February 2019, Volume XXXIII, No 11

interview

Launching careers to serve rural and Native American patients

Paula M. Termuhlen, MD

University of Minnesota Medical School, Duluth Campus

As part of the University of Minnesota Medical School, what unique curriculum does the Duluth campus offer?

Our University of Minnesota Medical School, Duluth Campus provides a setting that attracts students from rural and Native American communities. We have a holistic admissions process that looks beyond grades and test scores to find the best and the brightest who come from small towns and Native American communities and who wish to serve in those communities as physicians. We have specific courses that help all of our students learn about rural health and how to engage with American Indian and Alaska Native people to deliver the best possible care.

What does it mean that you are a “mission-based” campus, and how does this benefit the community?

For over 40 years, we have focused our education, research, and community engagement efforts to serve rural and Native American communities. In addition, we have nurtured an interest in family medicine such that almost half of our students choose family medicine as a career. Approximately two-thirds of our graduates will return to practice in Minnesota and most of those will practice in communities of 50,000 or less. Forty-four percent of our graduates practice in communities of 20,000 or less.

Rural medicine is a major component of your program. Please tell us about your rural health curriculum.

In the first year of medical school, students are assigned to a family medicine preceptor located in one of our Minnesota rural communities as part of the Rural Medical Scholars Program (RMSP; see www.tinyurl.com/mp-umd). Each student spends one week with the preceptor, shadowing their practice and often living with them. They do this five separate times over the course of two years so that by the time our Duluth students join their classmates from the Twin Cities in their third year, they will have had the benefit of living and experiencing rural medical practice as they start their full-time clinical rotations. As part of the RMSP experience, our students also learn about the community health needs assessment at their site and create a poster presentation at the annual Minnesota Rural Health Association conference in Duluth. More than half of our students will join the Rural Physician Associate Program (RPAP) for their third year and spend the majority of their full-time clinical rotations at a rural site, often located at a critical access hospital. In addition to these immersive clinical experiences, the Duluth Campus students have the opportunity to learn from regional health care leaders in the Rural Academy of Leadership course.

Please elaborate on the other rural health initiatives the Duluth campus has to offer. What can you share with us about the Center of American Indian and Minority Health?

The Center of American Indian and Minority Health (CAIMH) was created over 30 years ago to support the development of Native American physicians. On almost all health measures, American Indian and Alaska Native people have worse outcomes. Part of the challenge is providing a health care workforce to these communities to improve access to medical care. The programming in the center spans the educational continuum from early elementary school through medical school to provide a culturally supportive environment for our students to explore careers in medicine and other health professions. The CAIMH works locally, regionally, and nationally in partnership with tribal nations to raise awareness about the challenges and successes that Native American people have in addressing health outcomes.

We have a holistic admissions process that looks beyond grades and test scores.

Rural residents and Native Americans often suffer inequities in health. Please describe some of the factors contributing to this, as well as your initiatives to address them.

The health disparities that rural and Native American communities experience are often related to access to health care and the experience of chronic health conditions. The two-part mission of the University of Minnesota Medical School, Duluth Campus is to serve rural and Native American communities and is designed specifically to address these health disparities. When the campus was started, it was recognized that there was a great need for increasing the physician workforce in these areas as one way of improving access to health care. Our commitment to developing family medicine physicians was specifically designed to develop the type of physician for practice that is most needed, and who has the broadest skill set to serve these communities and to identify and treat chronic health conditions. Our research mission has followed our educational mission by ensuring that we have investigators whose work is of great importance in rural Minnesota and our tribal nations. We have current investigators who study cancer, opioid and other substance abuse problems, the role of diabetes in dementia, and culturally relevant behaviors that help people succeed, in addition to the many other areas in science and public health. We also have one investigator who is studying how access to legal services relates to health outcomes in rural communities.

Please tell us about your Bridges and Pathways program and how it helps to advance students academically.

The Bridges and Pathways programs are federally funded training programs to introduce students in high school and in college to the scientific method. Students are brought together to experience being part of scientific projects, such as studying Lyme disease. Being able to learn directly from scientists as role models helps to inspire students to consider studying the STEM fields in college and to consider continuing their education to obtain master’s and doctorate degrees to continue making scientific discoveries.

What does the Memory Keepers Medical Discovery Team do and how did it get started?

The Memory Keepers Medical Discovery Team is one of four medical discovery teams created by the University of Minnesota Medical School after receiving funding from the Minnesota State Legislature in 2015. Memory Keepers studies the impact of diabetes and dementia on Native American communities. Both diabetes and dementia disproportionately impact Native American communities. Understanding the interplay between the two diseases is of great interest to our Northern Minnesota tribes who are mostly located in rural areas. In addition, Memory Keepers is working to develop rural health projects that explore conditions that disproportionately impact all rural communities.

What can you share with us about the Duluth Global Health Research Institute?

The Duluth Global Health Research Institute emphasizes the importance of connecting with the world at large to identify and explore health care delivery and research in rural and under-resourced areas. Part of the work focuses on helping our medical students learn about other cultures by traveling to areas where we see growth in the immigrant population of Minnesota. This summer two of our students will travel to Uganda to understand how rural family medicine care is delivered. In return, we will host medical students from Makerere University in Kampala, Uganda, who want to learn how we practice medicine in rural Minnesota communities. Several of our researchers work with scientists in other countries to help us better understand disorders such as substance abuse and infectious diseases, including those caused by parasites.

You recently ranked second in the nation for graduating Native American students. What can you tell us about this?

We are extremely proud of the success that our Duluth Campus has had in developing Native American physicians. In a recent publication by the Association of American Medical Colleges, the University of Minnesota Medical School was recognized as being number two in graduating Native American physicians. Less than 1 percent of all U.S. physicians are Native American. We actively recruit to our medical school classes, individuals who are members of Native American tribes and/or who are committed to working with Native American communities to provide health care. We provide all of our students coursework about the unique cultural aspects of working with Native American people and information about health disparities that we are trying to resolve.

Paula M. Termuhlen, MD, is Regional Campus Dean at the University of Minnesota Medical School, Duluth Campus, and a Professor in the University of Minnesota Medical School’s Department of Surgery.  

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Paula M. Termuhlen, MD, is Regional Campus Dean at the University of Minnesota Medical School, Duluth Campus, and a Professor in the University of Minnesota Medical School’s Department of Surgery.