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The Upper Peninsula Mectica] Eclucation Program Doggie! S. Mazzachi and W. Donald Weston The federal government, concerned about increasing the number of primary care physicians in rural areas, awarded a Bureau of Health Manpower Grant to Michigan State University's (MSU) College of Human Medicine. The purpose of this grant was to conduct a feasibility study and design a program for predoctoral education to be located in a module situated well away from the traditional science laboratories of the main campus. During this same period, the Michigan state legislature appropriated funds through the Upper Peninsula Areawide Comprehensive Health Planning Association to assist in the development of the program and the feasibility study using the Upper Peninsula as the target area. In.lanuary of 1974, the Upper Peninsula Health Education Corporation (UPHEC) was formed to work with Michigan State University's College of Human Medicine tO implement the Upper Peninsula Medical Education Program. Final authority and responsibility for all patient care activity con- ducted in the ambulatory care education centers ultimately devolved upon UPHEC, including the appointment of physicians to the medical staff, assurance of quality of patient care, and management of the patient care system. The concept of a remote medical education module required imaginative approaches and astute political sensitivity. The curriculum, for instance, needed to accommodate the intent of the designers that the material for study would focus on topics germane to the practice of primary care. The learning environment needed to provide the kind of early clinical experience that would complement the curriculum. The admissions process needed to 276

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The Upper Peninsula Medical Education Program 277 attract the kinds of students who would not only choose primary care, but who would also choose tO practice it in a rural area, particularly within the Upper Peninsula. Finally, the region needed to welcome and support this medical education program recognizing the potential impact of improving health care in the Upper Peninsula. During the 4 years of the federal contract (1972-1976), the College of Human Medicine Office of Medical Education Research and Development planned and developed a model curriculum that embodied community- based, humanistic, and general self-learning principles. In 1977, the UPHEC was awarded a 4-year grant by the W. K. Kellogg Foundation to expand the educational mission of the program and to develop a postgraduate experience in family medicine. As a result, the Family Practice Residency Program was written, accredited, and subsequently opened in July 1979. In the first year of operation, the program attracted the interest of 10 potential candidates. In its third year, that number grew to 100, and this year we received over 180 written inquiries. Interest in the program comes from schools of medicine all over the United States, but principally attracts the interest of students who have either lived in or around the Upper Peninsula. The program is one of very few in the United States that is based in a community hospital distant from a major metropolitan area. This char- acteristic appears to be a major factor in the growing interest of students who seek to do their residency training with us. The setting for the predoctoral program is a primary/ambulatory care center called the Bay de Noc Family Health Center located in Escanaba, Michigan, and housing both an educational center and health center. Pre- ceptor/physicians coordinate on-site, medical education as well as the daily function of the Center's patient care activities. Coordinators in all fields of basic, behavioral, and clinical science are appointed by their respective departments on the East Lansing campus and are charged with appropriate departmental responsibility tO assure the teaching mission of the College. The present U.P. curriculum is the result of the combined efforts of program administration, faculty, and students and their concern for a high-quality educational experience in keeping with the objectives of the program. Currently our students receive their first 2 years of instruction on campus in East Lansing. Following completion of Part I National Boards, the stu- dents relocate in the Upper Peninsula, some 400 miles from the East Lansing campus, to complete their education. While many of the clerkships mirror those of more traditional curricula, there are a number of unique experi- ences designed to promote primary care and tO increase student familiarity with the ambulatory care setting. Multiple benefits are obtained from this community-based medical ed- ucation program. Not only do medical students and resident physicians in

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278 PART II: PRACTICAL APPLICATIONS training receive a more realistic look at the world of practice, but also the communities involved in their teaching develop higher standards of patient care and a more inquiring attitude into the problems facing both physican and patients. In addition, a host of direct medical services are provided by these medical learners under faculty supervision. As other regions in the state with a long-standing commitment to medical teaching have discovered, the very presence of a training program in the Upper Peninsula has made our region more attractive as a practice site and has enhanced our recruiting efforts greatly. At present, Michigan State University's College of Human Medicine, through its formal affiliation with the communities of Lansing, Kalamazoo, Flint, Saginaw, Grand Rapids, and the Upper Peninsula, has taken the lead among the medical schools of Michigan in promoting this community-based educational concept. Until recently, public policy has been directed to the alleviation of phy- sician shortages in this country, and substantial federal and state tax dollars were allocated to medical schools and health care institutions, resulting in significant increases in the number of practicing physicians. Current public policy related to health manpower indicates a trend toward declining federal support of medical schools and a reduction in the number of medical StU- dents and resident positions. There is, in addition, a shift in emphasis toward the favoring of medical education programs that seek to encourage the redistribution of physicians to areas of greatest need and the motivation of physicians toward career choices in primary care. Since the Upper Peninsula Medical Education Program was designed specifically to address the health care policy priorities of the early 1970s, it is interesting to note how closely the characteristics and results of this program mirror current trends in public health policy, especially in the following areas: . , . . promotion or primary care; . promotion of family practice in medical school curricula; and . development of admissions policies that encourage students to practice in areas of physician shortage. The UPMEP has been visited by distinguished delegations of medical educators from every continent under the sponsorship of the World Health Organization. These academic teams have come to the Upper Peninsula to study the design of this unique form of medical education and its relationship to medical problems common to their countries. Through these visitations, we have come to realize that specialty and geographic maldistribution prob- lems are common in all corners of the globe. A description of our program was published in a book of public health papers by the World Health Organization as one of 14 educational programs that have conducted im-

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The Upper Peninsula Medical Education Program 279 portent experimental activity in the field of multidisciplinary, community oriented, multiprofessional team teaching and the use of professional schools for the training of health personnel. The Upper Peninsula Medical Edcua- tion Program participates in a worldwide network of community oriented medical education programs formed in 1979 for the purpose of sharing pertinent information regarding our collective successes and failures. (This network is described in some detail by Dr. Greep earlier in this report.)

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