I'm interested in the whys and I want to know why the human behavior looks that way and what's the thought process behind it. So let's look at what the literature says. And then secondly, we'll look at what we're doing at our program. And we'll look at what the fruit of that has been at our program, what changes we've seen after implementing some of these things that we're going to talk. Then you want to go do a literature review on why people choose rule health care. There's actually a lot out there, which I'm sure many of you've already been exposed to a lot of it. Like what Dr. Jones said, I was thinking the same thing. It's like we'll see if it's something new or not. Hopefully it is, but there's three primary drivers. The first one. The first theme that you see that arises is going to be something that's not totally groundbreaking, but it's rule familiarity. If it's a place, it's home. Obviously, we give preference factors in our admission process for people if they're from one of our service areas, but that's a big deal that's helped us to retain, but not just if they're from that area, but even if they're a place from very far away, but it's similar to the communities that they're serving. Sometimes people can find a piece about staying in that, in an area with the familiarity. The second thing will be what's called social social connection and place integration. So the first part of that is the social connection in terms of are there adequate enough opportunities for them to meet people and to fill integrated into the community and to make relationships. One of the articles I read, it was really interesting. It said that even just the people in the community, if they knew the practitioner by name and discrete them by name, that made a difference. Whether or not the people wanted to stay there or if they moved there with a family member or let's say children or a spouse that help them to stay as well. To feel socially connected and integrated. But the second one is what we call place integration. And that can be where those social things can be absent. But if the person can feel a connectedness to the environment, whether it be a natural, natural things are having the environment or the built environment. You guys have a lot of attractive things here in Phoenix. Physically, that's a picture of West Texas not so much. We're not going to focus probably too much on place integration in West Texas, but we do have other things to offer the third driver and this is what we're going to spend the rest of our time on today. That is this idea. And this really arose over multiple studies that we're looking at why people stay in rural areas. And this had to do with the fulfillment of life aspiration. Which some people stating or some of the study stating that in rural areas it was even more important to practitioners than what they saw in practitioners and more urban areas. And that people needed to have a sense of identity in the rural area that was acceptable to them, that would make them retain their long term. This idea that I'm going to serve this area and that means something to me and that's part of my identity, and I'm going to stay there. Let's look at that. But one thing they left out these people. They needed a psych person on their team because they didn't talk about why, why is that, why are these people doing this? There's a separate body of literature that doesn't look so much at rule, but it talks about emotional intelligence. With the emotional intelligence studies, there's a lot of interesting literature, especially around health profession students and health professions practitioners, to show that emotional intelligence can really predict people who are less likely to experience burnout. And to want to stay in the same area and roots grow down deep and serve a particular area. Emotional intelligence is highly correlated. Empathy. There's some studies to show that emotional intelligence and medical students not only correlated with empathy, but a greater desire to serve underserved populations. We started screening for this at our program about three years ago. And I'll be honest, at the time, we weren't looking to increase amount of students that we would retain in rural areas. We had problem students. We wanted to figure out how we could improve our student population. But what ended up happening whenever we started screening for emotional intelligence is all of a sudden like what Dr. Jones is talking about. When we facilitate these discussions about social determinants of health, we have students with more bien, whenever we integrate service learning into the curriculum, we have students that are more interested. All of a sudden we see an uptick and the populations that we know are some of the most underserved amongst a rule patients with mental illness and patients with substance use disorders. All of a sudden we see this uptick and students that are willing to go and serve those populations. And even students going out and facilitating their own opportunities beyond what we're offering to them. With that, I would like to if you allow me, you don't have a choice, I get them next 10 min and I don't have anything else to talk about besides this. I really debated on whether or not to talk about this for more of radical standpoint of emotional intelligence. Or I'm just going to go ahead and fill back the current I'm going to give you. We're going to walk through some of the exact training that I do for our faculty that do admission interviews and also our adjunct faculty that come on with that. Here we go. What I've learned in training people to look for emotional intelligence and interviews over the past, I think this will be the third cycle that we've started. This is that sometimes it's easier for people to see what's not emotional intelligence. I've really trimmed the fat and we're just going to condense it down to really high yield ones. These are ones that we see commonly that are easier to pick up on the interview and that you can go ahead and start looking for, I don't know, a nicer word than maybe eliminate. Okay, so the first one would be perfectionism before everybody starts shifting in their chair and getting nervous. Because a little bit of perfectionism can be not uncommon amongst our group, amongst people like us. But a little perfectionism is fine when we're talking about perfectionism as a red flag that's indicative of very low emotional intelligence. We're talking about the highly critical person. You're looking for this full constellation of things. We're looking for highly critical, we're looking for super unrealistic standards. This is a person that's overly fearful and everybody has a tiny, some amount of fear of failure. But this is a person that's so afraid of failure, that doesn't try because they're afraid to make a mistake. They can be defensive, low self esteem, This can be a sign of low emotional intelligence. We're going to look at a couple of these softer red flags, and then we're going to look at some really high yield, high impact ones that are really the antithesis of EQ. The next is going to be the loner. This is the person that's going to be a little detached. They're going to be too independent and too distrusting. Introversion. That's fine. Introversion, totally fine. We're talking about in the extreme, somebody who's not going to be able to be team oriented. Okay? They're going to overreact to any difficult situation and be really defensive to any criticism. We always facilitate a group interview as one of our interview domains. And are one of our assessments when they come to interview. That's a place where you might could see some of these things precipitate. Let's look at some of the higher yield ones. I can't help myself with that picture, you'll have to forgive me. I just think it's hilarious. But first we have the aggressor, and this is the person who can be overly self confident on the interview. And really they're not going to present to you at all like this picture. This is the perfect interview. This is the silky smooth, But what you're going to look for is that it's just a little too good in the sense that they're going to be completely unafraid of failure or rejection. And they're not going to be able to truly go deep or open up or answer questions to the depth that you're wanting comparatively to your other applicant pool. Under the surface is going to be this aggressor with the impulsivity, the high levels of aggression, competition, intimidation, self promotion, simulation seeking. I think you can see how this is an antithesis of emotional intelligence. But also you can see how maybe it's not factored into our desire to have students come in that are ultimately going to want to serve the underserved hope you're seeing that next is irresponsible behavior. So there's a lot of really interesting literature about this. Most of it's around medical students. But if we're seeing this arise, we can be harsh on it. And at first I didn't understand that. Then more we looked at the literature, we realized the importance of it. That if people are not submitting application documents on time, or they are not showing up on time to interviews or just want to come to some parts or not others and you're seeing emotional immaturity in the interview, that's a big red flag. This is actually associated with board violations later in the career. And once again, it's going to be opposite of what we're looking for with emotional intelligence. The last one that I really would like to highlight, this is a really big one. This is one that's easy to pick up on an interview and this is a can't miss serious red flag if you see externalizing blame run. So if they can't take responsibility for mistakes or failures or there's vague or shallow expressions of emotions, they're going to see these things together. One, they'll say things like if we're discussing the academic record, instead of taking responsibility or identifying ways to improve, it might be a statement like, well, that professor wrote really poor exams. Well, that's externalizing blame, red flag. Okay. And this is just all throughout the literature, in any field. This is very highly correlated with predatory type of behaviors. This is the wolf in sheep's clothing. This is, this is, this is probably the ultimate antithesis to the emotional intelligence that we'd be looking for. What can we look, if we look at it from the reverse angle, what are we looking for? Then there's some authors, say four domains to emotional intelligence, or EQ, or five domains. And it's an interesting body of research, whereas IQ, pretty static, is not going to change out a person's life. Eq actually can change and can be grown after we institute this, and I'll talk about that briefly At the end, there are some things that we've put in place. Not to just identify these people, but to hopefully keep that fire burning. Not just suppress it all down. If you just throw at people cold hard clinical medicine, there's other research to show that that can even decrease empathy. Throughout school, we add some things within our curriculum to keep them service, hopefully to help them retain on into that once they graduate. But the things we're looking for and what emotional intelligence is going to predict is somebody who's going to be more internally motivated. This is the person who's gritty can set goals and delay gratification. This person hopefully is going to be mood regulating, better able to control negative emotions. They're going to be empathic, like we talked about, more self aware. There's no changing oneself without being aware what the issues are. Of course, we have to have those interpersonal skills and that's a big part of the motional intelligence. I think one important thing to note is that it's not just about behavior or service underserved. There's also information to show that these people actually might do better academically in school because they're grittier and they can navigate better and they can ask for help. This is a big high yield thing and this changed our culture and extent that we even use these things when we're doing our faculty searches as well. Really just get in alignment with our mission of wanting to serve underserved populations and to just have a very positive culture. But this is one thing that we've looked for and I can think of the few faculty members that I've come on board since I started, that we have, this was a big thing that we saw on their interview is that you hear them. They're the person that's willing to be the team player and show up early and stay late. And to help out in a selfless way. That organizational citizenship behavior is basically like, I'm capable of considering the We and the organization above myself at times and what the needs are. And this is very highly correlated with emotional intelligence. What has been our programs impact. I really talk to you guys about that already, but these are some pictures of our students doing the service learning. We started service learning once again. We have these students now, what do we do with them? They've been teaching classes at the local juvenile detention center. They also teach classes. We have a Families Matter program that we're involved with through the Permian based and Regional Council and alcoholism and drug addiction. And these are people who are at risk for CPS and have young children because of their substance use disorder, that they are voluntarily enrolled in the program because they want to be the best parents they can be. And we've really seen our students take a liking to those populations and interacting with them. And there are, we got a grant to facilitate purchasing some items to teach those classes. And there our students are using them, but it's transformed our culture and it's just been a real joy to see I could talk more and more about this. If anybody's interested in it, please just reach out to me. I would love to collaborate on any ideas that you all are doing. What you're doing, screening and admissions that Mike is helping to facilitate these students that are oriented to serving underserved populations like rural populations. So thank you so much for having me. All right. Next on the agenda, we have Amanda Aguerre, President and CEO of Regional Center for Border Health, talking about empowering rural communities through workforce development. Thank you so much for being here with us today. Well, good morning everybody. Buenos dias. Very enlightening presentations from all of the previous speakers. I really enjoyed. I would like to work closely with Texas because I think that you mirror our area and the isolated rural areas. I'm going to speak today about our regional center for Border health and who we are and what are the special initiatives that we have put in place to promote health careers among our population that we serve. Center for Health goes back to 1987 when we became the third center in Arizona for the area health education centers for those that are familiar with the health professional education and a centers. But since then we come a long way. We have established a college of health careers. We've been empowering a lot of the rural communities. How do we do that is very challenging. But nonetheless, we are focusing on increasing the access to affordable health care. But also training along the US, Mexico border, in Arizona, Sonora, Mexico, but also Western Arizona, um, La Paz and Mojave counties. This is a busy screen that you're seeing here slide. We have different sites that we have developed primary care centers with different specialties. Ns, pediatricians, family medicine, internal medicine, all integrated would be Heber Health. For us the integration would be Heber Health has been a big challenge. But nonetheless, it's comprehensive coordination of care that patients need. And there's a whole assessment that happens at the point of entry at the primary care center, where we are assessing the solar terminus of held's. We bring in promotors, community average workers. We call them family care coordinators. Whereas is not just the patient care and the coordination of addressing soul terminus for that patient, but it's for the entire family that we're looking at. You can see we have an enormous amount of different sites through Yuma County, San Louis Sarton, a new one in Yuma that is special license in family planning and women's health and pediatrics. And then the newest addition in Kingman that we just purchased, a new facility that probably in a couple of months will have a running through all the size plus the four or five mobile units that we have, all licensed medical mobile units that also go into different locations including the schools. Right now, we have contracts with Team, the school district, and also in Yuma district number one, Summerton School District. And now we're going into the Gaston School District, which is one of the largest districts, school districts in Yuma County, serving the area under third population, mostly migrant children or migrant farm workers in our area. Again, I think this is what gave me the passion to do. What I do is to target rural communities, the underserved communities in Arizona, in the western part of the state. But also we have a very good relationship. As I mentioned before, we got counterparts in the Mexican side. We work as the health care, these therapies on both sides of the border. We are focusing a lot of what happened on both sides in terms of public health, how we prevent some of those issues that we can share best practice with both sides of the border. Disease doesn't have borders, right? We saw that with Covid. So that with all the disease immunizations, we want to make sure that our border is and we are working with our health professional colleagues across the border. For us, the interprofessional clinical rotations, we are all our size or host students from all three state universities in Arizona, but also from out of the state, from New York, from Udl in California, Berkeley, an enormous number of different universities. They come to us, some of our medical providers there in the picture with Dr. Gonzalez from the Family Medicine Program that we just retire, we're going to miss them a lot. Back in 2013, we provided one point million dollar to the Yuma Regional Medical Center through an initiative through the Arizona a program to establish the first medical residency program in Yuma County. Not many people know that a lot of the Yuma Regional Medical Center has gone and be very successful with their residency program, but this is how we started. All back then, I was a State Senator and I addressed a lot of disparities in our state, particularly with my constituents in Yuma County, in La Paz County. And this was one way to increase the disparities in access in healthcare and and the health professional shortage that we've been facing. Here we are an enormous amount of work with the different universities partnerships, not only with higher education institutions that were community colleges locally, Arizona Weston College, but we also, they defend the technical certificate help Bachelor's degrees that we coordinate some of the sites clinical rotations with. This is just an average of 85 students rotations to the end of the fiscal year last year. This year, I think we got an enormous response. Joanna will speak more about it and my staff this afternoon. This is our building. This is one of our newest facilities that we train and provide certificate programs. We are licensed by the Accredit and Bureau of Health Education schools to provide different certificates and different levels of national certification, state certifications. But why are we doing this? For me, it was a big challenge when we started creating our primary care centers and addressing the lack of access to primary care, that we didn't have the qualified staff at this level to support my doctors or a nurse practitioner. We started back in 2015, creating this pipeline of students in very remote rural areas and disadvantaged people that were displaced by the works people. High school dropouts. We started getting, basically empowering a lot of our students that at one point they didn't think that there can be something becomes gain a certificate in the healthcare field. We started different programs that motivates them and get them from this high school. And again, I'm not going to go into that because Jon, I will highlight later on this afternoon the wonderful programs that we deliver at a high school level and even before that, and the leadership training programs that we have to empower the students to understand that they can make it into the health care, we can create a path into the health careers. One of the special initiatives that we have right now is the supplemental not patient assistance program that we have with USDE and the Department of Economic Security. Where our patients are being screened the community who is receiving food stamps or Snap eligible and enroll in college to get any of those careers. We also started providing classes. I'm spacing out on at least GD, I'm sorry, GDs and basic computer skills, customer service training, just to get some of the people into the field, and then they have all the choices that they can get into the careers. But this is one of the terminus of how that we are addressing. When the patient comes into our clinic, do they have a work? Do they have any skills? Then we get into the pipeline of working and impacting the economic that we talked earlier for the entire family. So right now, this is one of our most popular ones. Medical Offices Specialty. Sounds very simple. A certificate program in the Medical offices specialty. But let me tell you that I have many doctors in our community from Aldo that at the beginning of when, several years ago when we started this program, we were all complaining that we were stealing their best M As from our offices and somebody offered them $101 more. We're moving to Dr. Gonzalez, I'm moving to Dr. Rosado. And so we were stealing a shadow, the best trained MA that we can be and none of them have a formal training. It was just on hand training. Hired by the Dr. training the office to do all things. Now that we have this program, I can say that every class is being recruited almost immediately after graduation. And we have phone calls of doctors in different clinics recruiting our students and the placement. Job placement and retention is being very high among this. Right now we're working on an online program. It's a special initiative with the Alliance of Community Health Centers in Arizona, also with the Uab, to provide online training in the rural communities around the state. We have, this is the first cohort of training online was about 50, 52 Ms. They were already working in different clinics around the state and I have to say that all of them passed 100% their national certification as a medical office specialist. We're very proud of that. That's part of the Arizona initiative. This is to agree from CDC to a Dh that has been collaborating with Uab in to do this. In addition to that, provide other medical coding and billing has been one of the most challenging courses that we in rural communities. This is where you make the money in code. We're going to have rural clinics being successful. If you don't have the trained, well trained professionals coding and billing, you're not, you're not going to be sustainable. Having the well trained staff is important. And right now we can hire enough fast enough billing code. The hospital, the college actually right now announced that they're going to go into provide more of its careers and other certificate programs that there will be mirror what we're doing in Yuma. The difference that we do is that our programs are fast track programs. If you want to go into the CNA program, certified nursing program is six weeks, the medical assistant program 11 weeks. And you get out there with a certificate ready to work and a job offer in your hands is putting people to work, is empowering the communities. Empowering our medical professions, clinics, getting the pipeline of students, and also guiding them into a paline headline that can go into higher education as well. Because that's what we would like to see eventually, that's something that they want to choose. Let's go ahead and provide that. The nursing assistant right now has been an enormous demand, I'm sure in other communities has been also a career that we can graduate. Fasting program, six weeks program with the nursing homes, come at the graduation, handing out applications for our graduate. We have the first nursing assistant program in Parker. We did in collaboration with the tribe, the Colorado River Indian tribe. On their side. Um, and all students graduated. And I cannot forget that moment when we went before the Tribal Council and all students very proud to have been graduated. The chairman mentioned that that nobody will tell that their students. Native American students from the Clara Ribbon Tribe cannot learn or cannot be successful in a career in a health care field. And we were all felt very proud of that. Because sometimes in rural communities, people think that there's not enough resources or well prepared, well educated, or people with the will do to learn. And it's not true. They just need the means to get, be successful and give them the hands on and the mentoring to succeed in rural communities. And that's what we do best caregiver. Another opportunity we are training all our community outreach workers, promotes salute as caregivers as well. So we give them a second level. I know that there's been a lot of certification and promotion of the community outreach workers, including here in Arizona. Texas was the leading state in the nation that did that certification many years ago. But now in Arizona. But we have moved at the state level, the Department of Health Services Agency who leads that initiative with U. But also we have through the years before the certification, we started promoting our community Oris workers into caregivers or direct care workers. And made a lot of difference besides the basic training of what is a Pmda, community Oris worker, and all the different health education topics that they're so savvy on, Diabetes, hypertension, other other risk factors that were mentioned earlier that a patient brings when coming into our clinic that we can provide a very culturally appropriate education to the patients, not only in the clinic but also at home. Different way. Phone call follow ups that we do, we get paid. A lot of people are looking for a way to pay pathos work, community as workers work. But we do have a system to work with CMS, with the chronic care management that you can get paid. But it takes a team to be able to do that and to bill for that care. Coordination by the patient. But the whole team and it's available, which is amazing, right? Direct care worker is another of the projects that we're working with the state. And also we have the task to train 80 direct care workers in the state through a western part of the state with coordination with Wyhe. Joanna is our director of the Way Head Program. We were able to recruit right now, we went over the number of 80 folks that they've been trained a record workers. The latest initiative is our partnership with the pet programs, a secondary program for children of farm workers in our area. We've been working with the school to generate the interest on the students to have this training on site. And we just started this program in two different sites, in two different high school. It's almost like the jet tech program where you're training on the job on high school. Like dual, maybe accredit like when you're dealing with community colleges. But they're also going to get some units for the high school or part of the curriculum training. And then of course, the nutrition and food service management. This is one of my favorite training because we're looking for women. They have been victims of domestic violence. We are looking for women. They've been displaced. They are in welfare or anyone in general, but mostly the women. A lot of the trainees that we have had been working in the fields, in the farm fields. So we're taking women out of the field, the farm fields, which is a very hard work in gaining this national certificate with our nutrition and food service management. And then working in cafeterias and hospitals, and nursing homes in different setting, or they can start their own business. That's the beauty of this program. The bottom, I think that's a lot of people are scared of taking your blood. And we can say that we've been some of those volunteers to go with our students. Alex and I actually learned how to vaccinate during covid vaccine boosters. We wanted to show our students that you can learn. And we practice among ourselves, that's a 40 hour. And they go in through our labs into our clinics to do their rotations. Our clinics, our primary care centers have been the basis of training. Also our students, not only from medical students, practitioners as, but also our certificate program students training a lot of the good partnership they have been working for years now. I'm just going to go really quick with all this partnership. A course accreditation with the accredited Bureau of Health Education Schools at the national level in our partnership. Then the latest initiatives that we're working is our ah, scholar spring immersion. That is amazing. Joanna. We'll talk about the project in specific areas that we've been dealing with graduate students and a very proud project with doctors here with a rural health lunch internal integrated clerkship LC that we're looking into starting in May, student in the audience. This is a busy slide analyst. This is what we're going to go through for planning and developing, and we're looking forward to move into a formal residency program in the future. So that area our initiative. Thank you. Thank you so much, Amanda? Next we have Kim Russell, who's the director of Arizona Advisory Council on Indian Health Care, and the title of her presentation is Creating the American Indian Health Area Health Education Center. Thank you so much. Good morning. Good morning, everybody. My name is Kim Russell. I'm with the Arizona Advisory Council on Indian Health Care. I am originally from Chin Ley, Arizona on the Navajo reservation. I am Nam bitter water people, born for the tangled people. My maternal grandfathers of the coyote past people. And my paternal grandfathers are the bitter water people. I'm from heart of the Navajo reservation. To get anywhere about, think about 90 min to like a major city, Right. For me this resonates for me just growing up in Chin, being from a rural area and then American Indian. I'm going to Share with you the journey that we've had in the past decade to be where we are at. Today we're partner, the new kid on the block, so to speak, in terms of the Ac system here in our state. It took us a while to get here and I'll explain that journey we've had to embark upon. But I'd like to try to speak more to what we're wanting to do with our Ah, and some things we've already have been doing really quickly here. I mentioned, I'm part of the Arizona Advisory Council on Indian Healthcare. I am the director, a state agency. We're a very unique state agency because our agency is very specific to American Indian health. It's very broad. Our statutes also are very broad as well, very Medicaid heavy. But we were able to broaden our statutes so that we can work more like public health and workforce development. Really, health across the spectrum. Our mission is to advocate for increasing access to high quality healthcare programs for all American Indian in Arizona. If you were to ask me, what do you do? I'm an advocate. I let my staff know. Remember, were advocates? Yes, we are developing programs, delivering programs. But remember, the first thing you are is you're an advocate. Our vision is to be the premier resource for tribes and urban indians in Arizona on American Indian health care. The purpose of our agencies to give tribal governments, tribal organizations, and urban healthcare organizations in our state representation and shaping Medicaid and healthcare policies and laws that impact the populations they serve. We're able to do that on two levels, legislatively and administratively. When we're advocating, we have that ability to work with our legislature, with our governor's office, with our tribal leaders and really all the stakeholders to create new policy, whether it's on a legislative level or administrative level. Again, very unique for a state agency, but our statutes allow us to do that type of work or statutes. I just really want to highlight the advocacy part of our agency to create policy at tribal levels. Because all the different jurisdictions have policy, most of our time is in state policy, but we understand federal policy impacts state policy. And especially for our Indian healthcare system, where the federal trust responsibility to provide healthcare to American Indians lies at that level. But just to give an example of why we still work in that state policy areas like the Ah system, we had to engage in that policymaking because the Ah is funded through state money, right? Also our Medicaid system as well. We have to engage with our Medicaid agencies because of how the dollars go through state agencies. So this is where, I guess we officially started our journey that goes back to April of 2012. So about a decade ago, state holders came together and said, we need to come together to strategize and start discussing how do we impact our issue of lack of healthcare providers in our tribal communities. In 2012, there was a conference that was convened and they really wanted to just share successful healthcare pathway pilot models that were already occurring. We totally understand that the Indian health system, whether it's the tribal or HS system or the urban Indian health programs, they were already doing things. We wanted to share best practices and models that they were already using. Then just to share ideas and how we could increase the number of American unions preparing for health professions. We know that the number of primary care professionals across state that it's an issue, but we knew that we needed to come together collectively as tribal Indian health system stakeholders to talk about it as well. Because we do navigate. And a different system, another federal system as well, which is really separate, right? The Indian health service system. What came out of this convening, which is an overall agreement by all those there that we were going to embrace the grow our own healthcare providers. It just made sense to grow our own. I'll talk a little bit about that ten years ago. That's what happened there. Some of the strategies that are identified were health career pathway pipelines, education to employment, and really trying to create an assessment map. We have still to do this, but I think this is happening on a more national level. I think this is something that our agency is going to do a little bit more and is really creating that assessment map. We understand that there's a lot of resources out in our communities to assist our American Union students to go through that pipeline, right? But they're just all over the place. We want to do a mapping if a student, no matter what pathway or where they're at in their pathway, wants to do go into healthcare. Can have that resource for them. Right? We still need to do that part again, this is ten years ago, create a statewide strategic plan, Really coordinating those resources and programs across all those tribes, all of our states, and all of our federal partners creating that statewide strategic plan. There's so many things to consider. How do we as tribal stakeholders and partners strategically approach this? That has still yet to happen. Then they also prioritize advocacy. They really wanted to prioritize the issue. Those three strategies came out of this convening again ten years ago. I think some are still strategies that need to be implemented. But one of the things that we could start working on was the advocacy that was 20125 years later. Advisor Council, Indian Health Care, we updated our strategic plan and this is the agency that I am a part of. One of the goals specific to our strategic plan was to expand the American Indian healthcare workforce. And very specific objective, establish an Arizona American Indian area health education center. I had my marching orders. That's what we were, that's what my leadership said we are going to do. Kim, establish that. Ah, this is really where we started to hit the ground. A fall in window, 2018, we let our tribes know that we were going to go after the creation of the A Hc and started to secure support amongst our tribes. We drafted the bill language. We identified our prime sponsor, of course, myself, staff, and members of the council. We met with key tribal and state leadership in the governor's office. First of all, we needed to make sure that the tribes had the buy in. It wasn't just an advisory council, healthcare idea. We met with our tribes, the advisory council. We passed a resolution in support of that. This is the bill language, very simple bill language. We struck five. Used to be five, now there's six. And then we added that one sentence at the end. One center shall focus on the Indian health care delivery system. The Indian health care delivery system, we call IT system, is IHS. All of the federal facilities within our system, those facilities that are still run by the federal government, those are HS facilities. Then there's the T, sometimes former Indian health service facilities, which then the tribe took over. They took over the system or they built their own new systems. There's the T, and then Urban. We do have four urban Indian health programs in our state. Two in Phoenix, one Flagstaff, and 1.2 That is our system. When you talk about our delivery system, we think about the TU system in our state. It's across the whole state. I think coordinated at sometimes and then I think fragmented sometimes but it's across the state. We do have some area offices that actually go into other states and into Mexico. We have an interesting system when we work with the TU system are very specific to our state, we're working with other states we're working with just across. It can be challenging sometimes. Of course, Navajo nation, they're their own area and then they go into New Mexico and they go into Utah. It could be quite complicated. This was a legislative session. Long story short, we didn't pass the bill, It got held up. It did have a lot of support, but the bill didn't pass that session. Moving forward, we did our advocacy, we inform more tribes of it, garnered more support. Again, found another sponsor. This time in our 2020 legislative session, we found another prime sponsor, representative TJ Shop. It did pass out of committees. This is just a picture. I think I believe she's the first San Carlos Apache medical Dr. for her tribe providing testimony in committee here. I can't remember her name. Dr. Vicki Stevens. I think they actually have a second San Carlos Apache tribal member who has graduated medical school. They're very proud of their two dots. Again, just more resolutions we got from the Navajo nation, all the different tribes and organizations. We also had a joint tribal consultation meeting between the U Advisory Council and the Department of Health Services to talk about this policy strategy. In 2021, we dropped our bill again with representative TJ. Shop and third times a chart, it took us three sessions to get to here. There's our ceremonial signing of the bill and some of our partners that worked on the bill with us. Now we are in the stage where when that was happening, we wanted to get a better picture as an agency, what's going on right in our state. We commissioned a report, this is on our website that I'll provide to you later. But the Arizona Indian Health System Primary Care Workforce Assessment, it was really just to assess our system workforce challenges and opportunities across our state, and it was intended as an initial review. So I don't think I'm going to dive too much here, but we have high health professional shortage areas in our tribal communities. Our counties are really huge. But when you start to break them down into our reservation based areas, you start to see those hips, really showing that our hips on our tribal lands are higher than compared to the state average for most of our rural counties. I would have to say that that is, that would be true, of course. Just the need that we have in all the different disciplines of primary care, dental, and behavioral health. Here are just a few recommendations for future study. But to conduct additional workforce surveys with HSTU system, including assessing impact of obligated or temporary providers and providers planning to retire a number of Medicaid claims. We also wanted to include smaller tribes that do not have their own hips as assessment in the next assessment. And we did do that, some of our tribes are really small. You could blink and you go through the reservation, then they get absorbed into the greater hips. You really don't see their need because they get absorbed into the greater hips. And then assess other types of primary care providers such as nurse practitioners, nurse midwives, physicians, assistant dental therapists, and behavioral health professionals. We did not look at this space, I think really just because of the readily available data. But I know in our state we're moving more towards the mid level providers and creating more scopes of work for those mid level providers. Tribes in Arizona were heavily in support of the creation of the dental therapist model here in our state. I think around the same time that we were running the other bill. Actually a couple of years prior, we were moving on the dental therapy legislation that we passed here in our state. That was back in 2018. We have still yet to have a dental therapist come to our state to work in our systems, even though they could do so today. Another talk on that. But really because the support for the dental clinics aren't there to receive them, there's a lot more infrastructure that our tribes have to stand up in order to receive a new dental dental therapist in our state. Even though we passed the law, we're still working on the infrastructure support that new provider to come Again, this is to my other point of inventory, successful initiatives and strategies both within Arizona and nationally. We say nationally because our system is national, our Indian health service system is national. We recognize that we partner across other states as well, of course, that have effectively increased the health workforce serving American unions and populations from our other states. What are they doing in those other states that are impacting their tribal communities? Health professional shortage areas in the areas of primary care. Might I also mention, it'll be very interesting to have these conversation with tribes in terms of how we define primary care. Because I think Rsa, there's a definition of primary care, right? Behavioral health, dental, and primary care providers. But we've also had smaller conversations about our own care of traditional practitioners, right? When I see when, when I'm a part of these conversations, there's always that other piece of me. That part's never really a part of the conversation. I'm torn on that, right? Should there be a conversation? Should there be space for that conversation. But at the same time, I want to keep it guarden a Navajo lady. So these are just some recommendations. The grant proposal, RP came out just last year, March 2022, just a year ago. And we submitted a proposal, we were awarded that contract. And we started July 1 of 2022. It ends August 31 of 2023. So I believe it's like a 14 month contract. We are using this, we're just starting it up. We have a full time directorate and part time staff who are working on this as well as I am just wanted to show their faces here. They're also in line this morning. If you bump into them, this is who they are and this is who you want to work with. Jeffrey Axel and Mikaela Kms. This is our system, a new, updated map, right, of our Ac system here in Arizona. How we are approaching this Ac, because we had to start this up really quickly. When the RP came out, we've had to figure out what are we going to propose doing. We already had partnerships with two of our tribes who actually provided testimony, who provided support legislatively. We went to them first. San Carlos Apache Health Care Corp and Hela River Healthcare. The picture showed of Dr. Stevens, she was on the board of directors for her hospital. They were the first to say, Kim, we want to work with you, we want to help be part of the Ahec that you are establishing. This is our new in terms of our Ahec system here in Arizona. Right now, you just see those two tribes, right? Because we actually have formal agreements in place with them to provide funding to them. But really our Ah is statewide. It's statewide because our system is statewide. Every Ah do these different strategies and again, we're just getting into the spaces. There's new vocabulary I'm learning these months, but I'm just really happy to have our staff who's doing this full time. By the end of our grant period, we are going to produce a three year strategic plan specific just to the Aright. Just a few things that we've done in the community based experiential training. We have worked with Nau Lumberjacks. I'm a lumberjack myself with their nursing program to provide travel stipends to some of the students that are in their American Indian nursing program. And then of course, I mentioned the tribal collaborations we have with Gila River Healthcare and San Carlos Apache Healthcare in that area. Youth pipeline. Just some more things that we're going to be doing, working really close with our two tribes, San Carlos and Gila River. But also we recognize that there's a lot of other opportunities across the state to do this work. We are just getting all different partners coming to us, asking us to assist in them. So we're going to try to figure out, okay, what makes most sense in these areas. I'm really happy that we're going to be doing this strategic plan. I think eventually we're going to have to hire more staff to do this work. There's just a lot of work to do here, right? There's so much to do here. The professional development, just working in that area as well. We do want to develop a social media presence so that our youth and our younger adults can see that, right? Because I think that's how they mostly communicate today. Here are just a few comments from our students. I'll let you take a look at this really quickly, but I really like the second quote where one of my favorite moments during my clinical experiences is speaking my native tongue, which is Navajo. I thought that was great. That's who we want to impact, that's who we want to be working with. It just makes sense that we support these students because it really does emphasize the grow your own strategy. Then throughout this, we are going to fully embrace the grow your own strategy in all of our programming and all of our plan. Here's just some contact information I think I'm about out of time. Thank you for your time. We would like to invite all of our speakers that talked this morning to come on down for the panel. We have an opportunity to ask questions to the panel, both in the room and those who are on zoom. Feel free to either raise your hand on zoom or put it into the chat. But we will go ahead and start. Are there any questions? Okay, let's go ahead and jump on line then. Betty, would you like to just unmute and ask a question or let me know? I can read it. Sure, I can read it. Thank you for the presentations this morning. This has been great. I just have a quick question for Dr. Stringer. With your admissions focus on EQ, is there any worry about screening out individuals who may be neurodivergent so they exhibit the desired traits differently, but also have the potential to be effective healthcare providers. And if so, anything to do to account for that possibility. I know it's an issue that's been raised, a medical school admissions process is being discussed. I think you bring up a great point the way that we approach that to try to have as much equity and fairness around that. Because obviously there's going to be a level of subjectivity involved which, whether you're screening for EQ or not in admissions, you're doing interviews, that's just a reality. But what we do to try and mitigate that is that we have at least three points of contact for each applicant. That's two individual interviews in a group. And then we talk about it as a group. And we try to cultivate and demonstrate our own emotional intelligence in the group, discussions amongst the interviewers. In the sense that just say, this is what I'm seeing. Am I demonstrating my own bias? Is this discriminatory towards this person? And we just have like a safe space where we can discuss it or resist something that we all agree as a group that this is a concern and maybe it didn't precipitate in the other couple of environments or the interactions. But can you see something? And then in retrospect, if the other environments say, yeah, I think I can see that as well here, I saw this and it was softer here, but we can see that then there's got to be agreement. It can never be one person saying, I think this person has this red flag. It's always an agreement typically of three people. It's how we've approached that. Great, thank you. Hi. Thank you very much. This has been really great. My name is alias from Uc San Diego. My question is for you as well about EQ. I've seen several ways of doing that, either through MMI stations or longer more drawn out group sessions. What is your experience with that? What are you doing there with you or is it sounded like you're not maybe doing MMIs? I tend to think MMIs are not good for EQ, But what do you say about that? We avoided more formal assessments like that, sort of it would be from a legal perspective, we're limited in doing those kinds of things and for fairness reasons, we've just done it very holistically and homegrown. And the first year that we implemented this, I did a training like what we just did. We just went to the literature, what does it say and maybe how can we apply this in an interview setting? And the first year it was painful and it was all over the place. But as we've continued to grow in it and work towards it, it's just emerged this ability as a group to be able to ascertain these things holistically and organically. And it's permeated over into our faculty searches and everything. Thank you for presentations. You're all very interested in very encouraging my question. I have two and they might be more directed toward the university side. But I'm wondering how do you take rural character or rural admissions in your admissions process? Is there selection from rural communities that you're taking into consideration? And how do you do that to make sure that your students are being pulled in from rural communities? And on the other side of that question is, are the universities tracking their students once they've go out into practice? For how long do they track students that are going into rural communities? Well, I think we're going to hear from Lewis presenter. And Lewis is in our admissions office, but I'm on the admissions committee for the School of Medicine. And we have, by the way, question for Sarah, Are you Sky still doing online interviews? Yes. So are we And so I think we are doing online interviews forever. I mean, obviously we didn't do that before, but we do now and have found it to be probably the fairest approach because Texas is the big state. We have 50 medical schools, students are going all over the place to interview. And this is really a way to have to reduce the financial impact of interviews. But we do have an additional point system that determines where students are, their metrics, their point system that has a lot of different variables around their academic metrics and some of the other ways that the interviewers rate them. But their mission to Texas Tech Health Science Center, specifically around geographic location, are they from some area that's germane to our part of the state, Either because they grew up there or they went to college there or have continued to live there. We take that very seriously and it benefits them in the admissions process. Do you guys have something like that? Yeah. At NAU this is a newer area for us to be looking at. It's a great question and ones that we are asking ourselves as well. We have, some of our programs have been really good at getting and tracking this information. Our Pa studies program has done a really good job with that. And they embraced the whole piece of, you know, we're serving rural Arizona and that's their mission. That was their whole context. And then they have like 80% stay in the state and have more of a rural focus. I know OT has also done a really good job with being more community engaged. And so they have better outcomes that way. But what we will be doing is at this point, as of I think last week, Ab actually gave us our state board of regents finally gave us, we have confirmed our, the metrics for N Au. And they're very much tied to that kind of data right now, where we may have been struggling to actually collect that data on a large scale, we will now have more of a university focus on doing that and are also building that into our individual programs within the college as well. Yeah. Yeah, I didn't address your part about tracking. Certainly we know where students match for residency at the end of their medical school experience. And where they match. We do have a pretty robust way to track their performance. The Wmc has ways that they help us do that out five years, ten years. And as they go into potentially to fellowship training and elsewhere, our data are less reliable. But in the programs that probably we care about the most. And when I say Fred and David and where we're looking at where family medicine residents go, we absolutely know that. We brag about that every chance we get to talk about their ability. They're being recruited, going to talk about that. Recruiting, recruited into rural and underserved areas, and we're super proud of Amanda. Can I ask you to speak about the tracking for your groups, too? I'm going to try to answer that question too, because I want to ask from the perspective of the medical provider and for our students. We are required by accredited institution to track our students, to make sure that they do have a job placement, and that success has to be demonstrated. And also the need for any particular area, there is a need to train that particular profession that we're doing. Keep very close on who hires our students, how long they stay. There has to be more than six months. So there's a lot of track and a lot of time invested by my team to be able to demonstrate that we have about 75% 80% retention in the job and job placement. And we meet those guidelines. So far on my side medical provider ahead when we're recruiting medical professionals. One of the things that I have is looking at reviewing the applications of our centers, and we have different sizes from nurse practitioners to Pas, Ds, we found that there was a common denominator among the applicants. And this chemo research that I had to do internal research because the Los Angeles time was calling me about what's happening in the recruitment of health professionals in the border community and how is that being impacted overall to serve the families in our side and whether they're going into Mexico for health care or not. And one of the things that I find out that among all the applicants in the medical field, Ps, nurse practitioners, Ds, one thing in common that they had was they all had a history. The majority 90% of serving underserved area, whether it was in another country, Americorps, or admission through the church, and serving very remote areas around the world. And that commitment to serve and understanding the humanity and the compassionate care, it made a lot of difference where as direct patient those providers. So that that practice service that you mentioned earlier, Dr. Jones during the school is so important that they have something to go in practice in rural areas. All right. We have a question on line. Jason, would you like to go ahead? Sure. Yes. Thank you so much. My questions for Dr. Stringer. I teach for the Nau School of nursing. I'm also a mental health counselor and I teach mental health nursing. In our mental health class, we do some emotional intelligence or EQ, self assessment that involves self reflection. I'm just wondering, aside from the admissions component here, does your school, or any other programs you're aware of, engage in any of this EQ self assessment and skill building? Yes. That was the area I had the pushback from legal because I wanted all of our students to do that when they first joined the program and require and they just said we couldn't require it. You can do it, you just can't require. That was the rule for us. Because we wanted to do some data collection around this and get this published because it's something that we've just seen the fruit of. But it's hard to collect data around something like this to galvanize change or disseminate. But what we do is we have a wellness series for our students. We meet with them biweekly, just short spurts, 20, 30 min. And where we offer them tools, focus on self care, care for the care. The first semester, all we focus on is emotional intelligence and cultivating that just because of everything that we're talking about. That there's just a correlation between that and being able to serve the underst we really try to foster, we've picked these people, then we try to help cultivate and help them grow it. Thank you. I've got a question going back to the dental therapist. There are some challenges there and I don't know if there's any movement in trying to get dental therapists trained and out there. And I imagine I don't know if there are any dental therapists down in the Yuma or in your areas, but if any of you could talk to some of the challenges and maybe successes or recommendations we're trying to get, T's, I can speak to it as an advocate. And then I think Nu is trying to stand up, a program from a tribal perspective when we ran the bill. We had a provision in there that would allow, if a tribe wanted to hire dental therapists outside of the state, that could happen. We have requests from dental therapists that are trained in other areas of the state to come. But like I said, we don't have the infrastructure right, in terms of the building of the schools. We've been having preliminary conversations with some of our tribes in the region here. So I believe White Nevada, Utah, Arizona, New Mexico, to maybe have a hub school. We also have what they called tribal colleges and university system in our nation. We have I think, three colleges, four university colleges here in our state that are tribal. But we're still assessing whether or not they have the infrastructure and capacity to build that. But we have heard from Sippy, I can't remember what it stands for, but I can't remember what Sipi stands for. But it is a Tribal college in New Mexico, Albuquerque, Mexico. Who does have a desire to stand up a dental therapy program because it requires so many resources to do that. We're thinking if we could all work with Sip and then send our dental therapy students to that school, that would be great because we would embrace their curriculum. Their curriculum is two years. I believe it would be an AA degree. It's quick and you out the door because there's so many barriers that are put in place to attain these degrees. Right? But we know that the shortened curriculum that has been demonstrated in Alaska for decades works, which was then modeled in Washington State Works. Let's do it here. I think that's where we lose some of our students and we could keep putting barriers in front of them, especially when you do that for come from disadvantaged backgrounds. Right? You got to attain this level, then you've got to attain this level, and then you come out with all this, right? So that's from a tribal perspective, understanding our community, understanding our systems, and really understanding the need. And to get them out as quickly as possible. We want to endorse a study pathway that doesn't have those many barriers in place. That's all. Very preliminary conversations we have yet to bring back that group again. But standing up that curriculum, especially in our tribal colleges and universities and communities, there's so much infrastructure support that still needs to be created. I believe one of tribal leaders from Navajo mentioned one of his dreams was that our tribe had our own medical school. Wouldn't that be great? Right, I think that's been done in other countries. Why can't we do it here I watched a documentary Partners in Health with Dr. Gary Farmer and his work in Africa. And I was watching, hey, how did they do that there? Why can't we do it here? Now I'm thinking a little bit grander, right, in terms of what we could do with our tribal colleges. And of course, a lot of our colleges are very rural. How do you do that? But it is possible just wanting to share with you some of our preliminary conversations with our tribes around dental therapy. That's still preliminary. But then each tribe will decide how they approach it because they're sovereign. They will figure out what partnerships make most sense for them. Can I just toss out a quick question? You talk about the extort programs where we get rid of the barriers and pipelining people into our communities. By the way, I think the grow your own could be a theme for all of us. It's phenomenal. We found a lot of success that want Dr. Jones to talk a little bit about our Fmt program because that's a great example. She talked a little bit about that. But our accelerated medical school track, that could be something that as you grow this vision of the travel medical schools could be nice models there. Just let me follow up on the dental therapy, we had looked at a model that was not that quick model that got pulled off the table. But what we are looking at is can we do the shorter model? I think we have you and I need to talk and that would be great. Yuma has also AWC. When I'm coming down next week, we'll be talking about bringing dental hygiene there. And does it make sense to bring dental hygiene? Does it make sense to bring dental therapy? What is it that we need to be growing? We do have dental hygiene in our college. One thing I was sitting here thinking, I probably hadn't made clear, thank you for that question, David. But also, thank you, Kim, for letting me maybe piggyback on that, this idea of how you grow out your medical school opportunities. Where we are at Texas Tech, we have a distributed campus model. We have actually four different campuses where our students train. Everybody comes to Lubbock for the first two years of medical school. And then we distribute 180 students in each class among four clinical campuses. We have 180 students, about 50 go north to Amarillo. About another 24 go south to where Sarah is in the Permian Basin. And then we keep 30 of them in one health system albic and about 70 something in another health system, Bc. We as a distributed clinical training model, which could work. It's difficult. It's very expensive to have a medical school with enough patient population to deal with, to give your students everything that they need access to. When Texas Tech was founded 52 years ago, that was a recognition. We didn't even have that patient population in any one of those communities. So we had to use them all. And that would be my advice. Yeah. It's somebody who knows the system on how these things happen. One of the things we also have is a three year track to the Md degree. Everybody's interested in acceleration in our particular track. It's called the Family Medicine accelerated track. Although our students do two, the first two years of the pre clinical training, they do in Lubbock in the same way that the other medical students do. Then they're distributed among those campuses that I just described. They do one more year of medical school. Their clinical clerkships, they have already done their family medicine clerkship because that's a longitudinal one. Who talked about the, that's talked about a longitudinal integrated clerkship. We do a longitudinal family medicine clerkship and then they graduate. So they finish at the end of three years and they go directly into residency on one of those campuses. Fred gets the lion's share of those, but we send several of them to Permian Basin, into Amarillo 11 classes in. We have a lot of experience to share with you guys about how to build up an accelerated track program, but we are very insistent that it is directly into primary care and family medicine. Everybody wants a quick pathway to be a dermatologist or an orthopedic surgeon, and that is not our model. We are here for primary care and we are here for underserved. So you can imagine what that does to cost. It means that it cuts it in half. Our students, assuming they don't get any other financing, which is usually not the case. Usually they have something that we provide as support. They pay for a year of medical school first year, we give them a full tuition and fee scholarship in their second year. Depending on where they do clerkship third year, they may or may not still get another full ride in the third year and then they don't do a fourth year. Essentially their tuition and fee debt is cut in half and that's before you add in the time value of money. And all the things that are looking at debt as a longitudinal thing, it really does limit at least the barrier of, am I going to make enough money as a primary care physician to pay back my debt? Absolutely not an issue. And spreads. Going to talk about we place well, our residents go into really great locations and they do absolutely. Fabulous. Great. All right. We're going to have one more question. Thank you. I speak from PA education, at least the new thing in P education is hybrid programs. Their model is grow your own from the start. Things are already very competitive in Texas at least there are at least two hybrid programs. There's one here in Arizona. Now I know Nu very well. I know the success they've had with Burl education has not been from a hybrid model. But I wonder what you're experiencing in Texas Tech and perhaps even Nu now that I don't work here anymore. But are there plans to embrace a hybrid model of teaching and education to accommodate this? Grow your own model, which is a very good model. And the hybrid programs are really having a lot of success with it because for obvious reasons, update on that. We are actually proposing two programs, a rural fellowship program, which is a grow your own. We get someone in there, that person who then is doing a fellowship There is also providing support for placement in the rural community as well. We're building capacity to actually do placement there by actually having fellows that are there, which is a good thing. We're also looking at an online, more of a hybrid, but ADMSC, and it will be the first DMS that'll be offered by a State University here in Arizona. And that also, though we can again keep encouraging, growing as we're going forward, that's a hybrid model to want to, we don't have that necessarily in the works right now, but I think like everybody else with the pandemic, we're moving and changing and we're looking at some of those kind of things. But I can't say that it's officially part of what we're doing then. We just started last year with the medical assistant program that created an incredible system in collaboration with the alliance of community health centers where those individuals are already hired by those centers. And so they have a clinical component and then we're training the folks, they're going to be receptors and the evaluators in the clinical site. That's a lot of work, but it happens and has been very successful. The fact that all 52 students graduated took the national test and the pass flying fathers. But it can happen, but it takes a lot of coordination with the site to train that receptor, the supervisor, so they can do the clinical on hands right there in the clinic. And my instructors are delivering instruction, but also overseeing everything and assisting with mentoring to the faculty, the receptors and the students. That has been very successful, us. All right, well, let's give a hand to our presenters once again. We thank you so much for your time and expertise. I just want to thank everyone for an awesome, lively discussion. During our last session, I want to introduce Lewis and Monica. They are a senior director and associate director in the school, in the office of admissions for the Texaco University Health Sciences Center. And they work with and are really integral to, several of our pipeline programs. I believe Lewis has even pioneered some new pipeline programs into medical school. I'm really excited to hear them discuss some of our innovations and pipeline programs for medical school. I will turn it over. Thank you, Dr. Trotter. Thanks for everybody else who's offered their time to come and speak today. We've had some great presentations this morning and about to be afternoon, I guess, at least in my time zone. I'm looking forward to sharing a little bit about we do and how we go about our processes. And at least like Dr. Trotter mentioned, some of the pipeline programs like Kim mentioned earlier, growing your own, how important that is and things like that. And I know there was a question earlier for the panel about how admissions looked at some things like that. Dr. Brew Baker may touch on some of that a little bit. She'll be talking a little bit more about admissions, the selection process at least. But happy to field any questions during the Q and A later on without any further ado, we'll go ahead and get started again. Luis Perez, I'm the Director of admissions, and then joined by my colleague, Monica Galindo as well. Some of the things that we'll cover here in the next few slides are going to be a general overview of what the institutional centric missions are for the Texas Tech University Health Sciences Center, School of Medicine, at least as they pertain to admissions. From a recruiting standpoint, we'll talk about recruiting individuals that meet our missions. How do we identify those individuals? Where do we go look for those individuals? How do we take action? The importance of pipeline programs? And then how do we maintain those pipeline programs? What are maybe some of the possible outcomes that we have a have had so far? All right, again, a brief overview of these missions here as they pertain to an admission standpoint. I think it was Dr. Jones that talked about the 108 counties. If you shave this part of Texas out of the rest of the part of Texas and like in the office here, what we like to affectionately call the State of Tech, if you will. The State of Texas Tech, the West Texas area of the service area, 108 counties. And then Monica was able to pull something that the Health Sciences Center posted on Instagram recently. Of these 108 counties, 20 no practicing physician, and 11 have no practicing physician, no practicing nurse practitioners, and no practicing physician assistants. A very, very underserved area. As you saw by the many graphs that Dr. Jones showed earlier, we're responsible for servicing this wide area and producing physicians to populate this area and serve these individuals. As we go through and look at this, we're thinking of this in the back of our heads, okay, we have a lot of work to do. There's a lot more to be done. We've made a big impact over the years, but we still have a long way to go. As we think about this, what are some of the things that we need to start doing? How do we actually find these individuals and how do we identify these individuals? As we know, right? If we want to produce more physicians for the West Texas area, we need to actually look for individuals who are interested in pursuing healthcare, and particularly medicine for us from those same areas. We know that that's vastly important. We know that they have a higher propensity to go back and serve and practice in those areas. Those are the things that are most important to us when we start going and looking at how we actually insert ourselves into these communities and really attract these individuals to us. These are the things that we're looking for. We want to make sure that we provide individuals resources. And I think someone mentioned this earlier, right? Depending on where you are in the process, and I'll get to this in a little bit more in depth. We want to be able to meet people where they are, and we'll come back to that a little bit later too. But how do we actually go about identifying areas that we can find these applicants in Texas? A little bit different, right? We live in the state of Texas, so we tend to do things a little bit differently. Sometimes we actually have our own application service provider. It's a Texas medical dental application service. They service most of the medical schools in the state. And we're no different. We use the TMD, Sas application. I'll just abbreviate for short from here on out. But we're able to see where applicants are applying from and things like that. We use that naturally to identify individuals in the West Texas area. And that gives us a jumpstart on finding out where these applicants coming from, how many are coming from our region, and how do we go about meeting them in those communities. The traditional way that we go about doing this, and I don't think we're any different than any other school. Right. We have our recruiting efforts. Once we get into our recruiting efforts, I think the slide is a little laggy here. We have general ways of doing this, right? We have fairs that we attend, whether online or virtual, right? One of the byproducts of the pandemic is that now we have virtual recruiting sessions. That are, to be honest, very nice, right? We can be anywhere at the drop of a hat now. But we also have in person recruiting sessions, right? Tabling events, things that we go to, recruiting fairs where students can come to us, potential prospective individuals can come to us, get information, we provide them the information. It's a very, very push pull service, if you will. And educate them right then and there at the point of contact on maybe the next steps or maybe follow up steps and things like that. Right? But then we also have, outside of that more traditional type of recruiting, we deliver presentations, maybe we're asked to go speak, we're asked to go presented different groups and things like that. So we want to insert ourselves into those smaller communities around the area which we have been doing. In fact, just recently, we got invited to go to the Amarillo area. If you're not familiar, I'll go back to this little map here for the State of Texas. Right. Amarillas, about 2 H North of the Lubbock site here. And then we have the Permian Basin. You heard some other folks talk about a little while ago, about 2 H south here, right? So we just got invited to go to the Umbrella Mill Community College to deliver a presentation there. Presentations, tabling events, things like that too. But how can we really impact, we started thinking about this a while back, a long time ago. How do we really impact the number of individuals that we can actually pull from our region so that we can actually produce more applicants in the pipeline for us? And we thought to ourselves, and we said, well, we probably need to start at a very early age. We decided to develop a program called Early Dedication to Medical Education. This is our Me or Edm program and it really focuses on individuals from, as Monica likes to say, K through 16, right? K through 12, and then undergraduate institution individuals who are in undergraduate colleges and universities. Anybody can join this. Ed is really just a program that we're able to provide information to individuals. It's a hybrid format so people can come in person to the Lubbock campus or people can join virtually during these programs. What we do is we provide information on either different specialties, things like financial aid resources, how to be a competitive applicant, and all kinds of information. Now the tricky part of this particular program is since it's K through 16, we're really challenged on how to tailor that presentation and that material to those target groups. Sometimes what we'd like to do is we'd like to have other sessions spur off these events. That we can target those individuals. But that's just one of the particular programs that we have. When we started thinking again, we started thinking about how do we really start to grow our own, if you will. Not a phrase that's uncommon for institutions looking to further their rural outreach and further their institutional centric missions. Well, we said okay, well, we need to be able to reach individuals at an early age, and then we need to be able to provide them some of the resources that they need to be successful. I've always long thought of some of the other areas of the state of Texas. Some of the more metropolitan areas of the state of Texas have high schools. Had a little bit of an advantage on some of the regional schools here in our area, and that's because they have high schools that are actually dedicated to health professions. You have the Texas Academy of Math and Sciences. We have health professions schools in the San Antonio area that are dedicated to health professions. And it gives, really, those students, I think, a leg up because they're able to get insight into healthcare and pursuing healthcare a very early age. We don't have a whole lot of that that exists right now. I know that there are at least some schools in the area that have a little bit of healthcare influence in their schools, but no schools that are just solely dedicated to that. We said, okay, well if our students don't have that, how do we actually get them those opportunities? Then we started thinking about pre medical enrichment programs. Pre medical academies, should we have one just for high school? Should we have one just for undergraduate students? Then we started to develop some of those. And you can see some of the logos here with some of the photos of some of our participants and some of the activities that they've been doing. And then we had the State come along. At one point in time, the State said, we're going to actually put together a program and we're going to fund a program that actually provides an opportunity from individuals who come from disadvantaged backgrounds to get a leg up into medicine, and that's our Jam program. So this is a joint admission medical program. This is actually run by the State. Funded by the State. Most of the medical schools in the state of Texas actually participate in this. And then all of the undergraduate institutions, right, not 100% of the undergraduate institutions, but many of them can actually produce individuals to get into the Jam program, right? So again, we're looking for individuals or this program member ticker, looking for individuals from disadvantaged backgrounds to get into medicine. And then they do two summer internships, two different summers as they're on their way to apply to medicine. We happen to be a summer one school. We host them for a first summer session, and then the following year they'll go to a school that host them for a second summer session. During those sessions, they get exposure to Mcat prep, get exposure to our program. They go through an anatomy course, a physiology course, a neurobiology course, and various other shadowing experiences, mental health and wellness. And some of the things that I heard some great discussion about EQ and we've thought about bringing some of that to the table as well. But the program itself has some goals that we must meet, would be good conversation to have moving forward, I think. But we meet these requirements. Students go to the program, they complete two different summers in the program. And as long as they meet all of the requirements, they have their own match. And they're guaranteed a set in one of the medical schools that's participating in the state of Texas. That's a fantastic, fantastic program. Then here, as of late, one of the other programs that we've got up off the ground, we initially started it just before the pandemic occurred. And we actually had a kickoff event, and then the pandemic shut things down. We've had another kickoff event, and Monica is actually working really hard on getting a lot of it back up together again. And this is the middle school to medical school program or initiative that we have. This is really borne out of the brain of our Associate Dean of admissions, Dr. Felix Morales, who's a family medicine clinician also. But obviously what we're doing here is we're partnering with local middle schools to get them excited and interested in medicine. Monica, I don't want to put you on the spot here but I think you guys have some really cool ideas. Do you want to share a few of those real quick on what you guys might be doing in the near future? Yes, of course. Yeah. Like Lewis has said, middle school to medical school. There's been studies out there that if we expose children since middle school or even earlier, they already have that niche in them to want to go into medicine. And since we know the route or the journey to medical school is actually very, there's a lot of dedication that needs to go into it. It's good that they know early on what they need to do, so they're constantly on their journey to that. Some of the like a curriculum per se, for this program, we're looking at obviously a kickoff event to have all the students get excited about it. We had medical students, yeah, that's a picture from this past November we had medical students that. We're in their shoes as well when they were younger, without any resources or our guidance. And they spoke about how, what they did and how they got just encouraging words to get them excited and interested. I guess semester we're going to do other events. For example, we're going to have a lunch with med students. So we're going to invite several med students to come to the middle school and go to their lunch time so they can talk to them just to get them excited. For the students to ask them anything about medical school or even what undergrad, how it went. All of that. We're hoping to get that event up and running soon. And then we'll have another one in April 25, which is actually DNA day. We're going to also go to the school and have them do the strawberry extraction DNA experiment. We've actually done it with another group. If you can see on the bottom left side, That one was actually through my, through early dedication to medical education. We did have several students doing that. It's a really popular experiment that the students really get to learn more about the DNA and get excited about that. And then we recently just also had another event for M to M, which we had several students from one of our partnered schools come, which is called the Future of Health Professional Education. That one, we had different sessions, and this one was more of a collaboration with the whole health science center. We had nursing, pharmacy graduate school. We had different workshops for the students to also look at. And we actually did a dermatology session. We thought it was, it was very pertinent or pertaining to middle school students, since they're going through hormonal change in acne and all that, it was a lot of fun for them. They got to learn what different types of creams to the skin and the different types of, I guess conditions that skin can also develop. And that was a lot of fun. Then ultimately we'll have, I guess a farewell event towards May and we'll end the year with that and have another, just like a recap of what they did, slide shows, getting them remembering throughout the year, all the different things that they did with our program. Eventually we want them after, for this program to be able to go into our additional programs, which Lewis will continue to talk about. You might wonder, well, you guys are talking about all these programs and they sound cool, but how does this all work out together? We have the Jam program, right? The jam program is a state funded program, and some of these programs are feeder programs into that pipeline, if you will. And what we're trying to do here, I guess the long game that we're playing here is that we're trying to have a robust pipeline of applicants that we can continue to pull from. And we continue to turn out competitive qualified prepared applicants for medical school, the summer enrichment program, high school students, they can then go to the pre medical enrichment that's for undergraduate students and hopefully they're feeding in from the program or the Edm program. That's really what we're wanting to do here. And this isn't all of it, right? We have other programs too that we just couldn't fit all of their little logos on this college that Monica put together for us. There's an Mc program, the Umsi program Undergraduate Medical School Initiative, where we're targeting high school seniors. They actually apply to the academic campus at Texas Tech University, the Honors college at Texas Tech University and the medical school at Texas University Health Sciences Center concurrently. And they can get acceptance concurrently. Now for the medical school, it's obviously early acceptance, about four years early, if you will. But if they get into the program, they meet all of the requirements, they actually matriculate right into medicine after they're done at Texas Tech University. They're four years and we actually waive the M cat for them. That's a huge pool for that, for anybody interested in that particular thing. Then we have early acceptance program partnerships with other individuals too. Really, what we're trying to do here is show people that they don't have to leave West Texas to get into medicine, to get into health care. If you really think about it, we're wanting to do I believe Kim said this earlier. We want to meet them where they are right on their journey to medical school. They may not know, and kindergarten, first grade, second grade, third grade, that this is what they want to do. But at somewhere along the point when they make this determination that this is what they want to do, we can meet them where they are so they can get inserted. If they're under an undergraduate institution and they want to start medicine, we have a program for that. If they're in high school and they want to get interested in this, we have a program for that if they qualify as being having a disadvantaged status. We have a program for that too. Or if they know as early as middle school or before that they want to get into medicine. Or they at least want to start thinking about the idea that they might be interested in medicine. We have programs for that too. This is really what we're trying to do is we're really trying to build robustness in the pipeline. And here's our early acceptance program here, our undergraduate medical school initiative here. Obviously, the overall target here is that everyone is going to be getting into medicine and we're trying to help them get there. Again, they don't have to leave West Texas in order to do this. We want to be able to reach these learners, reach these students at any point in time where they are. It's vastly, vastly important, I think, because what we're really wanting to do is we're wanting to meet our missions. We want more physicians for West Texas. We want more physicians to go and practice in those underserved areas. We wanted to go back and practice in those rural areas. And if we could, maybe if we could waive a magic one. Although I think like Dr. Jones mentioned, we played very, very well when it comes to residency programs. And I'm assuming Dr. Anger may be talking about that a little bit later as well. But maybe if we could waive a magic one, they'd all be primary care physicians. I think maybe Dr. Roles would be happy about that. But what we want to do here is we want to attract more primary care physicians. And we have wonderful programs like the Fmt program like Dr. Jones spoke about as well. That's the importance here, right? If you really think about it here, it's a community effort, right? It's a big effort. Here we have a major state funded program that also helps fund some of the other smaller programs like Pep and Sep as well, right? They do provide some funding for Edm as well too. You heard Monica also talk about the F Hpe program, a future healthcare professionals experience program that we just hosted here. There's a junior version of it where we target high school, middle school, high school students. And then there's an undergraduate version of it, or an open house, if you will. And that's an institutional supported program. Again, this is a community effort here that we're working on. It's just so vastly important to the overall health of our application pool and how we can continue to meet our missions. We think about the things that we've done and we think about some of the opportunities that we may have in the future and some of the things that we have yet to do. But really the overall outcome here is that we want to produce more physicians to go and serve in the areas that we need them the most. To date, the summer enrichment program that's geared towards high school students, has produced at least six, at least in the past eight years, six individuals who've gone onto medical school from those programs. The Pre Medical Enrichment Program, which focuses on undergraduate students in the last eight years, has produced 40 individuals who've gone on to medical school. The Jam, the state funded program that I talked about, has produced hundreds of individuals who've gone on to attend medical school and gone into practice. And in fact, many of our faculty here have been former jam students as well. We know that there are positive outcomes. We know that the recruiting of it is vastly important. We know that the pipeline portion of this, an integral part to our success. We only hope that the future remains bright for it. And we only hope that we're able to build more and more robustness into those pipelines. And it's definitely a goal of ours and some things that we've currently been working on. Monica, anything you want to add to some of this here? I just wanted to say that we continue to look for ways to find resources, to be able to mentor, just so we can really fulfill those missions. And even though we have these programs every year, we get together to see what can we do to make it better, how to make it more efficient, and it's a continued work. Um, work in progress. Really, we're all, everybody at the Health Science Center. We all work together, as Lewis has said, as a community really to help these students achieve their goal to get into medical school and become physicians. Thank you Monica. Overall, we want to be able to generate more physicians in the pipeline, more physicians for our missions. But competitive qualified and prepared individuals for medical school. Then as they take the next steps, I assume Dr. Brubaker will probably talk to you guys a little bit more about that selection process. So hopefully we have them competitive enough that selection process, that can be sometimes a little rigorous. Thank you all for your time. I really appreciate it. Sorry, folks on zoom, I heard I just solve the world's problems and you missed out. But once again, thank you so much to Monica and Luis. We greatly appreciate your insight and I get the pleasure to introduce Mary Lou Brubaker Mission guided admission and she's with the Department of Physician Assistant Studies at Nau. Welcome, Mary Lou. Hi everyone. I'm actually going to do the mechanics. The rest of this was how to get people interested in your program. At this time, we have a large number of applicants that want to come to NAU. I'm going to talk about how we utilize the centralized application service and their software in the background to help us to move very efficiently through that process of selecting individuals that we'd like to interview. We do the admission process within our own department. We don't have an admission department that does it for us. We are reliant upon our staff, our faculty, and our alumni to help us do this process. Okay. We found the right way how to do it. The Arizona Board of Regents asked that they tapped Na U to create the first public physician assistant program in our state, and we then went to the process of putting that together. I was a part of the advisory committee way back in 2011, it seems like. That was a long, long time ago and we were charged to create the mission statement. We were very fortunate to have a chair that was, that joined the Nau program that had been involved in several other universities creating programs and brought his knowledge with him to our program. Here we developed a mission statement. You can see it. We're looking for the highest quality person that has a diverse background. And the thing that popped out to me that I really like in our mission statement is life experiences. We really wanted to learn about these individuals of a whole and what they bring to the program from their life experiences. We have the responsibility then to the students to equip them with the knowledge that they need to practice high quality compassionate care. And we do have a focus on the areas in the state of Arizona that are in need as well. We have a few that come from out of state, but the majority of our applicants are in state. Well, this was before the term holistic admissions. You don't see much literature 1015 years ago, I thought I understood what holistic admissions were. And I took the challenge and said, let me do a little bit more looking and see if I truly know what a holistic admission means. And I went to the first source that one goes to, and that's the dictionary. How do you define it? I learned that the term holism was coined back in 1926 by the Prime Minister and a general from South Africa by the name of Jan Smuts. He came up with the term and he expressed it as the whole is greater than the sum of the parts, and that's how we got started with that term, wholism. Holistic then is derived or is related to wholism. The definition there is related to, or concerned with holes or with the complete systems, rather than with the analysis of treatment of, or dissection into parts. Some of you within this room are old enough to know where we went from a family practice to a lot of the different ologies, cardiology, rheumatology, hepatology, and we can just do theology chain. We noticed that we were separating ourselves and putting ourselves in alleys and that we weren't communicating with each other. There was this emphasis on mind, body, soul, taking care of the whole patient. We're moving back to that, and part of it, you can see is grooming individuals that would be interested in medicine, as well as looking at the process of how we identify individuals that would indeed have that as our mission and carry our mission out as well. Well, that's a definition, it didn't seem very practical to me. And I went searching the literature, and I can't say it was an exhaustive search, but I found an article that was on the health and human services public access, and it's the holistic admissions in the health professions strategies for leaders. I found what resonated with me, and I hope it resonates with. You talked about what is a holistic review. That's the flexible, individualized way of assessing an applicant's experiences attributes, academic metrics, and how that individual might contribute value as a student and a future health profession. This is where I like to say we're on this path at Nau, happy that we still have places to grow, but this is what we do and I'd like to talk a little bit about the mechanics of getting there. This is a faculty guided process. And I would be remiss to say that if I didn't include the staff, the alumni, and the students that give us feedback in this process as well. It is a voted decision. The admissions committee brings forth ideas and then the faculty vote on it for the next application cycle. If you look at the last bullet on this side, you're going to see the exact same thing that we then come back around at the end of the cycle. Take a look at our information, our data, and see if there's things we could do differently in the future. It's a fluid process, fluid from year to year. It's fluid within the application cycle as well. We are looking to try to find three to four individuals for each seat of our program that we want to interview. And our process is designed to get us to those three or four in the most efficient way we can. That still meets our mission that we want. Supplies, documentation, supplies, supportive evidence. At any point in time, we can use the application software behind it to be able to go back in and look how we made decisions and not be spurring around for paperwork everywhere. When we look at that fluid process, we start out with a baseline score. And we're very generous in that baseline score, such that we're down in the 40% of the total score. We start very low and that giving the most value we can to as many applicants as possible. We go through that. If we need more applicants to be able to interview, we can make that adjustment. If we need less, we can make that adjustment as well. So it's fluid within the window, the cycle of application as well. We have what I consider pretty good communication with our applicants. They always want more of your time, as you well know. And they want us to answer the most important question, am I getting in? We always have to tell them we're not through that process yet and it will take us weeks to get there, if not several months. The nice thing about the mechanics of the program that we've designed, we don't send out early denial letters unless there's a hard stop. An example of a hard stop is they don't have the minimum GPA. And if that isn't there, they will have to tell them that they need to work on it. However, we do have some students or applicants that are working on course win work that would get them over that GPA. By the end, they still have that little small window to make it happen. We also have further communication as we go down through our process. The first, and it's done automated as well. The application service has software for you to put in letters, automatically generate that letter to an individual applicant, or if there's a group of applicants, you can apply it to the entire group, although the salutation is to that individual. We'll take advantage of the software that's in the background to us. The other thing is we have a constant quality assurance of the process. We're running daily reports, we're running weekly reports, we're checking and balancing each other between the staff and the chair of the committee to make sure that we haven't missed anybody and that we're processing people in completely. No one gets lost behind. I have to say that in the years that we've been doing this, less than two handfuls, if even that many, that we've had to go back and come back and take a look at the process in the report generation is very valuable to us. We have APA program email system that is answered. We save those responses. We can search that email if we need to go back to see what our response is. If it's a very important response or a phone message response, then we actually put that in the documentation, in the note fields of the application. Once again, this permits anybody to see that. If you have to come back in look to see what had been done, it's right there in front of us for it. And again, the end of the cycle. But where we really, and I don't know how many software have actually, this is the geeky part of me. As my previous life, I did a lot in generating reports and looking at data points and computer programs. This was like a little fun thing for me, that turned into a great big project. But the part about it is that the software that comes with the application system has all sorts of report generation underneath it, and we use the expert manager. We also use liaison analytics, which gives us more of the demographic picture of the applicants. Now this is the geeky part, but if you're not an Excel spreadsheet person, don't worry. This is intuitive and that's the nice part about generating a report. You can see on the far left side are the export fields, and each one of those expert fields is a drop down box that has additional choices that you can make. And so I showed you that I went under applicant. You can see right here it says where did I get that information was applicant and then when I do that, I can select and I decided my report. I'd like to know the name of the individual and so I can choose last name, first name then. Well, I'd like to know how many health related hours, experience hours they have. And so I go to the health related experience expert field and pull over that and the process goes down. I would say there's probably close to 200 optional things that you can pick what you want to have in a report. It can be very extensive and you can actually run the entire report if you wish. Well, we have a master report that we have generated that is the template for everything. And we can go in and choose and pick what we want. This allows us the flexibility, if you are an Excel user, to sort things and color code things so that you can actually visually see how the process is occurring. I want you to note that down here is a custom fields and then custom questions. And your software allows you to go in and create fields that you want to collect, data that's specific to your university or your needs. Also, the custom questions allow you to ask things. We ask the question if you've experienced any academic difficulties in the past, here's your opportunity to explain why those things occurred. We have other questions about the mission, other questions about if there are Arizona Connection things that are very specific to our program that you can embed into the software that already exists when you do this. Anytime that you embed something, you create a field that you can export into a spreadsheet. By the way, if you don't get them in the right order the first time, you just can move them up and down. You can slide them up and down so you don't have to restart the report. I didn't learn that right away. Now, I talked about having a minimum score and we have different scoring points along the way. And that we're very generous at the very beginning so that we can get the most people as possible through into the process. But the application software also includes the ability to take areas that you want to score and then assign value to them. And those are, again, not difficult to set up. But you say in this example, I want to know the military status of an individual because they will be asked the question, are you a vet or what's your relationship? Have you been a part of the military? Are you a dependent of a military individual? We are a yellow ribbon school university. And so that is something that we'd like to consider in our application process. Then you can assign a value to it. And the values, again, we go back through the faculty, help decide these values, how we want that represented. We want it on the academic metrics or do we want it on the holistic side? And our academics and our Holistic are 50, 50, 50% from academics, 50% from the holistic side. We have adjusted that once and we may adjust it again in the future as to how we value those. You can see then we've just assigned value, we assigned a value of three to military service. The minute they answer yes to that question in the application, all this data gathering and calculation is taking place in the background ports. We don't have to do that, we used to do, we don't have to do. Before I get to this point, you can see that we're going to have, after the staff that initial, that's a big pull, get all that information and move your applicants forward. Then when we do that, then we have the external reviewers come in and then finally the faculty reviewers. And I'll get to those, but you're probably asking yourself. I'm hoping you're asking yourself because I'm going to tell you about it. Is that what percentage are we dealing with? If you look at the initial screening and we've got 100% of the applicants that have shown up at a local status, then what percentage actually get to the external review and what percentage get to our faculty, we lose. Quite a few right off the bat. And what that means to us is that we don't have to do the full review of that applicant as they move through the process that we end up. If we have 1,500 applicants that come through to Nau, we're going to look at about the external reviewer is going to be a little over a third of them. And the external reviewer will do those. And then we'll have another point score and we'll see whether or not they go onto the faculty. And the faculty review gets about a little under one third of the total applicants. So again, that's that fluid process because we're looking, if we have 60 seats, we need to interview 180, 240 people to that. And we want to make sure that when we get to that, we have our highest quality, diverse, good life experience person that makes it to that place. The external review is actually doing some of the in depth reading for us, that personal statement. If anybody reads personal statements after a while, they all say the same. Now that AI is going to be a part of that process, we will be really confused. We do have courses on how to write a personal statement now so that you have better chance to get in. We don't really stand a chance when we read those to know if they're really truly real or not real. But we're going with it, We're in that personal essay, we're actually looking for their dedication to our mission. A lot of these people never read our mission statement that's on the website. And we're looking for that because we want to serve the people under serve people in the rural areas of Arizona. They also read their letters of recommendations and they go through those. And again, some of those can be just, they're fabulous, they're glorious. Then every once in a while there's that LOR that says, oh, by the way, I only recommend this person. I don't highly recommend this person. They're doing that. They document their findings. There are some points associated with the missions. The personal statement. They document it, but they make no decisions. They just do that process for us. And then it is then looked at. Then less than three then get onto the faculty for review as well. The faculty actually do the extensive review which is what we were doing for every applicant that came through. And it was just so time consuming since we do the internal process. They're going to look at what the reviewer said. They're going to look at what the transcript looks like. And we look at various things within that transcript. And we read with their academic difficulties. We look through that, we see how they recover. A lot of our students are first generation, their freshman year at one of the larger universities didn't go so well. We want to see how they did as they progress through their undergraduate process and then they come flying through. So you can see we, we don't pick the four point oder GP as otherwise I wouldn't be a pay. We're really looking at the whole individual. They also look at just the individual as the whole picture. Again, they fit in. Then that is the faculty that makes the decision. The faculty member makes the decision whether to interview the individual. Then we have this bucket. We're not quite done with them, and that is we're going to hold them or interview if we have space available. There's that little bit of wiggle room that we have that we've already got some people. If we have to interview more people, we're already set to rock and roll with that next interview day. Then we do have the do not interview group as well. We're not going to move them forward. Does it sound complicated? It isn't. I will tell you that we have a staff member that I can't do Excel. I don't know how to do Excel. Had a conversation with her just about a week and a half ago. She can do Excel better than I can now. She just, she says, I didn't realize it was that easy to do. It looks a little daunting, but they make it more intuitive, which is great. So what do we do on interview day? Well, we have two types, interviews. We have a group interview, and we have an individual interview. The group interview consists of usually two to four. Generally you try for three applicants with a faculty member and their goal in this interview process. And Dr. you actually hit some of the things that we were looking at and that has to do with how did they interact with each other. Do they show empathy, compassion? Do they have professionalism? Do they want to engage others? Do they want to work as a group? Good at teamwork? How well they communicate? Can they problem solve? They're given two or three questions to work through. It is oftentimes not just we don't really ask why do you want to be APA? We don't ask that question at this in the group interview. Why did you choose NAU? Because we know we're going to get a very canned response and they're going to tell us what we want to hear. We're looking at other things in that group interview. That group interviewer, the faculty member then scores each individual independently and writes comments behind it so that we can see those comments and that jogs the memory. If we don't do it immediately afterwards, then the individual interview, that is where the faculty member is in a position to ask those about those unique applicant items and concerns. So tell us a little bit more about this semester. Tell us a little bit about how you were able to recover and what did you do so that we get to learn them about them. The resilience, their grit, whatever you want to use as a term for that, we can ask him about the mission. Where do you think? I always asked the question, not so direct. I said, when you looked at Nyu, what was the one thing that stuck out to you for you? Why you wanted to apply to this program? They can't give you that can response back to you. You're always looking. And of course, I like to tell me more type statements so that they can do that. We're looking for their vision for their future, how they see themselves if they're going back to the rule community. And then we're also looking for their maturity as well. This is a little bit different, they're scoring, it comes together, the scores from the group and the individual are not added into the total score. What did they do at the other times? They're doing Open Link so they can communicate to the other applicants that day. On the virtual day, we also have the staff answering Q and A. We have the virtual building tour that the small groups do at the same time with the staff. The other thing is we do have an introductory introduction to the day we chose to video that because we wanted to give a consistent message to each group that comes to campus. If there's any special programs or offerings. We have the area health education scholarships and things that has its own video recording to send that message if they're interested in that. The one thing that was added this year is that at the end of the day, there is a group and AA panel group of faculty to answer. We try to get somebody from didactic, somebody from the clinical and anybody else that wants to come to answer questions. I've heard since I'm retired that that's been well received. I see one of the faculty members that is here and you can pick his brain about that too. The last part of that we do is the discussion of the interview we get together. Again, we hear from the group, we hear from the individual. All the faculty is involved in that process. They can ask questions. Most bring their own computers to go in and look at individual things if they wish to do it. We found that some of our faculty members, the Hone in on one thing or hone in on another thing that brings that ability to see those things the chair is looking at the whole picture might bring to the attention of the faculty a certain thing to remind them to take a look at that. We then review all the scores with the transcripts and ask any of the questions that we have left to do the faculty vote. The faculty vote is recorded for each individual. We keep that faculty vote and all the comments so that when we have our class and we start to create our weight list or alternate list, we've already done a lot of the work in the decision for that. And this is what our spreadsheet looks like now. No Ferpa. Okay, I took care of the Ferpa. And it just shows you that all that, if you just drag over what you want into that report guy, it will generate whatever you want underneath behind it. And you can see this is a spreadsheet about discussion on the deferred candidates. Remember, we could early admit or we could defer admit or we do not admit. This is on the defer. We're looking at the process of getting the alternate list made, and you can see that early. And if you look at the third applicant down. Montana, 40% of the faculty wanted to do an early admit on this, but 60% wanted to defer the deferred him. But then that gives us an opportunity though we had quite a few faculty that wanted this person to be admitted. Let's talk about that. Where do we want to place that person on the alternate list? Again, we have everything that's available to us. We haven't filled in the blanks. Well, there's a couple of columns that we do some math calculations for, but the rest of it is being pulled from the actual software and behind the application service. And I would be remiss if I didn't show you the mountain campus, and yes, there is that much snow, then most of you won't see the east facing view of this PBC building. But it's actually was designed to represent the Grand Canyon. I'm hoping you can use your imagination to see the Grand Canyon. Thank you very much. We're going to ask the two students to come on down, Amber and Jasmine and I will be joining us on the screen for the next 15 min. We've asked some of our students from the various programs to come and provide for us their perspective on much of what we have talked about today. We've got Jasmine from our PA program and Amber from occupational therapy, and Kofi from our School of Medicine. Thank you all for joining us. I know this can be a little intimidating, but thank you very much. I'll go ahead and am we have you start hot? My name is Amber. I'm a member of the Zuni tribe. I'm a second year OT student in the program. I'm born and raised in New Mexico. On my mom's side, I'm a member of the turkey lan. And on my dad's side, I'm a member. I'm a child of the corn, don't get scared, and I am a first generation student and I'll, I want to use this one because I've never used this before. I feel like one of those athletes after a game when they do like this is tell for me that's okay. Well, my name is Jasmine Nas Am. From Douglas, Arizona. I'm a second year P student from NU and I'm also the Vice president for class. Yeah, I was told to come here. I just want to say that I'm so glad I never saw Dr. Brubaker's presentation before I was accepted. Because what in the world was that? All this time I was thinking like the questions they were asking me were just like casual questions. Because that's how she interviewed me actually. She was my one on one Dr. Brubaker. And now I know that everything was just strategic. And I hope that she's the one that said, yeah, I vote for Jasmine because if not, I answer that all wrong. Yeah. And then I did my group with another friend, her name is Rebecca. She also made it to the program. Dr. Cope, want to share this? I'm sorry. It's off the track. Dr. Copeland did that interview and this was her question. If you know Dr. Copeland like you know, she said, okay. You have your mom who unfortunately has to get some spinal surgery done, and then you have the option of two surgeons. One and she used this word, I'm sorry, is an asshole, but is the best surgeon in the whole country? He's the best, but he treats patients poorly. He has a really bad bedside manner, but he's going to do a great job. Then you have another surgeon who is good. But he's not the greatest, but he's the best person. He's so nice and kind and has empathy. And this and that you to discuss and tell me what you decide. Who do you want to perform the surgery on your mom? And then she turns off the camera. And I knew like, she's still there. I know she's still there. Of course, she's still there. We both knew. And I was like, oh my God. We start talking And Rebecca decides to go for the nice surgeon and I go for the mean surgeon, and then she makes us like, go at it with each other. And I was like, then she goes, oh, Rebecca, so you don't care. It's okay if your mom does as long as she's treated nicely. I was like, oh my god. And then the whole time legitimate. And Rebecca, we're just being nice to each other like, no, it's okay. Like this and that. And we started texting each other afterwards and we were like, well, we just try again. Next cycle I guess we both thought that we weren't going to get in because we were just like going because like, I wonder if she thought we were arguing or if, like, I thought you were dumb or you thought I was mean. I wonder if she thinks I'm a mean person because I don't want my mom to be treated nicely anyway. Yeah, the whole interview process. I'm not going to share this with any Pa or prep a student ever. I won't. It's not going to help. Can you hear me? If you could introduce yourself and tell us a little bit about your experience with the admission process, if you don't mind. Yes, sir. My name is Kofi Jari. I am an MS. Two here currently at Texas Tech, you know, medical school in Lubbock. I went to Texas Tech for undergrad as well. So I'm quite familiar with the Lubbock area and all the programs you, Mr. Perez and Miss Galindo have been speaking on. I was born and raised in Aragon in West Africa. I moved here when I was 13, so getting to the jam program was a blessing for me and my family is already spoke about the advantages of the jam program. Mainly to get people in underserved populations, people who look like me, people who look like most of us here into medical schools so they can go after residency and come back to serve in these communities. But for me, Jam has been beneficial in a, in a hidden curriculum type of way. It's really giving me opportunities I don't think I would have had if I went through the traditional route, if I was able to go through the traditional route. And that's basically networking and meeting people who have already made who look like you, one of these people is actually a Dna admissions. I'm Dr. Morales. I met him in my sophomore year when I first got into jam. And as Lewis said, we do have two internships and luckily for me, and my first one was at Tech where I ended up going for medical school. I got to meet a lot of the deans. I got to meet Dean Dean Burke. I we had the anatomy course, I had to meet a lot of the same professors who made me again, luckily remembered me in my first year of medical school. So that was great because in anatomy is your first course, you're nervous by knowing people in there already. Making, having those connections, working with them, knowing what they know, that they know what you can do. I'm held to calm your nerves. And that's a hidden advantage I really didn't think about until I had to reflect back before getting ready to give this presentation. Apart from that, it's also opportunities like scholarship money. We've been getting scholarship money since my sophomore year of college. And even in medical school, we get, I think, a good, a substantial money every year to help us with our tuition. Because obviously, most of us, we have to take a load of loans, don't have the opportunity of paying for school from our parents pockets. That again, has been great for me and my family. Another thing is always talking about is just a network parking. I can say that Dr. Morales has helped me in many ways just to know him through the jam program. He's written me recommendation letters for an anesthesia program that you get to work with schools like Harvard and Stanford. And without the jam program, someone like me who have no access to those type of opportunities. That again, is something I'm very glad I got into this program. Another thing is the longitudinal tract. You get to know people who are coming up, who are going to be in the Gam program. You get to know people who I already been through the gym program, who have similar experiences to you. Who can say, hey, don't buy this resource. Use this resources instead, this is cheaper. Oh, don't buy this book because I have it for you. People who understand where you're coming from. And that has been, I think, one of the greatest blessings I could have received because I've saved so much money, saved so much headaches, Just from having people, peers that look like me, peers who have gone through the Gm program. You tell me these, all these little secrets that tremendously help my, my medical school career just moving forward, I would like to say, you know, obviously there's a great program and every program, there can be improvements. And for me, that one big improvement will be, as I was saying, helping to facilitate that relationship between, you know, kids in high school or kids in college and kids like us in medical school who are interested in medicine and who are in the Gam program. Because getting to know, luckily for me I was able to make good connections with people with am kids above me. But I don't know because a lot of the MS ones I don't really know, they don't really know me. And I feel like might be missing out on these opportunities to network things. Maybe having a program where we all get to meet each other, share resources and stuff like that. I feel like we'll benefit all of us more and benefit the program as a whole as well. I would just like to thank Dr. Trotter for giving me the opportunity to share my experiences, Dr. Bs, Miss Galindo, and Mr. Perez as well here in Lubbock. And I want to thank everybody for having me here. Appreciate it. Thank you so much. I do, in my mind. All right. So let's Kofi, thank you so much for sharing your experience to medical school. I'm curious to hear from Amber and Jasmine. What was your decision to come into occupational therapy and physician assistant studies? I always knew I wanted to do something in healthcare. But like I said, I'm from a very small town, you probably never heard of it. It's like 2 H away from Tucson, southeastern Arizona to border town. We didn't have guest speakers, we didn't have people telling us about different professions. It was like either you knew it or you didn't. So it was either like nurse or Dr. Right. I didn't hear about P as I didn't hear about P's or PTOT. I'd never heard any of that. So my mind was set on MD and like I was never like, fully convinced because I'm like, do I really want to commit that amount of years? Like I don't want to be a surgeon? Like that was never my goal. It's like okay. But like I was set like, that's what I'm doing. And then when I went to undergrad at UOA, after I had graduated from a community college because I had to, it was cheaper. One of my peers started talking about how she was going to apply to PA. And I was like, what is that? And then she talked to me and we became close and she did the whole thing and she had all her Pre Ix. And she had prepped and she had done her like GRE she had she had it all done, she was set. So after she graduated, she was already accepted and she went through and I was like, oh my God, like if that's what I want to do, that's perfect. That's exactly what I want to do. So fortunately for me, that was like early undergrad, so I just started working my way to get my Pre Ix and all of that stuff. And yeah, it was like it was kind of like a perfect fit later on than I thought. But yeah, that's how I decided to do PA. Thank you. Yeah, very similar to Jasmine. I grew up in a small town. No idea that there were all these other health profession that were available. Actually, like I went to school, graduated from Ov, and being a first generation student, entering from my home community where it's all indigenous people, and entering a predominantly white university was just a complete challenge during the admissions process. Talk like having that holistic process. My undergrad GPA was trash like. There was. I looked at different programs to get into. Once I graduated, I graduated and then I was working in social work, behavioral health for 12 years. That program got cut, and so then I wanted to go back to school, but I didn't know what I wanted to do. And so I started exploring athetic training, physical therapy, and occupational therapy. Came to NAU for a campus tour, and that's just walking into the OT lab, realizing all the things that I had done up until that point, My previous degrees, I also have a degree in care health in society, which is more of a sociological sociology degree. Ot fit perfectly for me. I had been doing some of the things that I had already been doing, and so I never thought that I would be have a doctorate at the end of my name. Like just my dad didn't graduate from high school. And being first I'm the oldest daughter, just being like a trailblazer, I guess has been a challenge. I've had to overcome so many different struggles throughout my journey. I love the talks earlier today about pathways because I feel like sometimes you just don't know what you want to do. I didn't figure out what I wanted to do until I hit 30. I'm 40. I now know what I want to do when I grow up. And it's nice to be able to find something that fits really well at wherever you are in life and meeting people where they're at. I looked at a lot of different programs once I knew that I wanted to go into OT and just those requirements of meeting the GPA and the competitiveness. And just all these different programs. I looked nationally and I picked AU because they had a holistic approach. They were the most diverse occupational therapy program across the country. I looked at pictures of OT schools in Nashville and I was like, I don't see myself in that. Having gone to a predominantly white institution before, and knowing how challenging it is to just fit in was something that was one of the reasons that I picked nu. I saw the things in my class, my cohort is I enjoy hearing a lot of different perspectives. I'm able to share perspectives from my point of view and it's a really safe, open space. And I also picked Nau because they have the Hersha Grant like Pfi talked about, with finances being a difficult thing, credit scores, Who knew that credit scores are going to have an impact on whether you're able to get approved for loans? And that's a challenge I, they'll face today and just all the other aspects of the NU program, the community engagement, the service learning. Having interprofessional experiences. All those things were just such good benefits. And I'm really appreciative of whoever I was. A conditional admit into the program and risk reward. Yeah, I've been really grateful and Na program has just been such a supportive. All the faculty have been supportive and encouraging. And each I continue to wake up every day and just be thankful for where I am and all the challenges that have put me to where they are and all the people that have helped me to get to where I am today. Well, thank you so much. Now I'm going to go ahead and invite the speakers to join us. Or Mary Lou, if you want to join us down here. And then we have you all stay your speakers. We'll have Kofi up there. Louise Monica, we will pin you now. It's an opportunity. We have about 15 min to do some Q and A from our audience. Really grateful that you brought up the issue of diversity because I'm sitting here thinking that one of the things that is, I'm thinking what's underpinning a lot of what we are all here to raise up is the need for a diverse healthcare workforce. For us at Texas Tech, I would say that rural background is part of that. We would consider somebody coming from rural west Texas to be part of our mission for how we value what they bring to a class. It is absolutely the case that I is under fire and we all really feel the need to be able to justify the decisions that we make and the programming we put into place that help us do a better job of I activities, whether it's at the admissions level or at the programming level, at the coursework level, whatever it is. I would love to hear your thoughts about that really to all of you guys, how you can help us build a really good argument for continuing to look at I issues at all levels of the training we do. That's definitely a challenge because then you're not only battling at individual levels, you're battling at structural levels. And how do you change structures? Right? And so funny enough, I am actually working on a structural awareness project for indigenous populations that grew from a health policy final paper. And it turned into a presentation at our state conference for occupational therapy. Now in a few weeks, we're doing a regional presentation. And I think that is one of the ways I'm trying is just to provide education specifically for me. It's indigenous population, puts that to identify with. But it's so that education piece about what marginalized populations have had to battle with throughout history. And how those historical contexts impact not just in the past but today's today. I mean the barriers that are some I mentioned earlier but all the social determinants upheld, those are all a result of historical impacts, like contexts based on things that have been set and now affect people's ability to have access to education. Have access. And how do you get access to education if you have all these barriers And how do you improve, educate or health outcomes? There was a study that was done recently, I can't remember. I think it was a gamma. But they found that there are better health outcomes for people who are served by people who look like them. And they also did a diversity workforce. And the numbers of the percentage of diversity within and across all fields is lacking. For Ot's, For indigenous populations it's 0.2% 0.2 and 80. I want to say 80% is white. There's an argument right there. And having people who serve their people, who understand all the nuances of all the different cultural contexts that are within each of all these communities. You're in a rural community. Metro, Even within metro systems, there are pockets where we have populations that don't have access to all these things. And it is a big challenge. And I think one of the ways could just be education, including that in curriculum, not just. All right. I won't even go into etiquette. So I think some of the pieces I, I've learned a lot more about even just indigenous historical context in undergrad. And so it's not as much of a policy battlefield there, but it just Yeah, my $0.02 Anybody else on line, Louis? Yeah. Kind of, you know, it's it's indefinitely under fire, for sure. You know, it's and it's interesting because there's so many different ways where we can find out what an individual brings to the table and how that could diversify a class of 180 students that we bring into medical school each year. Right? Dr. Brubaker talks about this. The holistic review process lends itself towards being able to locate, identify, and tease out these criteria attributes, these aspects of an individual's application that will tell us that they may be coming from a diverse background or that they have some diverse experiences under their belt. We can see all types of different things from an application process through the holistic review. And I think that's important to understand that there are many ways to be able to identify individuals who come from diverse backgrounds. To be quite honest, all of those many ways are just one of many factors that we use to identify, to select and to evaluate individuals during a selection process. I think that's really important to know that because we look for individuals that come from specific backgrounds. Rural areas, areas from West Texas. People who maybe have more higher propensity to go and serve in a rural area. Maybe perhaps because they're from that rural area. Right. It helps us that we're actually in that area. So I think that's important to understand. And I think it's also important to understand that sometimes one of the things that we've always tried to do, or maybe not tried to do, but just be aware of, is that we would like for the pool or the population that is applying to medicine to be reflective of maybe what the population looks like in the state. And part of that can also be done through the pipeline programs. Right? We've got to encourage more individuals from rural areas, from underserved areas to apply to medicine in order for us to actually get them as actual medical students. It's really a cyclical, a circular relationship that we're looking at here. But again, I think I just want to double down on the fact that there are many ways to be able to figure out whether somebody has a diverse background or at least diverse experiences. My question is about the EII work a lot in this space and I think one of the things that we often forget when we talk about anything J is the B. And the B is actually, in my opinion, the most important part as a person of color, myself. And that's belonging. And so many schools forget about. You admit and you recruit these people and then you don't know what to do with them and you don't support them. Although Nau has made many strides in this space, there's a lot of work to be done still, even in the indigenous space and even in the Latin space, which are more evident populations, but especially in the faculty space, where you're the only brown person in a small campus in downtown Phoenix, you don't always feel like you belong. And it's a tough road. My question is specifically for Kofi, because to give them context in PA school 30 years ago, I was sent from New Haven, Connecticut to one of the most rural parts of Kentucky to do a two month rotation where I did not feel safe. I did not feel wanted, I did not feel like I belonged. But I made it through and I survived. I was called all kinds of names by patients, not providers, think winess, but by all kinds of patients. And when I was here at NUI, remember, several of my black students that came to see me in my office were very worried for their safety in the rural parts of Arizona. Being from Texas myself, I know what the rural parts of Texas are like as well. And unfortunately, in the rural parts of almost any state to grow your own model doesn't work for people of color. Um, because people of color don't typically live in those areas. So it becomes a very difficult issue. It's a very uncomfortable conversation to have. I realize it's an uncomfortable question, but I wonder Kofi, how you have managed to have a sense of belonging and safety in an area like West Texas and in areas where sometimes you don't have a choice of going to certain places to study and to learn from people and to see patients. I know how I dealt with it myself personally. I know how my students, you know, helped them deal with that when they were here. But how have you managed to deal with that, if at all? Yes, sir. Thank you for that question. I came to Lubbock in 2017 and I quickly realize everything that you had said is really tough to find your niche. Where you feel comfortable Is really tough just to see you go through the day without having a type of like, you know, microaggression coming your way, or just bland racism coming your way. And for me, through undergrad and even in medical school, the way I deal with it is mainly finding people like having a community, with people who look like me, people who understand, people who I know you are going to be having uncomfortable conversations like we're having right now today. And people who I know actually believe what I say that's been through joining either S and MA maps, African student organizations where we have meetings. We talk about what's going on, we discuss it. Is there any way we can fix it? Do we have to bring it to the Deans? Do we have to bring it to upper, upper level people? For me, that's been a really charitable way for me to feel welcomed because T and TTHC, they have done a good job of providing you the foundation to have the foundation to find these people per se. That's been a big way for me to hear people's experiences, for me to tell my own experiences. I've made various friends through these programs where we lean on each other, we shoot ideas to each other. We're like someone can call me, a friend can call me and be like, hey, this is what happened. And then we talk it out. And it can be tough because everybody who is black, usually black, Hispanic, sometimes Asian. And we just have ourselves and it feels like sometimes we don't have people in people who are bigger positions, who look like as, as she said earlier, I feel like that would be easier because those people in those positions, they can better advocate for you. It does get tough with just having ourselves as my students or undergrads, just dealing with that. Definitely having people in bigger positions who look like us would definitely be beneficial. But to me, the main way I have really dealt with this is just having a community of people who look like me, people who are my age group. And just come out and speak from the heart. What's going on, Discussions about that, why not to shout too much? First of all, I want to thank the students for being here. And it takes a great deal of courage to stand up and share your voice and your experiences. We're just now getting to the point in the last, seems like five years where we have our faculty doing that. My peers have been sharing with me the difficulty it is really stand up and to feel so exposed, to be vulnerable like this. I really want to thank you for helping us understands that we can perhaps help more one or two things though I would like to just ask if you could actually think of what are one or two things. Getting more faculty that look like our students, who we would like to be our students, is certainly one piece. If there was one big thing that was really a barrier for you that you would really appreciate us addressing, I'd like for you to share that with us. I see. I guess it's not necessarily already in school, but before school, I feel like I kind of guided myself through the process of like what I needed to do and how I should apply and like when I should apply and stuff like that. And I know that probably isn't something that the school necessarily has to do. But if there's any like outreach programs or people that can go like coach you and talk to you about how to do these things, because nobody really shows you how to do them. And I looked for help in like my previous community college. I went to go talk to my advisor from there because I had a close relationship with her. And she kind of helped me with application. And she's like, this is what you should say or you should rephrase it this way and help me through the whole thing. She's the one that read my personal statement because there is a way of writing those. Yeah, she worked with, I had a coach in that sense, like she was coaching me in that sense. But I feel like a lot of people don't have that, especially where I'm from don't. If you don't look for it, it's not going to come find you. And I mean, I guess it's a good and a bad thing because in a way, like helps people, like like pushes them to go look for it. But there's a lot of there's so much potential. And I just talked about Douglas because that's where I'm from, that goes like Wasted away because they don't know where to go and they don't know what to do. So let's say Dr. Boeger, anybody like likes to talk and engage with people. It would just take one person, I promise you one person, to go talk to Douglas High School, just on it would motivate so many people. I legit wanted to be an architecture because there was a motivational speaker about architecture at the high school ones. And that's what I thought I was going to do when I was a sophomore in high school. I changed my mind really quickly. But I feel like if you go to other places that you don't usually go to, you would inspire so many people that already have that like intent of pursuing a career in healthcare or any career, really. And then like show them some guidance. You don't necessarily have to hold their hand the whole way, but like any sort of guidance would have been very helpful. I just turned 28 right now and I feel that if I had known everything that I know now, I probably would already be practicing at this point. I think. Yeah, I agree. I really like all the different pathway programs that they have going on at Texas, and I know that UA, University of Arizona has one I participated in one that really did help to get me to naudet for the admissions process And it was geared for medical school, but I was able to use that for OT school. But one of my personal biggest barriers was finances. I could only apply to one OT school between the OT cast system, The payments for their having to pay for each individual school for applications. Iii had one shot, and thankfully, I got in, but I think I found out after I had applied that there had been waivers. I think letting people know ahead of time that there are waivers available for people who are because my family, they're artists, my parents made money selling jewelry and because they're older and they can't, it's not a sustainable income. And that was one of my biggest challenges. And one ask that I have is just to let students know that it is out there are resources available. But sometimes not knowing where to go and having a pathway type program where all those resources are available be really helpful. Yeah, I'm just going to pick it back. What other students said, I think a big three barriers of having DI programs and having people of color come to institutions is one, obviously finance to making them feel that they belong. And three is having, being proactive and actually bringing other people who look like them, who have similar situations into these programs. Again, that goes with them being feeling belong, feeling feeling what's the word? Feeling careful basically. So for me, I think Luis, a big population, I think in East Lubb, where a lot of people in thinks a health magnet school in Estado where a lot of students are interested in medicine and interested in nursing and all these healthcare programs. But they genuinely do not believe they have not to drive per se, but they don't believe they actually have a pathway to getting into the into these programs. And I know Tech is doing a great job of going into these communities and setting up programs like basing these specific high schools. One of these programs is the Healthcare Collaborative, which I'm, I'm one of the students who started up, Dr. Cobbs, as well as one of our faculty members is going into these programs, into these schools and saying, hey, we're students and we're nursing students, OT students, BT students, and are you interested in this? And a lot of the times W'll be like yeah. But I don't know. I don't think I can do it. I don't even think I can get into college and stuff like that. And all these programs just start with there. Okay. What help do you need to get into college? Tt Help. Do you even have a computer? Do you have this and that? And just showing them that, hey, we're actually here, we care about you, we're here to help you get into these programs. I was in a similar situation. I've gone through it. So whatever help you need, we will be here for you. Acc the Healthcare Cooperative Program basically is going into these schools, helping them, teaching them how to take blood pressure, take temperature. Just getting them thinking like, hey, we're actually doing what healthcare professionals do if we can do. If we can actually learn from a day of doing these, like learn how to take bloo pressure, undertake temperature, learn what vital signs are, then why can't we keep that going and get into these graduate programs? I would think like programs like that, going specifically into high school, even middle school, and starting to get these kids thinking about going into these programs will also be beneficial. All right, well, thank you all so much. It's been a great group of presenters, so we greatly appreciate it. We're going to go ahead and break for lunch. There are box lunches set up in the cafeteria directly. If you walk out way and head to the back, we've got box lunches. And then we will go ahead and reconvene at 01:00 Thank you all. All right. We are going to go ahead and get started. Hopefully everybody had a nice little break. Got to stretch your legs. I have the privilege of introducing Dr. Regina Eddie with the School of Nursing at Northern Arizona University. She is going to talk about the Native journey to Academic Success program, also known as N. Jacks, promoting resilience among Native American students. Give me a hand or help me give her a hand. Welcoming her. Good afternoon. I just want to properly, first of all introduce myself. She, Regina, Eddie has the Tangle Clanking born of the towering House Clans. Grandfather of mini gots and then Tni, Bitter House Clan. Miss Russell introduce her clan. That's why we introduce clan. She's Ellie and I think even my daughter. I'm an assistant professor with nursing. I've been at NU Gosh for many years and I've been part of leading this program. What I'm going to talk about this native journey to Academic Success program. It's a college wide program within the College of Health and Human Services. And just hearing the conversation earlier, it's a very nice segue what was talked about earlier in terms of how do we support students. And then my presentation is a particular focus on our Native American students. We talked earlier growing our own. I think where I want to start for American Indian communities, tribal communities, why it's important, why we need to grow our own. Looking at health disparities in our tribal communities, we face many challenges. Health challenges, lower life expectancy, lower quality of life, greater incidence of chronic diseases. Why is that happening? Why are we dealing with these challenges? Um, among many issues that's been mentioned, historical background, historical issues. But a major issue barrier challenge that's going on in many of our communities is a shortage of healthcare providers. I came across some data in 2018 Indian Health Service, they estimated about a 25 to 30% vacancy rate across all health professions, and alarmingly, in more rural and remote communities. This could be as high as 50% Then I was looking, wanted to see what kind of data is out there in terms of healthcare, healthcare workforce for American Indian, Alaska natives across the US population in 20 2020 census, American Indian, Alaska Native population represents about 3% of the US population. Of the 3% This is what the numbers look like looking at dental hygienes, 0.5% of the dental hygienist workforce are American Indian, Alaska Natives, 0.5% nurses and then physicians, PA 0.4% and physical therapists 0.2% Again, just going off earlier, why we need to grow our own, We need more culturally diverse providers. That's very true in many of our tribal communities. That's a key strategy and how we can improve health equity by increasing the number of Native Americans to the healthcare professions. There are many benefits to that. Native American graduates are more likely to return. And work in their communities. Stay in the communities with these providers as well. They're more familiar with the culture, maybe even speak the language, know the health beliefs are in a better position to be an advocate, provide quality care for what our native people need by reducing, by increasing Native American health care professionals. That's going to help address the workforce shortages that we're struggling facing in many of these rural and tribal communities. Again, through this, by, by training, providing, educating more culturally diverse providers, then we can begin to address health disparities in our community. This is the background. I think just really underscores the importance of this program that I'm going to talk about. Native journey to academic success. Because the whole emphasis is to not only support our Native American students, but how can we grow the number of Native American students coming into health professions? Here is the mission statement for our college. But I just want to highlight the last part of a statement that we strive to improve the health and well being of diverse communities we serve. This very much aligns with the work that we're doing with this program. As I mentioned, it's a college wide program with the different programs athletic training, communication sciences, disorder, dental hygiene, health sciences, nursing, occupational therapy, physical therapy, and physician assistant studies. This program basically works and targets with these students. But what I wanted to mention first too, I think as we admit students coming into health programs, I think it's also important to be cognizant and recognize what they're coming with. Who are these students that are coming to college campuses? They come, they start the college environment with many challenges. A lot of it being maybe limited academic preparation support. A lot of this could be the quality of schools that they're coming from. If you've got schools in rural, remote communities, fewer resources, underfunded schools, what's that going to look like for our students in that aspect? They face challenges coming to our campuses. They're less likely to have a family member that has attended college. A little bit about what was talked about earlier, being able to have a family member, a resource, someone to help you navigate. This is how you do this, this is how you apply for this, This is what could be available. So many of our students, they don't have that background, they don't have such resources as well. Again, financial barriers being another challenge for our students. Food insecurity and then just coming to campus. Many of these students, they leave family far from home. They're leaving a family home. The cultural support and they're entering a completely foreign environment. Something that they're a minority. Literally, this is what our students, I want to mention a little bit about that native journey to academic success. This program was established in 2008, 2009 within our college. And it is a foundation grant supported by John and Sophie Ottens Foundation. At the time that this program was established, a faculty academy was appointed. Basically a representative from each of the faculty or each of the health profession programs. We had a representative to serve as a faculty mentor. The goal of this program, promoting to promote resilience and retention of Native American profession students. The focusing on three main areas, starting with academic support, cultural support. Social support. In terms of the academic support, one of the things that we do, we meet monthly and faculty mentors, they reach out the goal or the concept with this is being a faculty mentor, reaching out to students, begin to create that sense of belonging for students. Having an important point of contact while they're here. Peer tutoring, This is a part of the program where there's funds that are available to support a peer tutor as we meet as faculty. If there are certain, maybe challenges issues, we do check ins. Are there certain needs that may be a faculty is seen with his or her as a group? This is also another resource that could be available to our Native American students. Also under academic support, we have support to fund student travel. Maybe, for example, if students submitted a poster, had a poster accepted, doing a conference presentation, put in presentation. This is also another form of support that we provide. This is all done through. We have a system in place applications, and we as a committee review these applications. And we continually, month to month, we'll address such requests from students, cultural support again, and this is significant for a lot of our students. Creating an environment that's comfortable, that's familiar, being far from home. We usually start our academic here, launch it off with a welcome back event. And at this welcome back event, we invite a cultural speaker and even a traditional healer. Part of this whole gathering is to begin with prayer. A traditional prayer, a traditional song is offered. And gosh, I'm trying to remember like a couple of years, our last event that we had, we had a traditional practitioner that we brought from an HS facility. So he came in, did a blessing, and talked with the students, just encouraging them. And a lot of this too, storytelling in the form of storytelling, the importance of that, all of that is integrated, it's incorporated as part of this event. Then another aspect of our program, and there have been a couple of occasions where we have supported traditional ceremonial support. I've had students, maybe 11 on one meeting with students, understanding what are some of their challenges. I think that I will say it's, it makes a huge difference a Native American student to come to me as a Native American faculty and to be able to share what is really going on. I've had students that have come to me expressed and explaining their challenges and what they need. And some of this being traditional ceremonial help, which in some cases it requires money. We also have part of this funds. We're able to provide some support to that and even referrals to where they can maybe connect with the healer. At our institution, we have tribal elders, our Native American cultural center even making those referrals there too. Social support, gas, food vouchers. These are provided to students in times of hardship, financial hardship, childcare, and then referrals to campus, off campus resources. Whether this is an HS facility, different resources on campus. Another aspect of our program, in Jags, we talked about how we support our students, but we also need to attract, bring in more students. Um, so this initiative, middle and high school pipeline initiative, we're actually getting ready to bring this program back. Since Covid, we're bringing a school from the Navajo reservation to campus on March 3. Here again, all the college programs will be participating in this. This has been really helpful to having partnerships with schools across tribal communities, even within the local community. They're in Flagstaff Unified School District. Through this event, we're bringing students to campus. It's a six hour event to meet with faculty, different programs, hands on activities. I have some pictures I'll show you here. Then we have a mentor intruding program that we have established. There's a local residential dormitory that's in Flagstaff for high school students. We have our students that go to the study halls because a role models role models is important for youth like to expose our native youth to role models, seeing somebody older than them that they're in school. These are photos from our dream catchers event. This is APA session. Students are doing a su suture kit event here. This photo here, they're in our nursing simulation lab. This boy here is listening to heart sounds here then this is PTPTPTs Activity and Athletic Training. They're showing students how to do like wrapping, athletic wrapping. I believe that slide, that's a little bit about what we do native journey to academic success. Thank you. Thank you. Next step, we've got Dr. Lauren Cobbs. Dr. Cobbs is Associate Professor in the Department of Medical Education at TSC. She's also the Associate Dean for Student Affairs, and she'll be talking to us about supporting students through the academic journey. Okay, I think I've muted myself. Yes, we can hear you. Yeah. Okay, let me recheck. Is my title screen or title slide up. We're looking to try to get it up on the screen. Okay. Well, no worries. While that is in progress, I'll nonetheless start with, again, it is my distinct privilege to be able to be talking or speaking at this conference on such an important topic, which is how do we support learners who come from our smaller or rural communities? And I actually further appreciate my particular position in the program in that we've talked about the big initiatives that are coming through to bring increase our workforce for rural communities, smaller communities. How do we get them into our health professions, educational schools and programs? And then the next step, of course, is what Dr. Eddie and I are talking about, which is how do we support these learners towards success while they're in the programs, and then launch them into future careers? That is my task. And you can actually go ahead and share your screen now, if you Okay. Great. I think I had the opportunity to share my screen again. Yes, Your Honor. Okay. How's that? We can see it. Perfect. Thank you. Wonderful. Yeah. Yeah. Okay. So, as I mentioned, this is my opportunity to talk a little bit about how we support learners from smaller communities or small communities. Specifically at Texas Tech School of Medicine. And many of the themes that you heard Dr. Eddie reference are going to be themes that I'm going to talk about. Because health professions learners who come from small communities honestly doesn't matter if it's medicine, nursing, occupational therapy, physical therapy, et cetera, et cetera. Are health professions learners have similar types of, um, I say, challenges and needs need for support. But that being said, when I'm talking specifically about our learners at the School of Medicine that come from the smaller communities, I'm specifically referencing a heck defined West Texas communities. And those are going to be those areas in the red and orange you see there representing the Panhandle, South Plains, Big Bin and alpine areas. And then I went a little bit further because I wanted to really focus when we're talking about small communities in this context, I actually tried to find a definitive definition of what represented a small community. It turns out it depends on who you ask. If you ask the Texas Legislature, they come up with one number. If you ask the Texas Workforce Commission, they come up with a different number. Since this is my presentation, I came up with the number of a small community being defined by a population of less than 1,000 to up to about 20,000 Luckily, the Texas Association of Counties agreed with me with the map that they put out representing small communities and the vast density of small communities in Texas are defined by this Texas region here. Going on to specifically talk about the learners we have at the School of Medicine during our particular admissions process. And Mr. Perez touched on this through the TM, Dsas process for admissions. Students are able to self identify as being part of a West Texas community. They can just self declare that there is some vetting that's done by our Office of Admissions to verify that their association with the West Texas community is not necessarily having driven through Picos or Alpine, or sweetwater, but they actually have some type of meaningful connection. I say that to say that when we look at the number of learners we have in our School of Medicine who meet that definition of coming from a West Texas community, currently in our seated classes, that's from year one through year four, class of 2023, the graduating class of 2023 through the graduating class of 2026. About 50% of our current students self identifies being from a West Texas community. And I'll go further to say how many is that. We have 180 students per class, so that's a denominator about 720. Then an additional 15% of our current students also are considered to be first generation and higher education. That gives you a little bit of context about the type of learner that we are supporting in our degree program. Dr. Eddie touched on some of these topics related to what are the challenges that learners from small communities may face. I do want to be clear that what you see here is not intended to be a comprehensive or exhaustive list of challenges, but to be somewhat representative of the types of challenges that learners from the smaller rural communities might need to navigate academically and financially. It was also mentioned that there may be some issues or concerns with limited academic preparation or what might be basic science leveling needs. Again, referencing if a student has come from their secondary education high school and or their undergraduate or pre medical requirements have been completed in a smaller educational environment. That may lead to some or contribute to having some issues with the rigor, the depth or the volume of basic science content they come to us with. To be clear, they have obviously met our requirements for getting into medical school. That's not what I'm talking about at all. However, nonetheless, in getting their feet under them once they enter our curriculum, they may just have a slightly higher hill climb to level off with others who may be in the class in the area of the basic sciences. Financial considerations of the students in the panel touched on what the challenges may be just to get through the admissions process. Once some of our learners get here, there is a subpopulation that we noted occasionally are using their educational aid funds to not only support their own living expenses, but are also using some of those funds to support family back home, or their needs. The living needs of not only the student, but their family. We have had situations where students have made choices around paying their own rent or utility bills, or helping to do that for their families back home. Then there's a whole host of social, cultural, and familial beliefs and expectations that may create, I would say, challenges or areas to navigate for some of our learners. And they span from things like depending on their place or space within their family. There may be some either self imposed or from the family expectations to be a caretaker or have some type of caretaker role for those who are back home, even though they may be trying to complete their degree program, separated by 100 or hundreds of miles and traveling back and forth to assist with that and other stressors that can be associated with being a caretaker, while also trying to complete a health professions degree. Specifically in our case, a medical degree. Dr. Eddie absolutely touched on the issues that are related to the loss of environmental structures that have been contributing to that students either. Personal well being and or academic success previously, whether it's family, friends, faith community. That whole combination, if they're separated from that, that can create a great deal of challenge for their well being and success once they come to us. Then there's what I call the dysfunctional perseverance issues that can come up, where we have some students who are actively reluctant to ask for help at all. Or until they are experiencing fairly significant academic and, or emotional distress. When I say dysfunctional perseverance, what I'm referring to is a belief system that's hopefully just perceived and they truly believe it. But that they need to take care of their own problems that they need to keep and, or keep their personal issues or challenges private. And not necessarily share them with anyone outside of themselves and, or their family. Then I've had some students, one particular student that was in a very significant serious situation who when they ended up getting the help they needed, we started to explore why was it or how was it that they chose not to come forward. Up until that point, they actually shared that the reason was because you don't bother important people, important people with your problems. That was such a distressing thing to hear because for any number of reasons, whether it's a belief that you have to take care of your own problems or that you need to keep personal challenges or issues private, None of that is necessarily true, and it certainly can hamper a student's ability to be as successful as possible. If we're just able to mitigate those types of belief systems. Then the last one, which is true of all learners regardless of their background, at least for medical students, I'm not sure if this is for all health professions learners, but certainly for medical students, is the belief that you can't show weakness to perhaps yourself, your peers, and or those that are in your school of Medicine. And asking for help in any way, shape or form is just admitting to or demonstrating weakness in any number of ways that are not actually true. Then the last challenge, our area that students from smaller communities may face, may be in the career development realm. And that tends to focus around, not exclusively, but to some extent, our first generation learners in higher education. And that is along the lines of they don't know what they don't know. It's hard sometimes to advocate for themselves, to effectively reach out or ask for or sue career development opportunities. And it's really incumbent that we do a lot in our career development space, leveling and informing. Because just that category of learner, first generation in particular, does not necessarily have any idea or as strong an idea of what things they could be, should be doing in order to optimize their career development. If that's painting the picture or the table around what the challenges are. Let's speak more positively about where the support systems are and resources to help guide our students to successfully move forward. At least from how we look at it. At our School of Medicine, the vision and the philosophy that we try to follow is creating one of an institutional home for our students while they're completing their medical degree. I define or craft the idea of what an institutional home is around a couple of different areas and they start with a home, provide structure for our students. These are the things you need to do in order to earn your medical degree guidance. This is how you can do those things in order to get your medical degree. There's a lot of support and advocacy. Here's help and encouragement towards earning your degree. But home also has a fourth component, and that is one that we also alert our students to. That is one of accountability. One of our roles is to inform and make sure that our students understand and are aware that there are consequences that can be associated with not doing the things that you're supposed to do as a member of the School of Medicine community. The idea being is that as long as you know where the guardrails are around successfully getting your medical degree, there shouldn't be any issues in your success. I wanted to just step aside for a second because there was a really great question during the student panel that I wanted to acknowledge, particularly around the concept of at least student affairs at the School of Medicine being an institutional home. It was the question around how safe spaces are created for our students, particularly students of color. I greatly appreciate the response that Kofi offered. But I wanted to additionally respond from my seat at the table to say that at least within student affairs, we certainly cannot prevent or protect our students from experiencing society's ills, if you will. But what we certainly are responsible for doing is providing support structures and access to persons and mechanisms that can help our students address any type of concerns they have of whatever type. I think even more broadly, beyond what we do in student affairs in the School of Medicine as an HC, broadly or generally, and as a School of Medicine specifically is additionally a responsibility, very much so, to set and consistently model the behaviors that are expected as a member of a core community. Our core community behaviors, at least ATHSC, are defined by what's called a values based culture, has five pillars that include one, team, concept being kind hearted, acting with integrity, being visionary, and performing beyond service, or with beyond service mindset. I just wanted to really acknowledge that that question came up because it was such an important one. Moving back to our supports and resources and how we're here for you. This message of being an institutional home and having very much institutional support and encouragement is introduced very openly and consistently during our incoming student orientation. And then regularly reinforced during pretty much any and all encounters that we have with our students. Be it at the group level, through class meetings, in town halls, and through our individual one on one student encounters. Whenever we're just working with students, we try to be as open and approachable as possible, which is another component of what we do. We call it an open door policy. Amongst all of our student affairs team members, we have an eight member team that's based in Lubbock to help support about 520 students. Dr. Jones mentioned that we have a distributed clinical campus model across four campuses. Students, once they enter our clinical curriculum, a certain sub portion go to various campuses which also have student affairs personnel. But the vast majority of our students are Lubbock based. We have eight member team to support those students. And all have a variety of different personalities which are intended to help support accessibility, approachability for what I call all student personality types. Which really begs the question of which family member, as we say, do you want or need to talk to in order to address your concern, problem or just want to chat with Hang with, whatever. Whatever their tag line around all of this is really there's always love, coffee and snacks in the office of Student Affairs. That's a tag line we use to try to convey this aspect of accessibility and approachability. Okay, we do have a variety of proactive support and engagement programs that we utilize throughout our degree program. And they include each academic year, three years one through three students have an expected at least 11 on one. Well being check in conversation with a student affairs team member. You see that in year one, our Director of Student Affairs, whose training includes being a licensed professional counselor, she meets and talks to students, each of the year one students. Our wonderful Dr. Trotter, who's the Assistant Dean for Student Affairs and has his Phd in Clinical psychology. He meets with all of our year two students and then our Lubbock based year three students as well. Then in year three when they transition to the clinical curriculum. Because again, students are distributed across a variety of regional campuses. There are student affairs member on each campus that does a check in with our students. What do our check ins include? They do include a conversation on exploring any potential challenges, as well as supports that they may need for their own personal academic well being. And then we do purposeful intentional screening around just if there are any possible food, housing, or financial insecurities. And if there are providing some resources or access pointing to resources to help address what that concern or insecurity may be. We then subsequently follow up with our students in a targeted and or ongoing basis based on a variety of different ways that it may come to us if we know that they need to check in, but also all of our faculty. And even again, the idea from peer to peer, our students know hey, this is something that someone in student affairs ought to know about a faculty or peer referral that hey, can you check in on. So, and so then of course, if we recognize our own monitoring essentially regarding students, academic or behavioral performance concerns, we will check in with them far as other resources that we have for students, specifically role. That we've talked about academically. We do have a peer assistant learning program that is a free service for our students. We do pay our tutors as well through the office of student affairs, so they are part time employees through our office, but the service itself is free. Or students, and that's including one on one peer tutoring sessions, either by the students request or they're directed to participate in the power program. If they're identified as being academically at risk. Then for all of our students, our tutors hold a virtual and in person office hours to allow students, regardless of their academic performance, to do a little bit better if they want to. And those are biweekly, two hour sessions. As far as financial insecurity, the supports that we have, Thc has a helping hands food pantry that's available. And you see the philosophy behind the food pantry and access. It's to ensure that no one in the HSC community will have any issues with access to nutritious food. And any member herself or others, can request what's called a kindness kit. And then through our Office of Financial Aid, students who are on aid, and even if you're not actually on aid, if you come to a situation financially that you need a short term or emergency loan, you can apply for such through the Office of Financial Aid. As far as emotional and mental health supports, the Health Science Center does have what's known as a program of assistance for students. All of our HSC students, we have five schools within our health science, the School of Medicine being one of them. But all HSC students have access to eight free visits with a counselor associated with the program of assistance each fiscal year. It's not an academic year, it's defined by fiscal years that goes through September through August. Then several years ago, the HSC also introduced a program made available to students called Therapy Assistance on Line. See there that is a self directed or self guided web based program that has modules that students can go through to address common well being concerns such as stress leave, difficulty, social anxiety, depression and conflict. Those modules are always available and as they state, the idea being to allow students to get effective treatment when needed, when it's convenient to their schedule, so to speak. Then as far as career development opportunities, we do what's called just in time longitudinal career advising. Throughout all four years of our degree program really focused around in the pre clinical space, encouraging our students to explore understanding themselves, their values, their interests. And then mapping those aspects of themselves onto specialty exploration and fit, a best fit for a specialty. Then as they move into the clinical curriculum, we talk about how do you then apply for and get a job. With regard to getting a job, we are very specific that we have three tiers of goals with regard to getting a job. For our graduates, the goal level is get a graduate a job in the specialty they want at the institution they most want to train. If you've done that, you've won all the things. Yeah, not always possible and we're realistic to say that we also have secondary and tertiary goals. Silver is get you a job in the specialty you want, depending on what that specialty is and your performance in our curriculum. Sometimes we also say, hey, let's just make sure we protect your ability to get a job. Our career advising component covers all of those things. And then I'll finish up talking about our mentorship opportunities. And I want to be clear, what you see here are going to be our structured or more formal access to mentorship opportunities. Informal access to mentorship is always available to students, but through the school itself. We have for research mentorship, the medical students summer research program. That is a funded program that students are paid typically the summer between their year one and year two in the degree program, to work with a faculty mentor in a research project. We also have the Texas Tech Apprenticeship Program. That's a clinical mentorship program where a student compare themselves with a clinical faculty member to explore a longitudinal preceptorship relationship with the faculty member over about eight to ten month timeframe. There are a variety of rural community clinical experience selectives that are available for our students to participate in through all years of the degree program. And we also assign students to specific mentors once they transition to the clinical curriculum. So they're able to get guidance based on the specialty that they think they want to go to. And talk about what life as a practicing clinician in that field may be and how likely they are to be a competitive applicant in that specialty, et cetera, et cetera. The Fmt program has been mentioned several times at this conference already, and that is the program that I'm going to transition to, talk about how we return, at least with regard to family medicine, our graduates to practice in small communities. Referencing outcomes for the Fmt program. I am aware that Dr. Anger may talk in far more detail about this. But we do have a high percentage of our students in the FMF program who come from West Texas communities. Since the first graduating class, which was 2014, we have had 83 graduates. And of those 83, 49 have already finished their residency training. And 63% of those 49 are currently practicing in a rural or medically underserved area. 55% of the 49 are also specifically practicing in a West Texas community. I greatly appreciate Dr. Jones for sharing those statistics with me. We additionally have a very specific rural health track residencies associated with our HSC residency programs in family medicine in the Permian Basin. We send trainees to communities in Alpine, Fort Stockton, Sweetwater, and Picos. Those communities span a population of about 6,000 12,000 We also have a rural health track surgery program that is based at TTHSC. And those in the rural health surgical residency spend additional time training in areas that will allow them to do surgical practice outside of what would be traditionally considered part of surgical training. Thank you for listening. And this is a picture that I'm very proud to say that actually Kofi may be in there. Because this is a picture of our class of 2025 who are about to transition out of the pre clinical curriculum to the clinical curriculum. Thank you so much for your time. Thank you Dr. Cobbs. We greatly appreciate that insight and not a problem. All right, well we are moving into the next presentation called supporting students and clinical supervisors during rural health rotation. So hopefully we gave you a little glimpse into how to support students during the didactic portion of the curriculum, although that could be used during the clinical piece as well. Now we have Dr. Gina Bobbin and Dr. Zach Sneed to talk about how do we support the students when they're out on clinical rotations, and also the clinical supervisors who are working with them. So we are going to All right. Good afternoon everybody. I am Dr. Gina Bob, and I work here on this lovely campus for the occupational therapy department. I'm the Academic Fieldwork Coordinator. That term is new for you. I'm responsible for managing all five clinical rotations that our students are assigned to throughout their 30 during their 33 months on campus. I feel like I have the front end and the back end of service to our department where I'm big on recruitment and also admissions. And then I support our students when they when they're away from campus doing their clinical rotations and alumni support as well. And did you want to introduce yourself, Dr. Snead? Yes. Thank you. Can you hear me okay? Yeah. Okay. Perfect. My name is Zach Sneed. I'm the Program Director for Addiction Counseling in the School of Health Professions at TTUHSC. Also Assistant Dean for Outcomes and Assessment. And I'm really excited, one, to be invited to share with you all today. But two, this has been such a great day. There's such good information that's been shared so far, I feel like I already lost my train of thought. Dr. Ban All right, so the topics that we're going to cover today are rural health components and priorities. And how we fit that into education. Designing education to fit rural health placements in state versus out of state placements. How do we support students during rural health clinical placements And how do we support clinical supervisors? And then Dr. Seed, did you want to cover this slide? We took turns putting this presentation together. So we're just going to go back and forth. Yeah, absolutely. While we were getting ready for this, we were talking about the things that students talk about whenever they're considering rural health placements or sometimes they don't know that they're considering rural health placements. They instead are talking about wanting to go home and serve and do clinical work in their home communities, or near their home communities. I think that's really interesting. That's actually one of the things that we look for, at least for my program in terms of students and applications. But we came across this and a lot of you've probably seen this from the Rural Healthy People 2020 report that came out a few years ago. What we really saw whenever we were looking at this slide and this data is that this fits with the main thing that people are looking for, whether it be the population, it'd be students, it'd be the clinical supervisor, it's access to quality health services. And then if you follow across the slide from left to right, you'll notice that the descending histogram, but different categories of services. These are all major categories right now that affect Great deal of a variety of health professions. There are so many ways for medicine, nursing, occupational therapy, physical therapy, counseling to be involved in a lot of these facets. What I saw and the reason I wanted to include it was that a lot of time whenever we're thinking about rural health, we're thinking about possibly integrative care or the need for integrative or inter professional care. And that there's a space, time and space for a lot of different service providers. It's just really interesting to me that we still haven't been able to quite figure this out yet, but feel like we're getting closer. All right. Recruitment and admissions has been covered today. But something that I do want to highlight is when you do your open houses, your high school presentations, undergraduate graduate, career fairs, how do you highlight rural education in your curriculum? As mentioned earlier today, we are opening a hybrid program that's supposed to launch in fall 2023. And we are projecting that the student profile will be people from rural areas and who are primarily caretakers. But how do we know when we market ourselves, that the students are going to find us a good fit for their career goals as well. When you're giving open house presentations, you highlight how you address rural health curriculum. I know we do a broad general like here's the matrix of what we do. But I always point out certain highlights of what's different with our program versus other programs. Because we understand that students are going to be out there researching different schools, what sets us apart. We're always happy they choose OT, but why do they want to choose us? And are we a good match for each other? Another thing that we do, because our Department is very mission based on serving the needs of Arizona residents in the workforce. We have a map of our clinical rotations during our slide shows and I will talk about how, um, clinical rotations are assigned with our students. Because once again, we find that's different for every school has a different way of how the students are assigned. We're transparent with that information because we know a lot of the knowledge that real life knowledge is going to be gained during clinical rotations. So how do you market that when you are recruiting? And then we've talked about diversity with faculty, but also diversity with faculty experiences as well. Do you have faculty who has worked in rural areas? When I meet with all our clinical sites, I can gather information. What's the population they work with. Setting it is in what are your hours. But me personally, I don't have that experience. But if you have faculty on your team who has that rural health experience, that's going to be a great connection for your students who are interested in rural health. Then we talked about this earlier as well, but regular admissions versus holistic admissions. I think we were the conversation circled around holistic admissions. We do that in our department as well. Dr. Seed I know mentioned that they do that in their department too, But also just to see the whole picture of the candidates that are applying to your program and knowing that it isn't always GPA based, that's going to be indicative of success. Dr. Bu and I would just before you move on on that slide, I would just highlight that I think that there's a couple of ways to look at the recruitment piece. One, faculty recruitment absolutely. But one of the things that I like to play into that because I think it has a long term effect on outcomes for the students, is whenever you are recruiting faculty and you're looking at, at their backgrounds or experiences, the things that they want to do. I think it's really beneficial if we can find people that have a diversity of experiences or direct experience in rural health. For us for example, our service area is 130,000 sq mi. And so in counseling and behavioral health, that's very different than the majority of say, PHD educators who probably trained at a university in a big city. And trying to imagine what they're going to do and how they're going to do it. My point is that it's a great thing to include. It's also, for some people, a real draw. You can start to match potential faculty members up with your program and think, oh, this is how this is going to transform and how it's going to connect with the students. It's just such a neat idea. As I did mention with the admissions thing, one part of our mission, at least within the counseling programs, is that we are training people to work in the communities where they live. We recognize that 130,000 Mi is a really big space and not every community can support a counselor. So we've taken to the idea with recruitment admissions, also talking about what the future of counseling and behavioral health looks like and how that crosswalks into some of the technology, some of the tools, how that cross walks into rural health. And then at the same time, you have to walk it back whenever you start to problem solve together. All right, so now they've applied to your program. They've got accepted. And then what do we do when they're in the classroom as well? A couple of things that Dr. Seed and I both said that we addressed in our curriculum, connecting students to rural health mentors. Like I said, I don't have that experience. But now that we have more alumni out there, I've been working with alumni who do work in rural health. And if a student has interest in rural health, I will connect them to this mentor. I find a lot of people in rural health are so into advocating and wanting Ots to work in their areas. Connecting students to mentors. Whether this is your fieldwork educator or clinical supervisor at a site, our alumni is something that we do. Another thing too, is that for our program, traditionally like we are in an urban area, most of our students want to stay in practice in urban areas. However, I feel like we are growing in students who are from rural areas and want to go back to rural areas. I feel like our mission is getting out there and people are choosing Na U and our program because they know that we are very Arizona focused and not just the urban areas, but statewide. That's exciting, but for those students who come here and all they know is an urban area and you're not exposed to other areas, you don't know what's out there. Incorporating workforce profile information into your courses, I do that into our competency courses. They're aware of what is the need for Ots in urban areas versus rural areas throughout our state and in comparison through the nation, which I think this helps plant the seed for students to, oh, okay, there's a higher need for rural areas. I may be more open to doing a rotation in the rural area now for our students, they have to go out of the area at least once or twice. I repeat this several times throughout the year, but when it becomes closer to reality and that they're doing the rotation, it's like, oh my gosh, I'm going to go out there. But planting those seeds early on, that this is the information, this is what the job market could look like for you, may help serve some of that excitement as well. Did you want to talk about population doctors need? Yeah, Yeah. I think the next two points on the slide are interconnected and they relate to differences with regard to what people have available to them. And oftentimes students, I find that they come to us and they either completely understand this or they just have no concept of it. Americans think that all of us have the same or similar access to a variety of health care. Or that it's maybe easy to go and just go and get it. But I think we have to include as we talk about the workforce profile, healthcare literacy or health literacy. What it means to understand, say, blood sugar or the number of drinks in a week. What might be healthy or what's a good sleeping pattern? How much physical activity is helpful or harmful to an individual? Lifting patterns, some of that information is more rare. I think you build it into the curriculum. Whenever you come to cultural aspects or cultural determinants of health, that way students have this opportunity to go, wait a minute, we're trying to grow their perception of cultural determinants and understanding and applying cultural skill sets and go, oh, this is a really different thing and I always use the distance, the geography example. How many people in this part of the state that we live in, it might be 60 mi between towns. I'm sometimes shorter, but I often hear from people, oh, I live 100 mi away, I can't take off and drive to an appointment, I can't go 100 mi. I don't have that much gas money. I also don't have that much time. Whenever you put all those things together and you presented as like a case study for students, they go, oh, 100 mi both ways, plus the time for the visit. That's what is a half day off of work. Now you've knocked out that much salary for a family, and how are they supposed to make ends meet? It puts it in a different light and it helps them understand, wow, we have to do better at bringing care to where people are rather than moving them to that urban setting or that big place where things are collected. It's just interesting and even still, I'm just surprised that students are so surprised by. Yes. Then into your classes, can you pull in guest speakers? I've pulled in guest speakers from rural health. Just to paint the picture of what it's like to be a therapist there that you have limited resources, that it can take longer for you to get durable medical equipment as well. Indian Health Services. We had our first presentation this last semester and it was a great opportunity for students to learn not only about rural areas, but how it is very important to be a generalist. I think sometimes students struggle like I'm team pediatrics. I just want to focus on pediatric content. But when you're in rural health, you have to be a generalist and know a lot of skills. Be resourceful with what you have in the tools that are available to you. Another thing, too, that I wanted to mention is just telehealth as well. How do you educate your students on how to complete telehealth? That could be another issue because sometimes in rural areas you may not have the best access to Internet services. But that's another way of incorporating telehealth and how do you meet rural health needs and then rural health populations. How do you incorporate cultural competence training into your courses as well? We have cultural competence embedded through AJ that's embedded throughout courses from the first semester. We're starting to get some data when they come back from capstone week, just doing focus groups what's valuable Now that you've done your clinical rotations and your capstone experience, what do you need to know so we can start incorporating that feedback and applying it to the curriculum as well. Because it's very, I think for some students who like Dr. Seed said, where you just don't have that perspective. It can be not just a lot of applying of like your clinical knowledge, but learning what populations I'm serving in this rural area. Do you want to add anything to that? Well, I think you said it really well. For the counseling programs, we implement a very similar concept, multicultural or cultural aspects, in almost every single course. And it's typically a required component of some major assignment along the way for that coursework, because we want people to be thinking about who they're going to serve and how they're going to make those services patient centric. And it's rather than me doing only what I know, how do I make what I know usable to that family or that person that they're serving. So yeah, I completely agree this is something that's different between Dr. Steven. I like I said earlier, we're very focused on the needs of our state. Dr. Seen did you talk about Yeah. Find your clinical placement? Yeah. I only focus on Arizona, but all around Arizona, not just this area, Northern Arizona. Southern Arizona. And I always feel like it's a little bit of winning the lottery. When we get a new site, it's tricky. We're a Texas University. We designed our curriculum to meet the Texas Licensure Board guidelines and things like that. But our program is distance based. It actually allows for students who are out of state to come into the program. And the program requires them to do their clinical placements in an area near where they live. So we actually do encounter this sum probably about 20% of the time where our students are out of state. What it does is it creates this sort of, it's almost like a feedback loop. Like every single year I have to monitor all 50 licensure boards across the United States for any updates changes. I need to know where if I had a student in a specific state, if they were to be eligible for licensure or if they were to do clinical training there, what special guidelines would we have to follow? So it's tough, that's not an easy thing to monitor. 50 licensure boards, I don't know if that's a thing anyone else has to do, but it's like a rough four weeks that it takes me to read all of those regulations and analyze it. The thing about it is at the university level, they like distance based students. And they like out of save students as well. There's a push and pull to take more students to grow, to open up new opportunities. And at the same time, working with people very far away is even more difficult than working closer to home. So I would say if this is an area that anyone's looking at or if you're thinking about making an online program, I program, think about the state lines because oftentimes those rules change with just a couple miles of difference. So I can really change the way that your contracting process goes for clinical placement. It can change the way your outcome measures go quite a bit. And I've even seen it, it's so complex that we had to rewrite entire degree plans for people. So it can be a tough thing along with placements too. Like I said, during open houses and day one and orientation, we go over field work. I'm very transparent on our process that I'm the one that's out there. Recruiting sites, our students are not allowed to do it. However, if the student's curious, if we have a contract, or if you've ever sent students to this site, I'm very open to meet with them, because that could be a new possibility. So I'm just going to put Amber on the spot light again. But she's going to be completing a level two rotation which is 12 weeks in her caption project, which is 14 weeks at IHS Zuni. That was her goal. We've never sent a student there. But being open to that process, that this is her goal, she wants to go back and serve her community. We worked on this, granted, that's in New Mexico, but they still serve residents of Arizona as well. Just being transparent about that process, that you are open to hearing stories. Because if I wasn't open, Amber may have not felt comfortable sharing her story with me and her dream with me of what her career goals are. This is just something I'm playing around with, but I mean, we focus on Arizona, but we need to have maybe a certain percentage of rotations outside of the state because we have two more programs, OTD programs on the recruiting faculty. One just put in an application process. There's a lot of competition within our area as well as anybody in this clinical coordinator role. You're always trying to think of creative ideas on how do we get more placements with the growth that's out there. And then in terms of changes in applicants base, what did you want to say about that doctors need? Well, there oftentimes people will apply to a program based on knowledge that they have, maybe about that profession. But there's always a geographic lens around it. And so for us directly gets what that profession can do inside that state. And they often have preconceived notions about what they might be able to do or they'll have some kind of difference in their background or training. Sometimes it's a great thing because it lends a new sense of diversity to the program or a different perspective. But sometimes it also presents a wrinkle where someone goes, oh, I want to be able to do such and such well in their state. And I'll just use, in Florida, for example, if I had a person from Florida, they have multiple certification boards and licensure boards that use some really similar terminology. So it's really easy for a member of the public who doesn't really study those things and clearly know what's going on to get them confused, and then to think about what's the pathway to get to the top one. Well, you actually have to go through a couple of those boards to get to the top one. And a Master's degree doesn't get you to the top one. It gets you through the first one. Sometimes having those conversations with applicants or potential students. They're really important conversations. It's really important that from the program perspective, you're speaking honestly. You're right. You don't want to mislead anyone. You don't want to harm their dreams the same time, I don't have a lot of contact with it. It's hard for me to be really authoritative on this subject matter. Sometimes it can be really beneficial and sometimes it's just really tough. It's like 50 different versions, 50 ways it can go. And then I think you cover different licensing and standards. But in terms of contracting and planning, more often than not, when I trying to get contracts with rural areas where we don't have a current contract in place, I find that takes a little bit longer to do. I think the one for IHS Zuni took about a year to do so. Just keep in mind that sometimes you're going to have to be flexible with your time line as well if you're getting a new site. I think a lot of people in the clinical coordinator role, sometimes you have to start really early, especially to get your student in there. And every school has a different procedure on how they recruit sites for clinical rotations to. Some schools may do it two years in advance. Some may do it the year in advance when you're competing with other schools. I think it's just always good to start early and be consistent with your communication as well. Then in terms of planning, what I've found too is that sometimes in rural health and more specifically to OTI, may have a contact. Um, and they may commit to taking a student, but then maybe three months down the road, they no longer work there. And I don't always get that notification, I just get a returned email. So what I'm saying, be consistent with communication. If I'm consistently communicating, reminding them like yes, you're taking a student at this time, that can hopefully prevent a student finding out two weeks beforehand that they no longer have someone to take them at their site when they've already booked housing as well, which can be really hard to find in rural areas too. Is there anything else you'd like to add before I go to the next slide? No. Do a great job there. Student considerations. That planning word as well, Again, logistics, housing, travel, broadband access for us in the OT program, students are responsible for all the extra fees. Unfortunately, right now, we don't have extra support to give them if they're going outside of Maricopa and rural areas. I am working on that though. I've submitted for grant, so we'll see logistics in terms of planning. Does the student have enough time between finals week and the start of their rotation to make travel arrangements and their place, maybe in this area and then travel to wherever they're going next. For our students, they do 112 week rotation, have a week break, and then they go into another 12 week rotation. Do they have that same convenience of cleaning up their place and traveling to a new site or back home to their area as well? Housing, that's always something too, I think, especially nowadays, if you're renting anywhere, just like with the housing market, everything has gone up as well. I think what's also risky is what does that policy look like and that contract look like? If a student's rotation cancels, can that student also cancel their housing contract as well and not be locked into that travel as well? We don't have to well, I shouldn't say, most of us in Arizona don't deal with time zones, so we don't have to worry about what does this mean, traveling if I'm meeting here at this time versus Arizona time. But broadband access as well In rural areas, you may have limited access to internet. If a students have assignments during their rotations and they can't access the Internet, how are they going to complete those considering alternative method. The other thing too is this preparation work life balance. For us, we don't get compensation for our rotations, but occupational balance for our students who in rural areas, they've come from this community that they've built on campus. And then they go out there to a rural area where maybe sometimes they do have family because they want to go back to the area. Or maybe sometimes they're brand new to the town as well. How can you support that student who doesn't know anybody? Something that I've found that students have done organically as people in certain regions of Northern Arizona. They've planned to meet at this weekend. They preplanned before the rotation starts. We're going to meet this weekend and have a social hour. The other thing on the academic side is you can have a during week three, there's going to be an in person or zoom option for just all of us to get together where you can share your wins during your clinical rotations. Maybe you have questions, but just a time for you to interact with your other peers because I feel like when they're ready to leave campus, they're sick of everybody and want to leave. And then they're out there like, oh, I miss everybody giving them that opportunity. For us, it's a 12 week rotation. Week three, giving this zoom in person opportunity for everybody just to connect and it's optional. And then week nine as well. And then week six, we have mid term visits. I go and I travel all around Arizona and I meet our students in person. Over the past few years though, it has switched to zoom. Just because of what we've learned with the pandemic. It's always up to the site if it's zoom or in person. But it's another way for me to check and make sure that the educator feels supported, feel supported, and that you're not alone. Like even though you're out there in clinical practice, you are still a part of us. We're thinking of you, we want to support you. What do you need, what does midterm look like as well? And then you want to take away client demographics. Dr. Sneed. Yeah. And I think you're doing a great job with this. But one of the things that I think we have to prepare our students for is that oftentimes they come to us. And it was mentioned earlier, I think you said Agena, we have to be a generalist. Oftentimes, in rural settings, my students often come to me and they have like a specific population they want to work with or a specific problem, or a topic that they want to address. And they may not always be realistic whenever they're in a rural setting, it's probably there, but just not in enough volume for that to be the focal point of their whole experience. I think we have to meter their expectations a little bit. Okay, Think I saw we have 5 min left. I got the sign. I'll scoot onto the clinical supervisor. But one thing, something for us that we find with OT is that there are some sites that provide free housing. But we don't have priorities given to medical students, which is great. But that's also something that we struggle with too because they could say, well, we can cover the student for ten weeks of the rotation, but there's two more weeks of rotation as well. Then like I said, just funding, supporting ideas, Trying to work on grant and. Grants to support students who are going to rural areas to help them with the funding of it. Because we know that's a big concern for students as well, the cost of education. All right. So clinical supervisor considerations. Did you want to start off with this one, Dr. Steve? Yeah, and I think this is one of the things that we see it pretty frequently is that clinical supervisors or preceptors, they're sometimes interested, sometimes nervous, but they have a way that they conduct business in their site. While we want our students to merge into that and observe that and learn that, there are also things from the faculty perspective where we need them to do certain functions and probably do it the way that we need it done. Maybe that's record keeping or you mentioned midterm evaluations and things like that. I think those are best done whenever we walk in and we start with clear expectations. One of the ways that we've done that is we've built a variety of training resources. This is in later down the slide, but a library if you will, for our supervisors to access things. We also find sometimes that the supervisors may be new and don't have the skill set fully developed. Or maybe they're ready but they haven't done it a lot. So maybe there's something about supervision that they're uncomfortable with were trying to build like miniature lessons or modules that they can access or we can direct them to if there's a need that we identified and we make that freely available to them and I think that's really beneficial. Thanks. Then I'll point out some other few things before we have to wrap up, but we also both of our departments, offer free continuing education opportunities. This is actually our former chair, Dr. Rogers, started, but lumberjacks give back. It's something that's free. It's available online, but each course is three PDU. But it's an opportunity for our educators to receive education. We've had topics on how to be a fieldwork educator, how to transition into academia. We've had ones about a review of anatomy as well. All the topics are varied. That's something that our department puts on then. I think just the key piece is like establishing relationship and having strong communication as well with your site so they know that you're going to support them too. Whatever happens during fieldwork, there's a win. Or maybe there's a student concern that they can reach out to you and you're available to them. Because committing to take a student is a big commitment. When things are going well, it's going well. When it's not going well, it's everybody needs support, the student and the educator. Anything else you want to add to that, Dr. State? I think we have like 1 min left. No, I think we got it all there. It's great. All right. See the five minute warning row? All right. Yeah. We'll be available for questions during the panel. Thank you for your time on. Okay. I'd like to invite the students back down again, I want to thank you all for coming up. I know again that it takes a lot of bravery to come up and talk about your experiences, but we've been talking about institutional supports. And I'm wondering if any three of you would be all willing to share what supports for your relative programs and institutions have you used what has been helpful, what's been lacking? Let's see, a hick is one for me, for us, so I'm part of chick and they help with housing like economically when it's like rotation size. I've only used them once, but I know a lot of my peers have used them for all of their rotations because they happen to be away rotation. So basically you do the research and you look for B and B's or hotels, whatever it is, You tell them the price pay for it upfront, which is a little hard, but then they reimburse you 100% That has been very helpful for myself and other students who I think Ah helps students who are not necessarily a Hick scholars as well. If I may be wrong, but I'm pretty sure they do help them. That's thing that is helpful financially. And also they have a lot of resources and stuff like that. And then us, I think this is more like didactic. We have a lot of like imposter syndrome presentations which were very helpful to myself. And I feel like they time them well because they know at what point in like test wise we're at. And they know when to do it. Because somehow they always did it. At a point when I was like, I do like I can't And then you hear Dr. V like at the front. Like believing yourself type thing. So that was really helpful. It seems silly because you know, but hearing it from somebody else is nice sometimes. And then we have Zach Baker, I believe it is his name. He's like a learning specialist here, so I used them twice during didactic or guy never visited him again. But he was super, super helpful. So that was very nice for me. I know other people in my class used him as well. But even then, like if you didn't want to do on one on one, we had like meetings that you could sign up for and just go if you wanted to. So that was really helpful. Yeah, I really like that. I feel like my program is really good about having a lot of resources, whether we use them or not. It's like, because we don't have a lot of time, it's like I'm struggling with this class, do I want to go talk to somebody about it or should I just stay here and study thing? I don't know. It's time management on our side that's hard, but the resources are there in that sense. I think awesome. I'd love to say that imposter syndrome goes away, and sometimes even we struggle. Great. It's better. I wrote my whole list because it's almost like the Academy Awards for like, thank you. So I didn't want to leave anybody out. Zach is definitely on my list. I struggled with anatomy and neuro, going back into a graduate program where you're learning how to study again. For someone, that school was easy, never had to really study before, and you just get by in classes without having to actually put and work to study. It was hard. Zach was really helpful. Has a really insightful tips then. He would always just send these emails right before exams to check in how you were doing, and send these really encouraging and positive, supportive, just check ins and you don't know that you need it, but when you get it, it's just such a nice boost to keep you going in the program. And that's also one of the big things that I've really appreciated about my program. As the faculty, they're so supportive. We do have a program advisor that we are paired with throughout the entire duration of the program, which I feel is really nice. Because then you get to meet your advisor, you meet with them, you're required to meet with them once a semester. But then it doesn't feel like a requirement. It's checking in. And they're not just checking in on you academically, but personally, whatever you're comfortable sharing with that first year. My first year was just so hard and I honestly would not have made it through without Zach, without my advisor, Dr. Bachman, just all the instructors, like the anatomy instructors because I struggled. Dr. Ivy, Dr. Tide Bond, they were just there. Dr. Tide Bond will meet with me on the weekends to provide tutoring. And then I got Covid and so I had to she was willing to meet with me during the semester was over. I had to stay in school a week longer. And she met with me every day to make sure that I would pass my anatomy class because I almost had to remediate. And it was just a struggle. But having the faculty support and just getting to know each of our faculty like they're mentors, they're encouraged. Like they're just so supportive in so many different ways. And anytime as we're going through these, Dr. Bachman, my advice, she, she has the saying of like shoving aside of the nest and doing it in a way where you still have so much support. And knowing that I can go to any of our faculty and ask for questions about how do we tackle this thing, what do you think about this? It's always nice to have that. Another part of that, again with anatomy, was the cadaver lab, being an indigenous person who traditional cultural beliefs are just the complete opposite of the medical model. Having Dr. Rogers, who came to me that very first day during orientation, and being open and sharing my concerns with her, and knowing that was a safe space, and knowing that they would work with me to get to figure out a way to get me through the program. That was something that was really helpful. And then injects the native journey to academic success program which was talked about earlier. They've helped pay for registration fees for the state conference and regional conferences that I've been accepted to. They provide food and gas cards, which I'm actually using next weekend to go attend a ceremony that hasn't happened in a really long time. That's just another way that I've felt supported. And then the Herschel Grant, that scholarship has helped. A lleve a lot of the financial burden for tuition, and that's been really helpful lots. And then like you mentioned, like the very first, like during orientation week, I was just overwhelmed with how many resources are available. There's so much like this is just a tiny smidgen of the resources that are available. But it's sometimes it's a matter of like making the time and then figuring out where to go to find the resources that are most appropriate for something awesome. Thank you. Covid, do you have any thoughts? Yes, sir, I do. Actually, that was a perfect way to end it because the amount of resources you get with these programs actually is very overwhelming. I remember during orientation, Dr. Jones was like, you know, we have so many resources, it might be overwhelming. Just pick and choose. You don't have to use all of them because it does tend to just derail your progress sometimes, Especially with not just institutionalized resources, but resources such as, you know, let's say first aid for medical students, you know, boards and beyond and sketchy that type of resources as well, they provided for us, you know, even if they don't provide, I think for us we didn't have board and beyond. But we told them like, hey, it's a good resource people use is really expensive if there's any way the school can provide it. And it took that into consideration. I think they are considering giving it to the cluster below us. Stuff like that type of support has been really appreciated by all of us. Also, the Dean's office, the School of admission, the admissions office, the student affairs office is also being amazing support to me personally. Um, there are programs, you know, a couple of Michelle and I wanted to start and we just, we just email student affirms or you email the dean's office, or you email you Mr. Perez at the school of admissions. And they're going to put you in contact with those deans and they're going to hear you out. And most of the time they will help you initiate these programs you're thinking about. Also, we have mental support. As Dr. Cobbs has said earlier, students do meet with Dr. Trotter or Dr. Perrin once a semester, once a year. I think you can even set up appointments to talk to them. Anything that's on your mind, I know. I've definitely use those resources. They'll set you up at the counseling center. With being in healthcare professionals, there's a lot of stress, there's a lot of anxiety. Things go on outside outside of your school life that you have to talk to people about. All these resources are free. I think actually at School of Medicine we do get eight free counseling sessions, and that's basically once a month. And if you do the math, you're basically having free counseling sessions for the year, and which is crazy, you don't have to pay for that. Those have also been helpful, You know, let's say something goes wrong, you fall into some bad, you know, some bad trouble. You get called to a counsel and all of that, you know, they are still there. They're not going to shut your way because you did something wrong. They will still call you up, It's like, hey, we're going to work you through. This is how can, you know, you can talk to the counsel, this is how you can go away, try to get your case taken care of. Even stuff like that. They're still there to help, you know, they're not just not institution that, I'll just leave it to your own. Basically once you get in, they try to make sure whatever that comes your way, they stick with you and you get through it. So that's also been really appreciated by all of us. What else was it? I also have a list of names that I have, but I've pretty much covered everything. It's like a family here. They're always here to support. So that has been really a big plus for me going through the School of Medicine, ITHC. Thank you very much and I'm wondering, I thank you very much for talking about the things that you have found helpful. I'm curious and always a little hesitant to ask this. What are some things that additional things that you would find helpful that maybe your programs aren't providing? I think for me it is because we are a satellite campus and the main campus isn't Flagstaff. Don't have access to a lot of the things that happen on campus. I know there's a lot of indigenous events and a lot of different like graduate school socials and all these things that happen on campus during the pandemic. It was great because they would provide zoom links. But that's one thing that I feel is lacking is just that engagement with other students outside of our cohort is it would be nice to engage with other students in other programs. We do have interprofessional. Just not school related, something fun, something. And that's not something that we have a lot of, just being that we are based in Phoenix and the main campus is in flags. I honestly can't think of anything. Same here. It's really tough to, I think it's you get such a broad opportunities at the school that it's really hard to narrow down something the school should improve on. But I would agree that as School of Medicine school, Professional Health, School of Family School, School of Pharmacy and all of that are in the same institution. I think both schools honestly having some interactions with them outside of professional meetings and talking about drugs and how that relates between doctors and pharmacists, But actually just getting them together and just trying to meet each other and make friends and other programs will be honestly helpful. I didn't think about that. Thank you. Thank you for that suggestion. A. Great. I'd like to take the opportunity to invite our speakers back up for AQ and A, and we'll get our speakers back here up on the screen. Back to that previous question. I know you have mentioned it too. I think one of the big challenges is we do get grants to help with the different things, but we have to provide the money upfront and then reimbursement takes a while. I feel like that I don't know how to address it, but it would be nice because sometimes we just don't have that money. We'll go ahead and open up for questions. I want to also join with you on that. I want to ask the institution about that reimbursement for students, because I did hear from directors, from some of the institutions saying that takes up to six months to reimburse students for their travel. And yes, we're working with, we're supporting students that have financial barriers. Right. What can the institutions do to speed up that process? That's a good question. I feel like I'm looking at Dine because I feel like that's above by pay grade. I can offer a little insight because that was a barrier we had with students. How do we get this stipend to them? And they didn't get it until after they graduated, right? But we got it to them, great. But the one thing that we figured is, well, we can't do this. This is not fair to the student, right? We're just creating another barrier for them. We're actually going to create a financial intermediary working with Vitals Foundation so that stipend can get to them right away a lot quicker than, I don't know how many months post. But that's what we did as an agency. We're a state agency, so there's all these barriers that we've created. But we found a way where we've created a financial intermediary that we're going to go through for this specific stipend. That's what we did as an institution, that's our example. Thank you for sharing. We have undergone a lot of change over the last few years. And working with service teams, that's definitely been an evaluation because that is a problem for anybody getting reimbursed from the university. Just recently, I've been on a work group that the goal is to get students reimbursed within a month and making them a priority over faculty and staff. Not saying that that's necessarily the best approach, but definitely prioritizing students. One thing that I've been advocating for is how can we pay for this upfront? So that way we don't necessarily have to go the reimbursement route. We've done that, I think with N Jax trying to do it upfront so that way the students don't have to have that reimbursement. Definitely a work in progress all the way to the leadership president Cruz Rivera knows that it's an issue, something that is being prioritized for sure. Thanks Oak Ley for mentioning that about the service teams. I was here when those were implemented and yeah, they were challenging and I bet they still are. But I went from an institution that had problems with service teams to an institution that is all service teams all the time, support tickets for everything, and can't get anybody on the phone to ever answer. One of the solutions that has worked out from an institutional standpoint for this particular issue on reimbursements. Although I don't have students yet, I do have staff and faculty who need reimbursements quickly. They can take up to six months. The P card has been the saving grace in that situation. Having an expense card that we can use to pay things up front, hotels and meals and whatever else, we have a travel and entertainment card too, so that one also helps with food and whatnot, that word. And you speak food, but nonetheless, it does work. Just maybe one solution institutionally for those here that those expense cards can work. Good afternoon. I have a question for the students. I do live in a rural area and Flagstaff, and I know that there are cultural differences, whether it be ethnically or sociologically or geographically. There are cultural differences for the students. I'm wondering, have you found it built into your curriculum that cultural Are addressed while you're doing your rotations or any part of that, where the cultural differences in practice are officially recognized by your teachers and it's also put into practice while you're doing field work. Yes, we actually have an ethics class we call ethics class, but they talk about a lot of different things that are not necessarily medical related. Like we're not learning anatomy or a specific disease or anything like that. We talk about a lot of different things. Dr. Plan gives the class, we talk about the LGBT community, like how to address them. African Americans like the different things that they challenge. Like dram, for example. You see a lot of pictures in Dram. Most of them are pictures of white skin rashes don't look the same in black skin, stuff like that. How to talk to people who are very religious or people who are not religious at all. How to not bring those things up different ages too. It changes the way that you approach somebody depending on their age, where they're from, and knowing there, I mean, you only have a certain amount of time to talk to people when you're a primary care provider. But having an understanding of where your patient comes from and what they can and can't afford, you can't be recommending intermittent fasting to somebody who doesn't have the money to do these kinds of things. Or like you can't be recommending a whole food diet to somebody that probably has the money, but what if they don't have somewhere to go shop for these things? I feel like my program did a really good job of talking to us about all of these different. And it's so much more than I can say right now, but I think they did a really good job. I was telling people that I had lunch with today. I'm currently rotating at Gastar Family Medicine here in Glendale. It's a Middle Eastern clinic. Patients don't speak English. I didn't even know there was a thing here. It's only Middle Eastern patients. That's it. Some younger people speak English, but most of them don't at all. The medical assistants, the doctors, there's only two physicians who speak English and one of them is APA, who graduated from AUA few years ago. So that's how I'm thinking they got the site. But yeah, like an EU is not afraid to send you places like I am Hispanic, so I usually get sent to places where I know I'm the translator. Right. Like I know what they're saying. They're not afraid to send you to places like this. And I've learned a lot about the culture. And I have a friend who's from Syria who's also in my class. So I really like them. And yes. So to answer your question, I would say yes, from my program 100% Then for the OT program, we do talk about a variety of different factors such as social determinants about and they're throughout the duration of the program. But we have our librarian Katherine Lock Miller, who, I mean, she's just amazing. She covers a lot of these topics that aren't addressed in regular curriculum, I guess in undergrad. But I feel it's like the concept of cultural competency. Can someone be 100% culturally competent? No, but we have a lot of opportunities to talk about different factors that affect a lot of different people across a lot of different sectors and different intersections come into play. And Katherine Lochmiller is really great about talking about those types of things. Bringing in case scenarios, bringing in questions, bringing up opportunities for us to expand and put ourselves in these scenarios that maybe we hadn't thought about before. And I do think that there are, it's something that's talked about and discussed. But again, can you be 100% competent in somebody else's culture now, having the opportunities to go out and do rotations in Roa health. I know one of my cohort members, she is from Michigan. She went to Shoal and she came back and she is now just like advocating for Ots to be in rural health. And I think that's a really great way to go about it, and our program does provide those opportunities. Yeah, I would agree as well. Straight from the jump here at T Statist School of Medicine, we are put into four different campuses. And we have the opportunity of students have the opportunity of rotating a premium basin down in Midland, Odessa, and to the north and Amarillo outside of Lubbock. These populations have a more rural populations, they have Migrant populations, I have enough need to go to other rural towns to work with these populations. We learn to be more competent. Learning to check out biases is a grep tiny that tech gives us straight up. And to get into medical school, we also have AP three program patients populations and I think physicians or patients. Physicians and population course headed by Dr. Betsy Jones as well. This curriculum is just basically curriculum outside our lectures and stuff like that. Basically whatever we don't learn in those lectures as I said previously, being more competent in dealing with different populations, learning about how, how the lack of equity has propagated these populations. Just to have the background and as I said earlier, check out biases as well. Tech has definitely done a great job in providing us with education to better serve these different populations. Katherine Lochmiller, she sets up this yearly event too. It's called the Living Library, And she brings in a lot of people from a lot of different intersections. I think last year I attended a mom who had to advocate for her child who was autistic. And a couple, there's just layers on layers of all these intersectionality pieces. And that's one of the most memorable experiences I've had to date at NAU. And I think it would be nice to have something like that across all health professions. Because then it gives you, like, straight from the horse's mouth, someone's experience. And it really helps you take a step back and think about like your own biases and your own thoughts and your own presumptions about how you might go about doing something. Yeah. Living library was amazing. All right. We've got a question on line. Becca, you're up. Thank you. Hi, my question is for Dr. Bob and Dr. Seen about the preceptor recruitment and retention. Dr. Bob, you mentioned the lumberjacks gives back program. Can you talk a little bit more about what that does provide for clinical preceptors? Yeah. Okay. Yes. Yes. So, it's currently happening right now, but during the beginning of the year, we offer three courses that are free. And it allows, there's pre work that any attendee will do. They attend the course as well, for each course. And like I said, they vary in topics. Our first one was how to be a clinical supervisor, how to get into academia. And then they get three PD Us for each course that they attend, and it's free. The topics are varied every semester. Right now we have one upcoming next week on anti that bias. We have one on health literacy as well, their faculty generated. And just based off like the needs of what we hear our community partners need, we market it to our clinical partners and we market it to therapists or a state organization as well. And then like I said, all of them are on line and sometimes they're presented by faculty, fully. Are faculty and a student too. That's wonderful. Dr. Sneed, what does your school do for preceptor recruitment and retention? It's it's a very similar process to what Dr. to how Dr. Boban described it. So we try to identify sites, try to meet with preceptors, talk about the benefits of working with us and supervising one of our students. And then we have these courses that we've designed. And it's sort of twofold, right? Like, you know how to be a good supervisor. Going to benefit us, it's going to benefit our students, it's also going to benefit that supervisor. But the idea is that we can generate use based on whichever credentialing board that preceptor has affiliation with. We can individualize the report for them and for that board. That way they see it. They're not only getting some help at work, they're getting a chance to take on a new role, teaching and supervision. It's good for their community, but it's also good for their career. We try to design it, essentially the preceptor role as a win for everybody. And then Becca Oakley Rogers, myself, and then our capstone coordinator, we published an article on it. And then I can always send you to just some of what our marketing material looks like and how we did that Right. As well. I can send that your way. Yeah, that'd be wonderful. Thank you. Welcome. My question is for the faculty in the rural space, the LC model has become really popular in the longitudinal integrated curriculum type of situation. The NUK program partners with the Ua in Pace in eastern Arizona to get that done. But that's just one place that's interested in that, I find it. Really difficult to find preceptors and sites that are interested in students staying a little longer for long term, 12, 20 weeks or more, and see multiple types of patients, et cetera. What experience does a faculty have here? Getting some buy in from preceptors and sites to say, yes, we'll take your student besides grants, because I know that grants do help When you have money to give people, they'll take it and they'll take your student as well. But when you don't have money, any experience with the LC model and how to get from trainers out there. You're familiar with this too. But our mission, I think a lot of times the therapists out there, they see the need. What's been my biggest by is knowing the students that want to return to their home place and finding them a clinical rotation and what's our mission? And then stating that the student has a high interest in returning to work there. And that's where I feel like the biggest buy into. Because then they're like, oh, this could be recruitment for us, that's just more of the natural opportunity that I found to get them there. But in terms of another creative piece, I still struggle in terms of how do we get that buy in when, especially sometimes it's like what's the benefit for me if there's not the monetary gain to Yeah, I agree with that, that statement and characterization. I think one of the things that sort of supports all of this, and it was mentioned a couple of times earlier, is that we have to establish a relationship that's supportive with the clinical supervisors and the preceptors. I've had interactions with them before where I believe they thought I was trying to like pawn a student onto them and, you know, it didn't go well. And then I've had interactions where it took a long time trying to work with the same site and over time was able to establish a relationship. And then it became very easy and that person was like, yeah, I'm excited for this but sometimes, depending on how long the student is intending to be there, that may not match up as you're describing. It may not match up with the supervisor, how they conceive things. And that can be a fluctuation. I don't know, maybe a number of semesters or where the student is in their program. How many hours a week they're, they're fully able to commit. And I'm thinking of some students who had families and children and lots of responsibilities, but they were trying to do everything at the same time. I think a lot of it falls back on the, the relational aspect and just being able to have an open and honest conversation with the supervisor about how this will help them, how it'll help their community, but also how it's going to benefit the student. And they know that we're not. We need them to understand that we're not just sticking a student there and seeing them as an outlet for training. But they're not a free training outlet. But they're actually part of the system and part of the bigger mission. Hi, I just want to respond to your question as well. Since we're actually launching the LC program for MD students in May 1, of the structural logistical supports that we put into our planning was that using the block rotation schedule. But pulling out the students for the longitudinal experiences from their block schedule. So it makes it not so much different or it's not the mother hen approach, right? Are providing the preceptors in each specialty, but then pulling them out to follow their case studies or patients so they have two schedules. Okay. So that is how we approached it. We're really excited to launch it in May. All right. Send a Europe. Very good. I just, I'm currently teaching with the College of Nursing at the Ohio State University and have a great opportunity to work with a lot of interprofessionals. I'd really like to compliment each and every one of the programs and the presenters today because what we have seen in working in our rural communities is just overwhelming stress in our students. And what you have described and what you're providing for your students, regardless of your programs, seemed to be very supportive in hearing the three students speak about the resources of support. I just would like to compliment each of the programs. I know our focus has really been on wellness for students, faculty, and staff since the pandemic. That has been a huge stressor on top of other elements of normal programming. But I'd just like to say, I heard that in the elements of your presentations and the comments. And I'd just like to applaud all of your programs because I think it's very, very important. And thank you. The work that you're doing. One quick question. I don't know if it's so quick, and this is maybe for Regina and Lauren. We've heard from the student panel, as well as so many speakers including yourselves, about how important building that sense of community really is. And so many of your programs are built to do that. Can you talk about any ways that maybe you're using peer mentors throughout from students that are further on in their didactic year or maybe students in their clinical years. Are you doing anything with that? And I know Regina with some of the undergrads, with some of the social events. I don't know if either of you could talk to some of those success stories or strategies. I don't know. Is Dr. Eddie going to speak? I don't know if I should go first or second. Yeah, I can go first. Sorry. Yeah, I have a couple of stories. I think a big part of a message to the programming through in Jack is giving forward when we have students, we're supporting students, whether it's through vouchers or sending, sending them to a conference. We always want to emphasize to them, giving forward, given back. We've invited even graduates to have come back when we've hosted events, luncheon events. I remember several years back we had a American. He was APT student who's now working in Flagstaff at the Urban Clinic there. And he came back and talk with the students and just shared his story, his experience, what it was like. And just really sending the message that it can be done. Then even currently for our nursing students, for example, our American Indian program students will arrange for junior senior students, fourth, fifth semester students that are getting close to graduation. We invite them to speak to our first, second semester students again, to share their story, what worked for them. Because for this particular program we have students, they're on the reservation. They're doing a lot of traveling. How did they do that? How did they survive with all the commute? Sharing such stories like that with some of the new students that are starting the American Union program. I think that's really helpful clearly. Yes, peer mentors is very helpful for these students to see. Yes, for us, we have peer to peer support mentorship, if you will, in two ways. We have a big program, big little program that our year two students agreed to be paired with incoming year one students to help do all the things from just how do I survive this, to what type of educational resources or books that are most helpful to me. I would say that the pairs, we do have a questionnaire to try to optimize pairing, but it is not a perfect system. It is not a perfect matching algorithm just yet. But that being said, we do have some of our big sit pairings that quite successful and continue throughout the time, not only in the degree program but beyond. Then on the other side our graduates, we ask them to become part of an alumni contact database and that's paying it back. Paying it forward, depending which way you want to look at. We provide that information to our current students, these by specialty and or institution providing mentorship around If you want to come here, what is it like to be at this program? What is it like to be in the specialty if you're going to do away elective or an external clinical elective, hey, you can be on in my extra room, et cetera, et cetera. Those are some of the supports that we have along those lines. Great. Well, I want to thank our panelists for another great discussion. What we're going to do now is we're going to take a break for about 10 min. We'll come back together at 03:15 to hear our last group. Thank you. Turn the icon. Let's go ahead and get started Again, I want to introduce our last speaker before the final panel. Um, Dr. Frederick Anger. Dr. Anger is an Associate Professor in the Department of Family and Community Medicine. He's also vice Chair of the Department of Family Medicine and all things residency for our residency. So thank you for coming. Thank you very much. I want to thank everybody for your great presentations. This has been great. I've learned so much since we started this morning and it's just really incredible information regarding communities of people, populations of people, and the aqueduct, what it takes to get things from here to there. Getting people from here to there. For us is mainly health care and all that's involved in health care. I really thank you guys for this opportunity and what do I do? I am on the end of that pipeline, You guys do all the work getting the students to come in in all the different areas of health care. Then I am the terminal end of the education, my specialties in family medicine with obstetrics, I deliver a lot of babies. I do comprehensive family medicine and everything in between. I also have tremendous passion for education and lastly, putting doctors where they're much needed. I was amazed when I was in training. We did a lot of moon lighting. Moonlighting is basically going to places where there's a facility, there's a healthcare facility, a clinic, a hospital ER. But they don't have providers, they don't have doctors. And I took time as a resident and finding myself moonlighting, working outside of my residency training hours once I got my license to provide care in these communities where they did not have doctors. And they realize one thing, we need doctors in order for these people to get help, proper help, and to decrease the burden of travel for a lot of our patients In those communities, we have to put doctors and all the ancillary staff that they need in those communities. When I became, I was in private practice for a few years and then I just had this calling to go back into academia so that I could really effect change in those areas where they were much needed, where doctors were much needed. I got involved in residency education, became program director, and it gave me a conduit to be able to do that, which I felt I was strongly called to do, which is placing doctors where they are much needed. The objectives for this meeting is best skilled to exchange ideas and strategies of attracting health professional students and rural communities. I believe all of our speakers have shared in this area quite a bit. I'm not going to spend very much time in that area. I'll pretty much be repeating myself if I do that. And then on review some learner facing activities in job placement. How do we find jobs? How do we place people where they're needed? It's just not enough to place them there. But how do we keep them there there once we place them there? And then also discuss market facing activities, where does the market bear? The market is very dynamic, is shifting, is changing. It's driven by so many factors, both state regulatory factors, federal regulatory factors, then personal regulatory factors. We also have things within us that regulate how we behave, how we live and how we do things. And then lastly, just discuss and share experiences at TTUHCI. Believe we're going to have a panel at the end and I want to be a part of that just so I can share some more experiences that we've had over the years. Now, education is we basically focus our job attainment on something, some factors that we have seen over the years to be very, very helpful in getting people where they need to be. We want our learners to be successful in the market, but you cannot be successful in something that you don't understand. It's critically important that we educate our learners on what the market bears, what the market looks like. Good job placement is good for the learner, is good for the program, is good for the community. What I mean by good, it's not just coming there, it's just not getting a job. It's when you come there, are you impactful in that community? Are you going to be a part of the community? Are you going to invest in the community? Are you going to live in that community? Are going to stay in the community. Those things are very, very important and I think that's great, successful job placement. And then lastly, most learners do not know how to get and then I put in parenthesis match with a good job. Getting a job to me is like dating. Matching with a job is like marrying. Dating ends. Most of the time marrying hangs around for a long time and some of them end. Fortunately, most of them hang around when you match with a job. There are so many factors involved in that, your community investment. Number one, do you feel like you're part of the bigger picture and the future of that community? Residents, most doctors come into a community with a spouse. Spouses tend to bring children. Do you see your children graduating from that community? 14151617 years from male. Do you see yourself investor in the Chamber of Commerce? Do you see self invest in the high schools? Into the middle schools and the elementary school, the churches, all those things that make us be who we are. If you cannot see that community, you don't need to get that job. That's not a good match for you. But if you do, that is something we can talk about. That's how I look at opportunities for our residents when they're going out. Is it a good match for them? Okay, and when people come into health care, they all want, we all come in with this idea of it to help. That's for the medical student school guys in your interviews. I just want to be a part of the solution. I don't want to be a part of the problem. That's all of them. Sounds so great. Then what happens along the way? What happens that makes doctors become jaded? Our health care force become jaded. And then the focus becomes the money, which is important. Becomes the money, but not the work. Not what brought them into health care to begin with. What happens along that path, and most of the time is a mismatch in ideas, Mismatching dreams. What they anticipated, what's going to happen is not happening the way they thought it was going to happen. So it is critically important to understand what's important to that Dr. when they're coming into training, tell me a little bit about yourself. Tell me what you hope to get out of your training. Tell me what you hope to land in when you're done. If we don't understand that in three years after training in residency, or four years regardless depending on what they do, if they do a fellowship, you're going to have a very unhappy physician. Basically, somebody who's done, and then they don't know what to do with that education now that I have, there's all these opportunities. But what do they mean? Because for all those years, I've never addressed those things as they were going along. It's critically important for me as a program director to sit down with a resident. And then as they're talking to me and telling me what they want for their future, what their dreams are, I start thinking about communities that would fit them well. Then I need to know where they come from. Because if they come from miles Texas population, more animals and people, then they probably won't do well in Dallas. I don't need to look for opportunities for that Dr. in the Dallas, Houston, San Antonio market, I need a smaller market. And then you also, after factoring the spouse if they're married, okay. Where do they come from? What are they looking for? Because if they are not happy that doctors not going to be happy in the community factoring all those things, and then you start pairing a Dr. with a community even when they're still interns. I introduce them to those community. I want you to check out these communities and then I have doctors in place in those communities where they can actually go spend some time with those doctors, spend a month there with their Dr. Rotation. We have some money from the state of Texas, we're going to talk about that. Places these doctors in rotations, rural communities, And really that helps our placement quite a bit, and I'll show some data with you when we get done. Okay. So we take a multi pronged approach to job placement. We focus on some learner focused activities and then market focus activities. This is an area that residents really do not do not understand very well. This market focus activities, and that's where I come in and my team of doctors who've been training and just getting them involved in what's happening out there very, very well. And really works out very well for doctors. The learner focus activities, these are group based activities and the practice management education, We are the only residency program in Texas in family medicine and in other specialties really that provide a rotation. Practice management, what does that mean? It's basically marrying their future dreams with what's happening in the market right now. How do you manage yourself as a physician? How do you manage your practice as a physician? What does that practice look like for you? Is it a group practice? Is it is it a multi specialty practice? Is it an individual solo practice which is a dying art in medicine right now? Or is it a small group, a large group, a medium sized group? How do you fit in, how do you become a very strong member of that group? And benefit? Get the most benefit out of that group without killing yourself along the way. Okay. How do you become a positive factor in the practice? Those things are critically important along the way. And then educational pair models, there are so many different pair models, the biggest pair still is the Government, the Medicare Medicaid. Those are the biggest pairs period. Okay? And then everything trickles down from there. Not the Blue Cross Blue Shield and all these other insurance companies out there. It is important to understand how those third party pairs align themselves with the government. Pair is Medicare or Center for Medicare and Medicaid services. But at the same time, how do you negotiate with these companies as you go along in your training? There are some basics in the market, basically what the market can bear at this time. Back in 2016, we saw a shift whereby most graduating residents coming out of residency started taking employment positions as opposed to going to private practice, not just in primary care but in all specialties. Really now we have more cardiologists, orthopedic surgeons. Neurosurgeons, radiologists, everybody, all the secondary and tertiary level specialties taking employment positions as opposed to going into private practice. The solo practitioner is dying fast. Nobody can stand alone out there right now, because the market just is not looking for that. Because now, for good reason, a well founded reason, even the government is looking for outcome based payment models. They want to see if you're really doing what you're supposed to do. Are your diabetics under good control? Is your Al and C the right number compared to your cohort, compared to your community doctors, compared to the region where you come from. Now we have pairs third party payers also joining in that file in that they want to see outcomes. And then they're going to give you a payment and a bonus based on your outcome. If you're an outlier, they're probably going to drop you from the insurance coverage plan. The residents don't understand that, The doctors do not understand that. That's just not something in their Amaru as far as their training is concerned. How do I get them to understand that you cannot just be the average Dr. anymore? Now there's so many eyes peering on you, staring at you. And actually measuring how you compare to everybody else in your community, how you compared to everybody else in your region, and how you compare to everybody else in the nation. And if you're an outlier, you're going to be left behind. You really need to keep your skills sharp and you need to be a part of the game. You cannot be standing outside watching the game any, okay? So it's important for them to understand that. Then I bring in guest speakers and screen them pretty carefully because I'm really not interested in somebody come from Dallas or Houston or New York City to come and present to my residents. They don't have the needs. Those are not health shortage areas, Those are areas that have plenty doctors, they just want more workers. As opposed to communities of people where I don't have anybody. Patients have to drive 50, 60, 70 mi to get to a Dr. those are the people that I want to talk to. Those are the people that want. I want them talking to my residents. And I also want to manage what they're going to say. I need to know what they're going to say before they talk to my doctors, okay? Because it is important that I make sure that I marry my doctors to those communities as opposed to just getting a job. Because when people get a job, they can wake up one day and get another job, then then get another job. And then we've actually failed in our mission. So how do we were discussing pitfalls and resident overselling themselves. Over emphasize on income. I have no dog in the fight anymore, so I can actually oversell my resident. It is okay. I can do the negotiation for them and it is okay. I can bid pretty high. And it is okay because it's not them. But I'm going to get something that's good for them because once again, it's no longer the solo practitioner going out there. It's corporations hiring, now it's corporations hiring our nursing staff. Now, occupational therapists, now you belong to the corporation. And their profit margin is huge, most of the time, their revenues are huge, Why cannot be part of that equation? So my negotiations really lean hard on these guys to make sure that my doctors get the Bs they can get because the financial burden that residents have coming out of a medical school, okay? Some basic financial counseling is always helpful and I do with my doctors all the time and it really helps them out. And then I also get them connected to people who have certifications in this area. I'm not chartered financial counselor, so I've managed medicine. I've managed my practice. I've managed my business for a long time, and now I'm managing education. I can share some experiences that I have with them, but if necessary, I have some people in place that can help them. Then, with the learner focus activities, we also have one on one activities that we also do with our doctors. Just knowing what the values of the priorities are. I do that early when they're interns coming in, sometimes for their Ft students, the family medicine accelerate track students. I do that early in that I need to know who they are, what's important to them, what do they think the future looks looks like for them? Okay. And then I start planning for them when they come into residency, how we can move forward for them and give them the best opportunities going forward. Okay. What are their goals? What they hope to accomplish while in training? If they're going to be working in a small town, rural community, what does that community provide? It is important for me to find out what the community needs. And then I talked to the CEO, the hospital. I talked to the community leaders in that area say, what do you need? And Stevens County, I just talked to our CEO, say, you know what, you are doctors when they come here, they provide the most bank for a buck. They get a pediatrician, they get an obstetrician, they get Er, Dr. They get a surgeon because a lot of our doctors can do a lot of minor procedures. And from where I trained and the way I was even doing colonoscopies and EGDs when I was in private practice, some Gr procedures, our patients do not have to go all these other places to get this work done. I was able to provide that even in my residency program Right now, I still have some of my former residents doing EGDs and colonoscopies. And I sent my residents to get those done if their future requires for them to be prepared for those opportunities. It's great. We also connect them with their potential employers. I still advocate for moonlighting quite a bit because it gives my residents opportunity to work in places that they would otherwise not go to Fiona. Texas. Who wants to go to Fiona? There's not a road that goes through Fiona because it doesn't get you anywhere when they have a great hospital Fiona. Because my residents were moonlighting. I guess what I have three former residents working in Fiona today, if they didn't have that opportunity to work, to moonlight in their ER, in the hospital as hospitals over there, they wouldn't have seen the need. They would have seen how beautiful Fiona, Texas now three or my doctors work in Fiona, Texas because of the moonlighting opportunities that they had. Okay. The same thing with Little field, the same thing with level land, the same thing with plain view, All these places that would otherwise not have a Dr. now have a Dr. because we expose them to those opportunities. Okay. And then contract reviews. I negotiate the contracts with my residents. I can read that language fairly well. Most of the residents are not experienced enough or sophisticated enough to understand what the language means. And so they take it to a lawyer, go sign it without even looking at because they just see the dollar signs in it, but they do not see the language. And that is where a lot of unhappiness in a match between a Dr. and a community of people comes in. If they did not read the contract, they don't understand the contract, they find out a year later that the language just not favor them whatsoever. So often I look at those contracts and review them, I call those people, I sit down with them in front of the resident and just tell them, I don't like this, take this out, add this if you really want my Dr. you need to do this or forget it. We have other opportunities we're looking at and most of the time they do sign those contracts, they come out pretty good. They make the adjustments that we need, okay? Market focus. Focus. How am I doing on time? All right, We're good. So there's a market focused activities established relationship with communities of clinicians and healthcare system. And that's where the networking comes in. I have doctors all over Texas and I keep I follow my doctors out ten years, at least some of them I follow for 15 years. I know where they are. If I need to connect my residents, all my students with the doctors, I just make a phone call and it's done. They go there. They love the community. They decide to stay, which is great, or they decide to come back and learn more about the community. The Texas Healthcare Coordinating Board, I serve on that committee, and this is a state level committee that helps me with my networking. Okay. There's also monies given out by the State of Texas for residents, family medicine residents to have rural experiences. And I require all my secondary residents to have a one month rural rotation across the State of Texas. It works out really, really well for us because we have some communities that if not for that rotation they probably won't have anywhere doctors. And because of that rotation we are places like Gonzales, Texas, We now have Dr. Hatten Bag for example. Goal are small rural communities but because he spent a month with those people out there, he decided to sign a contract and stay in that community. Okay. Keeping in touch with private prior graduates. I do surveys, I do visits. I actually literally go and visit my former residents whenever I can. I do surveys every year, and I follow them out ten years, see if they're still where they are, if they're still happy. And what does that mean? Happy with what? Is it just a practice community, the money, whatever. Okay? Those surveys are very, very important. And it keeps those, keeps me in touch with them so that when they move, like Dr. Boban said earlier, I know know that they've moved. Okay. It's very, very important, creating corporate partnerships. Yes, we do talk to hospital districts all the time. I have the number, They have my number. And moonlighting companies. We have Concord, we have emergency staffing services. We have all these companies out there that I've created partnerships with so that we can get these doctors where they're supposed to go. Okay. I also offer the rock preceptors for my residents academic appointments, Make them an assistant professor. Looks good on their CV and they like that, and that's a hook that's actually better than money. I'm an assistant Professor, Texas Tech. But it's really great. It's just a little further on their cap and makes them feel very, very good. We have a 100% board pass rate for 15 years in a row. None where residents leave our residency program without passing their boards. That is something that we actively engaged in preparation in getting them to pass their boards before they leave residency. 100% of 12121212 residents per year residency program, that's a huge number to get across that line every year before they graduate 100% board pass rate. That's something that we sell extremely hard out there and it is something that is important to us. Okay, we get the guest presenters. Like I said earlier, I want to know what they'll come present and if it is something that is really good for our residents and then just a very strong program reputation. We are known in Texas thanks to all that our Dean, Dean Burke has done to make sure that we have all the support that we need. The Emt program has been great for Texas Tech because that has given us a national presence and so they know what we're doing. We've been quoted in many magazines and important journals like the New York Times Journals and stuff like that for the work that we're doing, and thanks to Dr. Betsy Jones and the work that she does with Fmt, our student, a Pdc department, they do a tremendous job. Dr. Cobbs and Dr. Morales in recruiting the right people for West Texas works out really well. For then, what are the outcomes? I have about 2 min left. This is a ten year cohort. Over 124 residents. Over 50% of our graduates practice in rural communities across Texas and the US. That is huge. I mean, doing everything comprehensive in places. And I'm talking about 2000, 3,000 4,000 less than 10,000 population. That's great success. Only about 15% of our residents practice in urban areas, over 35% not the other 35% do hybrid work between rural, urban and suburban communities in that they're working was called critical access hospitals along the huge, major highways in Texas. And that's just a tremendous, tremendous service for those communities. These guys do hospitalist work, they do work. Some of them are just slow tendons and it works really well for the communities. 95% of our rural doctors remember that number that we talked about earlier, remain in those communities ten years out. That's tremendous success. In other words, we matched them with their job. We did not get them a job. We truly matched everything that they desired with that community of people. And 95% of them remaining in those communities. Really a big score. Another thing that I'm learning that is happening now is that those communities approaching from each other. Now, those small town communities approaching from each other may not fun. Some of my doctors were in Littlefield, Texas, moved to Plain View, some of my doctors were in Level and now moved to Littlefield. Okay. Just stay. Don't come to Dallas. Don't come to Houston. Just stay in those communities. I think that's great. Okay. Is expanding our learning opportunities for medical students, expanding our relationship with rural healthcare administrators and hospital districts. And we have better contracts and renumeration for doctors. I think those are Yes. Really big scores. Okay. We've talked about that. And any questions, I think we're going to have a panel. All right. That's great. Thank you very much for listening. Hopefully that's helpful. I keep talking before this thing's actually on, We're going to spend our last little bit of time together just opening it up for any last minute questions. I know we're on the list for an hour, but we'll have fruitful conversations for as long as that is that lasts. So if any of our remaining panelists in the audience will I think we have we've got a presentation. I'm sorry, I'm getting way ahead of myself. No, she's part of she's part of the panel. Okay. Thank you. Perfect. Come on down. Good afternoon. This'll be really quick. We're just going to take a few minutes to focus in on a couple of topics that we're going to be further discussing on our panel. So we're focusing on developing a diverse, wait, okay, so we're focusing on developing a diverse role. Healthcare workforce, helping graduates find the perfect role job. That's pretty complex, right? So we're going to discuss this with our experts in just a minute. I just want to introduce a couple of the areas in which we're helping to do that as an Ac center, as you heard about earlier, with students saying As, have been very supportive and with our university partnerships, how supportive they have been, so resourceful. We're just going to focus in a little bit on that. Let me see how I do this. Yes. Okay. And you heard miss Amanda Aguda, President Ceo, talk about our Regional Center for Border Health initiatives. And Wyhe, she's also the former State Senator of Arizona, which was pretty interesting of different initiatives that she has put into place and continues to work with our government to improve the lives of our communities in our border towns getting access to health care, quality health care. And again, here's a quick map of all our different centers and our medical. 64,000 sq Ft. A lot of our students love going to the Medical Mall for their rotations because it's absolutely gorgeous, something you find like in Scottsdale and they're just amazed. Right. We were established the Ah centers in 1987. I'm going to focus you in a little bit more on that. Health professionals, recruitment retention, interprofessional clinical rotations. And that's our headquarters in Somerton, Arizona. Very rural community. Yes, the rural job recruitment is a complex system as we've been all discussing on today's topic. Right. Let's look at what we need in our pipeline. Programming, We need a commitment to rural practice, which is what we've been all sharing all day long. Is that we're all committed. And it does take a team to recruit our best students to provide that academic training and that rural practice that they stay there. When we're growing our own health professional recruitment retention on an inter professional clinical rotations, we offer a lot of different programs that start from the elementary age to the junior high and high school. One of the high school clubs that is very successful for us as host through host. These are healthcare professional interested students, right? We do engage with them and provide them even sponsorship to leadership conferences that are national. And they compete. And a lot of our kids in rural, guess what? They win those national competitions. Here is one of our Na, up a students with Dr. Richard or OBGYN during his clinical rotation. This student actually was able to, during just one clinical rotation, deliver 13 babies with Dr. Richard. Very exciting step. Here's another Nu student, one of our mentor students, Oscar. This is one of our success stories. And networking with students and being able to be the platform to have students network with each other and be able to encourage, guide men to support them in their career pathway. Here's an example. This young lady came to our office and she's actually one of our CNA graduates from the College of Health careers. And she was super interested in finding out how do I become APA. She told me she's like, I have no idea, but they told me to come talk to you. Of course, we have our wonderful partners with NI, called up Jacob Boler, which was a director at the time. And I said, hey, help me out here. How do I connect this young lady to learn how to apply for the PA program and what are the requisites she need? Again, we're in a rural area. We don't have access to it. Right? So, I'm reaching out to my partners that are a little far, right, Right away. Jacob connected me with his student that was doing his student plunk rotation at that time with us. It was like perfect timing. Right? And so we pulled him in and he was one of the ambassadors. And so he was able to guide this young lady for the whole process. And the success story to top top the icing on the cake right now is that she's been admitted to the PA program through Nau. Yes. These are things that excited Oscar was given the program mission award. And you can see here, this is Jacob Boler, upper corner professor, where he nominated Oscar. And he talked about why he was nominated. And I know that we're all like super tired, so I'm not going to go. But I wanted to show you that one of our pipeline programs, two that's very successful in the high school level is start with the University of Arizona. Medstar is a program that takes place in the summer time. Several of summer programs, but this one is for students that are interested in a healthcare profession. And they also do a community project where an Ahec center like Wh, Western Region work directly with those students to help them identify the social determinants in our area and help guide them in a project. These students identified a project for Covid 19 variants and how to educate the community about Covid 19 variant and how to stay healthier and mental health and all that good stuff. Again, there's more information, but I'm going to just go over this quickly because it's the end of the day. Another project that the Me students went over did with us was being part of the Center for Children with Special Needs and Autism. This center came into fruition. But before it came into fruition, it was a project that the actual Meds Start students were working on with this, one of the students ended up working for UA. And she became a mentor to future Future Meds Start students. And always shares this with the students, how their project came to fruition. And the Center for Children With Special Needs and Autism is the only autism center in Yuma County, servicing autism children with autism. And that's through Regional Center for the Reporter. Here's one of our hosts, a club, students from Lake Vis. And these are the students that just attended the fall leadership Conference. Again, one of the ways that we sponsor and support the Ah scholars immersion. Ii don't know how familiar our audience, the Ah scholars immersion. But this has been one of the most beneficial this year. I think having these two cohorts working with us. These are all graduate students from all over the state, with all the different universities. And in their two year program with us, um, they're able to assess our community needs and then they're able to identify an action or an intervention to better Right. The, the medical support that's offered to our patients in our areas. So, in this project, or I'm sorry, in this program, a scholars, students, the students recognize that Pdc 5 min. Okay. The students, I'll talk more about this and if there's interest in, but they, they, they have identified the project being that our youth, our children are experiencing a lot of anxiety and depression post pandemic, Right? And what are we doing about it as healthcare professionals? Right? So what they're doing is they're creating an intervention plan that's going to start at their primary care. When they see a pediatrician, they're looking at what interventions and what resources can providers give at that point versus refer them to behavioral health and then that's it, right? And not help, not intervene what they're doing. They're being very proactive on what can we do. What community resources are available in our rural areas because we're short on behavioral health, right? But what can they do as health care professionals in primary care And be able to provide resources and intervention for children that are experiencing anxiety and depression. This project is like, they're just so excited about it and now they're going to be, they've already started teaching the second cohort, the new one, coming in, a Hec. Scholars to continue the implementation and evolve it as an agency or healthcare agency. We're supporting this project, we're super excepted. All right. And so their emersion, they came to us on last month. January, it was barely last month. Part of it was immersing them in the school, community based clinics that we have in our region and teaching them about, you know, how to reach out to the community. And they were part of that. So they volunteered in our community health fairs, at our schools. So they got to participate and educate the families. And it was an awesome experience. We learned a lot about public health. Then I think lastly, we are launching the LC program with AA starting this May. We're really excited about that. You can see Dr. Karzon is there too. He was here earlier This I will leave open for discussion so I don't take up more time. But we're really excited about this project as well. And then that's it. All right, well, thank you again for Yeah. Okay. Do a little dance up here. Thank you so much for sharing about, from that community partner perspective, what it is that you're doing. What I kept hearing is the collaborations and the partnerships and same thing with you, Dr. GI. Mean continuing to have those conversations. So we wanted to just open it up if there were any final thoughts from the panel in regards to anything that you want to share. I also wanted to open it up to the few that are left in the room. But I know we've got several people still on line. Just as some final thoughts, opportunities to contribute to the discussion that we talked about today. First of all, I'm happy to be here. This is a space that we're just getting into, right? But it's an issue that we're always having to contend with, even though we're not actively in the space by being an official. A heck, now we have a seat at the table, so to speak, right? We're just going to figure out how to leverage that seat now, because we're new to the game, right? We recognize that our system is separate. That has some challenges of how to integrate. We already know that. But I think now that we have some dedicated resources to really dive into those barriers and try to eliminate them. I'm excited about that. First of all, just a separate system. There's a federal and tribal system trying to collaborate with state universities and we're trying to figure that out. The other thing that I'm very aware of is even though we have authority to do some of this stuff, we don't have the resources, the systems that we operate with, and I'm pretty certain you all know this. Our system is heavily underfunded. Even if we want to work in that space, we don't have the funds which then does not allow us to build the infrastructure to move forward. Even though we have a seat at the table, sometimes we really can't participate, right? We're trying to be strategic about how we move this a forward and how we move the conversations forward. But the one thing I do want to say is looking at our tribal communities. We have the resource, we have the people who want to do this. We work really closely with our CHRs and their workforce. We've had for over 60 years because we've had federal funding to support this program for over 60 years. I believe we're the first community health worker model in the nation because we've had funding to do this. And really that funding was to connect the community with the professional who is usually a non native person. Right. So we've had that funding for six years, so they're still very highly utilized in our tribal communities. But I did sit down with a few CHRs a few months ago and I asked them about their path to becoming ACHR, and over half of them said, well, my initial route was to become a nurse. Over half of them. Okay. What happened? A lot of them had children, a lot of them women. So I asked, well, being that your CHR now, is your desire still to go on to become a nurse? Yes. The good thing about that is the tribes that employ them encourage that to happen. A lot of our community health representatives who already have a higher level of cultural competency, who speak the language, who are from the community, there's a ready pool for us to tap into and for our tribal community. I'm really excited to work with our community health representatives. A majority of them want to continue on their educational pathway into nursing or into a higher scope of practice. I think the thing and then the other thing just wanting to say is because of the lack of resources, we talk about our health professional shortage areas and the data really doesn't paint us what it really is the need. And I always say we used to work on legislation and I tried to make advocacy points about really what the need is in our tribal communities. Because we're underfunded already. Let's say that the need is ten dentists in a certain area, but because we only get funding for half of that, we only have five positions that we can advertise. Then we're only able to recruit three. Right? Your vacancy rate isn't too bad, It's only 20% we only need, right? But really the need vacancy vacancy rates, what, 70% That's another thing just to closing thoughts is that the data doesn't really reflect our community and we have to be able to, like I said, have that seat at the table to share that information. That's why going back to my initial comment, we have a seat at the table, how do we leverage that seat on the table? So really happy to be a part of that Ac system and just having these platform to share that knowledge. Thank you for sharing. I'm also wondering, as you're talking about, for somebody, who, how long have you guys had the heck, about 30 years. So maybe there may be some opportunities to collaborate or discuss some potential ideas there. Okay. Already talking. Fantastic. Okay, anybody else have any final thoughts? I haven't seen any questions pop up just yet, but the inclusion of our students and our providers and um, into our community, and it's really that authentic learning experience. By providing that platform for them, that's how you hook them into your needed you needed. And if you found your purpose here, we want to, right, Just creating that support system, that safety net. Also being very conscientious about our students, our rural students, they don't have all of the resources at their fingertips like if they would in an urban area. So we have to bring the resources to them and we have to create that safety net amongst ourselves. I learned something today that I think I'm going to incorporate into my speeches in the future. And that is the B part of the diversity, equity and inclusion. And I don't know what your name is, but you said the B part is often forgotten. The belonging part that I've really given that a lot of thought since you mentioned that. Yes, you can be in a diverse environment. You can feel like this and attempt to equity, whatever that means for that particular environment, that particular space and an inclusion. But do you feel like you belong? And that is something that we really need to start thinking about, a discussion that I think needs to be held. And I really, I learned something important that I need to include in that discussion or add into the mile, if you may, just to expand that space a little bit wider. Thank you so much for sharing that. I got used to it. I don't have a question, but I'll regarding my colleague from Texas Tech, I do want to applaud the efforts made with the model of requiring every student to do a rural rotation here in Arizona. The University of Arizona College of Medicine in this building has a different model than the Na, up a model for rural health. They have a separate track. They might have a handful of students in there that have to apply to it, and they have to be interested. They give students a choice. And although I believe in learners having a choice in their education, sometimes learners, even though they're adults in this medical education area, sometimes they don't know what they need to know and what benefits them. When I was here, I implemented a very controversial policy that said basically each and every single one of you will do a rural rotation, whether you like it or not. Because some approached me with pushback and I don't want to do that. I live in Scottsdale, I live in Peoria. I live here, I can't travel. I can't. I can't was the constant pushback because we live by the mission here and the mission was to serve underserved and disadvantaged communities in Arizona. We had the opportunity to say, yes, you will do this. And in our recruitment efforts, the intentionality that you need to have to tell people you're recruiting at all our events, whether it be a webinar or here in this, in the room across and say this is what we're about. Every student that comes here has to do this. If this is not for you don't apply here. There are 300 other Pa programs you can apply to because you have to do that here. So that you start getting a culture in their mind of this is an expectation of this program. And you start early training them early so that there's no argument and there's no pushback or very little because you say, without exception, for any reason, everybody has to do this rotation. One. What I found with that is I think it serves two purposes. One is that it, of course, allows you to follow this model of you place them there, they grow there, they learn there. They want to stay there. That's really what we want out of it, right? For those people that that's not going to happen with. And I would say even in the Na, up a program, probably 70% are not going to go into rural. But guess what? They'll all say that their eyes were opened and the experiences that they had in these rural areas. And they developed a skill set in that practice that they would never have learned elsewhere. And they would never have seen the way people struggle to get health care in those areas, specifically in this state, in the reservations. How far people have to go to get primary care is just incredible. It's daunting and people don't believe it. I had so many students that I never knew this occurred. I never knew people were living this way in West Phoenix, like a mile from here. People that just don't know that they're not homeless, but they're living in such poverty. And the social determinants are just, I mean, it's like a textbook of that anyway. There's something to be said for inner city urban rotations as well because those also are very fruitful. And those were not forced yet because we didn't have enough, but we had enough rural rotations, thank goodness. I'll also say that the rural Arizona came through during the pandemic. We were one of the very few programs that stopped for two weeks when the pandemic started because of people like Joanna who helped us to get that going. They still kept our students and kept them going because somebody needed to provide practice. And our students are a value add. You brought up renumeration. I hear renumeration too much from physicians, from P, as from P's. How much are you paying me? How much is it worth? Time is valuable. You need to give me money for this, this renumeration bit, or the RVU bit, a bit in medical centers. Part of this idea is a perfect example during the pandemic is that students were really evaluated. They really helped process patients. Maybe not seeing Covid because they were restricted. But all the other patients that came in, they were very valuable. I commend you, Congratulations. Thank you for supporting that model. Obviously it's very effective and it has been effective here as well. I think I would add to that when you look at information about it doesn't matter what type of stigma you're trying to decrease, but if you look at information about even if it was towards race or just any group that's different, one of the ways that you can decrease stigma. I would argue that for rural communities it's not right, but there can be a stigma even about going into those and serving them. There's something called, you guys already might be aware of it, but it's called the contact based hypothesis, that basically just contact with communities and people different from you can begin to humanize them and decrease stigma towards them. And we definitely have 100% of our students, that's our first programmatic goal, is that 100% of our students get exposure through clinical rotations to multiple rural sides. Yeah, I think that makes perfect sense because obviously our communities that we're working with have health professional shortages and all disciplines. Right. They're going to have to come to you possibly, right? Even if you're living in an urban setting and you're practicing there, they need to come to you obviously. It just makes sense that you've had some connection with that community. When this person comes for your service, which most likely is a specialty, then you know where they're coming. Hilly would encourage those rural rotations as much as possible. Because for our state, we're very rural and for our tribal communities, we have to come into the city all the time for a lot of our services. I have actually a question for you all. I feel like I've been sitting here and just watching, just Fyi to everyone on line. We do record these and we put all the presentations online for people to view later on. But that being said, any student that was watching today, and just me personally, every time we have these workshops, I just get so inspired. It doesn't matter what topic it is. It's like I'm going to go home and I'm going to go focus on this and get back to school, and two days later it's all gone. But just listening to all of you has just been really inspirational. But for those students that are on the fringe about maybe they want to work in rural health care, maybe they don't. I know in your slide, Dr. Unger, you put you still got to pay the bills. I think we talked a little bit last night about this. What advice would you give to these students that maybe want to commit to a rural healthcare job, but are just unsure, don't know what to do, not sure who to reach out to, just any advice in general. Thank you. A lot of times whenever you're dealing with a student like that, obviously they've made a decision that they want to study medicine or something in the health profession. That's good. That's 50% of the battle. And then get an understanding of what it is that that means to them. And then when it comes to the underserved population, if I may ask your question, it's do they know what that community looks like? What's the understanding of those communities? What do they look like to him? And what do they want to get out of it? Is this the model that they saw themselves, the life that they saw themselves in? Because if you're from Dallas, and that's your dream and we need to talk, because those communities are extremely different and those are the ones who really need to take time to go to those communities, spend some time with some doctors in those healthcare providers in those communities. They understand what's going on and do it hands on. Our osteopathic counterparts in Dallas, the College of Osteopathic Medicine, the University of North Texas. They have this program called the Rome program, the Rural Osteopathic Medical Education. For those students, they put them into that group and they have them in rural communities all across the state of Texas. And there's some funding that comes from the Stereo Texas for that. And it really helps those students make up their mind based on two or three experiences in different rural communities. And it really, really helps them solidify that decision. It's not a tough process. Immerse them, you don't know how hot that water is until you get in. How cold it is until you get in it, but you can talk about it all the time, is like describing water. Somebody's drowning is very difficult. Does that make sense? Yeah. I want to press on that just a little bit. Dr. Unger, you talked around this, but I'll ask you to maybe be specific and the premise that I want to poke a hole in that. Everybody in this room is heard, either said about you or about somebody else that you care about. Who you're too smart to go into primary care. You're too smart to go into family medicine. And what they mean is you're too smart to settle for a lesser salary by being in primary care. But the honest truth is that's not the way it's playing out for your residence. Yeah. We don't want to talk too much about salary and let that be the lodestar. But to answer your question, Nick, about if you're on the fence and those are the issues that may help you make a decision because why want to go into health care? Because they were helped. Their experiences were with a family Dr. or with a nurse when they broke their arm or whatever it was that gave the first experiences. Probably in a primary care setting. So how do you make that work and how can you make sure everybody knows it's possible not to settle. That is really the big gorilla in the room. The money part. And I had in my slides, but I thought it was going to be a longer discussion, so I just completely skeptic. But obviously Dr. Jones saw it. The money part. There's there's plenty of money in primary care, let me just put it like that. There's plenty of opportunities, my doctors on average, even as family physicians work in rural communities, just to go straight to the numbers, average about a half $1 million a year. As family doctors, I have young doctors. One was actually an athletic trainer, That was my son's high school athletic trainer, Dr. Teman Abline High, when my son played soccer and football in high school. And she was the Doc at that time. And I remember her sharing with me that she wanted to go to medical school. She got into Texas Tech School of Medicine and she nontraditional student went through the program and graduated from our residency program and does everything that I do and some more because she wanted to draw medicine. So she's a community just south of Lubbock called Andrews, Texas and she's one of my great successor stories who on the average fast of residency made over $800,000 and not killing themselves. People don't hear that about primary care. Thank you Dr. Jones for bringing that up. I don't like bragging on my doctors like that when it comes to money. But they're not hurting, they're not hurting my doctor's average contract for any Dr. leaving my residency programs for about 300,000 $350,000 a year. That is just the first year out. Most of them by the second or third year are making a half $1 million. Going forward, we see all the cardiologists and all those guys, orthopedic guys, and we don't talk about it, we don't tell them anything because we don't want them to change professions that come to us because their reasons for changing would not. My doctors got into primary care because they wanted to do what was right and they're being remunerated well for the work that they do, for those communities that they do. One thing people don't understand about rural communities, Even the federal government knows that they need help, the federal government understands and even the state governments understand. If we don't put the money there, the people will not come there. People do not know that. Hospital districts often come to me, COCF, Os, whatever, hey, we need a Dr. how can you help us get a Dr. This is the contract that we have available for your Dr. say but I know you have the monies and the monies and the monies. How do my doctors get to a piece of that? You have critical access monies out there for rural communities. You have monies for health shortage areas, rural communities. Those monies are housed within the hospital district or housed within the Cfo's office. I want a part of that in order to sweeten apart to bring my Dr. in that community. Oh, you know about that? Yeah. I had a resident from a small town of Sudan, Texas. Small community. Once again, more animals and people sign a contract in Seminole, Texas where every single patient that came. Practice, whether they had $1 quarter $1,000,000, every single patient was dollars in his pocket paid for by the state of tax. So whether they had funding, if you saw 100 those dollars to every single patient that came into that practice. So right off the bat his salary was over half $1,000,000 That's not including the work that he was doing on his own, building up his practice. Yes. So there's plenty of money in primary care and most, and a part of the negotiation for the contract includes loan repayment. Okay. If you cannot help my residents pay off their loans and some of them just say, we'll just pay it off. How much is it? 100,200.50 thousand. We'll just pay it off if they promise to stay in my community for three years, at least three years. By the 30 year, those people pretty much decided to stay in that community for the rest of their careers. Like I said, 95% of my doctors still practice in the first place where they went because they've just made it so nice for them to be able to stay in those communities. Would you say thank you, Dr. Jones. Would you say cost of living in rural communities are absolutely very different even with a lower salary? Yeah. In Phoenix, you probably a very decent home cost 800,000 600,000 Phoenix, that'd be a great home. 300,000 For 300,000 In Texas, you probably get some land, a house, a few cowan, and a dog to work the cow. It just depends the cost of living those communities really low. And a lot of my doctors are very, very happy working in those communities because it's just really cheap to live out. I just have to this conversation, I don't know if you can tell by my mask, you know that they make that much. Because we cannot compete at all with that salary at all. I mean, I'd say what you're talking about is easy. Two to four times more from what our system will provide. I mean, again. Right, we're coming into the space and I know that our salaries are no where the numbers that you're talking about, Which then just makes me think, oh my gosh, we get even more behind. A little bit more behind, right? But I think it's again, just to share my thoughts and knowledge. I think I'm having one of those they call. I just look it up. Right? We are behind other states, we are vastly, far behind. And now it makes me start to think, how do we compete, right? But the thing is we have systems though that have professionals that are committed to working in these areas, which then makes me go back. We really need to embrace that Ern model. We just have to, but how do we do that here? You can also, I think one of the things that that's lacking in entire system is educating doctors on the business of medicine. You see educating doctors and how you can maximize your opportunities in medicine. And that's the other thing. See, that wouldn't resonate in our system. Yeah. Because we don't have private practice in our reservation. So a lot of the conversation that I've been hearing today, that's not for our system because we don't do managed care, we don't do private practice. We don't do a lot of those things because, yes, we are rural. But remember we are in a very separate type of silo and system that's very different than a lot of the conversations that I've heard today. Again, being the new hit on the block, right? I'm trying to figure out how do we fit into these conversations that have been happening for years, right? And how do we come be a part of this? And so that we can start changing or educating people about how vastly different our system is and how the structures that have been created will not apply when we talk about health professional shortages in our tribal communities and within our Indian health system. Anyway, just to add to the conversation, I'm really happy to be here, but I'm realizing there's a lot of gain that we have to have because we're a minority of, the minority of minority, Right. Our systems are people. Again, you probably can't see it behind my mess, but I'm just like, wow, well that's crazy, right, In the perfect world. But anyway, just just to add to the conversation, but thank you for sharing that information. It's opening my eyes a little bit more and really figure out. But I like challenges, so we'll see how we can address it. The nausea program just excites me hearing about it. I think it's just great that you guys are really big on physician assistant. The program is huge. We have a small program in middle our campus, but you guys seem like you have a lot and I think that's a tremendous opportunity for your physicians. And your fleet physician leaders. And so how do you use what we call physician extenders to make sure that the communities where they serve benefit In a huge way. I mean a place like this where I can have P, as, as a physician, I'm like salivating over that because now I can actually put 34 doctors in two or three different countries, counties, and just travel to those places, make sure that the systems are working, things are working well. Thanks to Zoom, we can actually have a zoom meeting every morning. You see what I'm saying? And then make sure that those Ps are renumerated appropriately so that they have a desire to stay where they are. Okay, so you're a physician manager who now owns the business. You can actually just get a percentage of what those people are working. But most importantly, those doctors out there working, doing what they're doing. And that percentage can get really huge, really quickly. And make them want to say, you know what? I don't want to be orthopedic surgeon, I don't want to be a radiologist. I want to be a primary care Dr. And not only that, I have be health person here, mental health and p over here. I have the young lady who was talking about being a pediatrician and one of them was talking about. This is just a great opportunity to just really explore opportunities that can really even help the Indian health communities in a very big way for your communities. I learned so much about Indian health. I do not know, I do not know anything about that at all. I don't know if Indian health is the right terminology, if it's the tribal health, I don't know what the terminology, I hope I'm not using the wrong terminology, but yet, it seems like there's systems within your system that need to be revisited. Doctors and health care people are competitive people by nature. If you don't give them that competition, you're not going to get very much out of, believe us. We've been trying to advocate for that. There's just I could go on but, but I think at least here in Arizona, we have some idea, right, about our tribal health disparities in terms of the people in the community. But I think there's maybe a lack of knowledge of the policies and the system and the infrastructure that adds to that. Right. I think that's maybe some I think where because that's my whole career, I can speak to that, I understand how to navigate through that. But it's when institutions or programs don't understand that, they don't build around it. Does that make sense? I really am appreciative of why Nu and U as U. At least our three universities here that do have commitments to working with our tribal communities and having liaisons within our universities that really the university challenge the system to start speaking our language and learning our systems. And learning not just the people in the culture, but the systems and the silos that I was talking about. Again, just very enlightening conversation. Clearly, I'd love to provide information on this topic if there's a desire to. Absolutely. Are there any other questions? Final thoughts from Zoom, Land or room Joyce in Colorado? We found that folks around. Sorry. It went away right before I could read it. Joyce said that she's had the same experience in Colorado that Eli has had in your Unfortunately, we lost several rule sites due to students refusing to go outside of Denver. Yeah, in Colorado, we found that folks screen insured Joyce, do you want to come off mute? Maybe more PTO. Thank you. I'm sorry. Can you hear me okay? Yes. Thank you. I came from Colorado University of Colorado PA. Program. I was there almost 20 years. I was involved with a heck in our rural sites And the Colorado Ahec conference, What some of the healthcare systems leaders said for recruitment was that you can only spend so much money. Now, that seems odd to some of us, right? But what these people wanted to move to those sites, and I'm a rural person, I grew up that way. They wanted more time off. Not so much the $400,000 or 300 or 200 even. It's, can I take 12, 12 weeks off or ten and come back and not be buried in emails and patient catch up. Does that make sense? That's, I think, one way we could reward these people versus just offering them more money, but no time off to spend it or share it or volunteer somewhere. Thank you for the opportunity today to speak and this was a great conference. Thank you, Joyce. Absolutely finding those other motivations right beyond just the salary, but what else could be beneficial? Absolutely. Thanks for sharing any final thoughts, Dr. Trotter, You okay. Great quotes. I have no more great quotes from Dr. Linton. No. But I just wanted to thank everyone for coming today. I think this has led to some great conversations and I hope some great partnerships. It's just been really neat to get to hear the entire spectrum of healthcare education. And I really want to thank our hosts at AU. This has been really cool. Again, it's kind of felt like coming home in many ways and putting up with us West Texans and all of our shenanigans. But again, thank you for the opportunity and if anyone has questions or additional ideas, I know the team would be really interested in hearing them. So thank you. Oh, there's a survey, There's AUR code on the back of the program that you can scan there. Please take time to fill that out. Would you look at all of that information? It helps craft and helps the Avr C group find their talks. We appreciate your time. Thank you.

ABRC 2023: Developing a Diverse Rural Healthcare Workforce

From Nicolas Beckett June 14th, 2023  

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