NEPA AHEC NewsSpring/Summer 2000

AHEC Has "Ultimate Opportunity" Programs Benefit School Children K - 12 Schools Surveyed on Health Education How Well Are Students Prepared for Health Sciences Schools? Value of Community Based Teaching to Students, Preceptors ...

NEPA AHEC Works to Improve Access to Primary Health Care Services

The Northeast Pennsylvania Area Health Education Center, known as NEPA AHEC (pronounced A-heck) is one of six centers serving the state as part of a national approach to improve access to primary health care services in underserved regions. It serves nine counties in northeastern Pennsylvania, and is centrally located on the campus of Keystone College in LaPlume.

This is the first issue of its newsletter, Access Health, which will help you learn more about NEPA AHEC and how it can work with you to improve health care. Your comments and suggestions about the newsletter and our services are always welcome.

In 1970, the Carnegie Commission on Higher Education recommended the establishment of AHEC's as a national strategy to address the shortage of primary care physicians and the maldistribution of health professionals. With the impetus of the Carnegie report, the national AHEC program was established in 1972. Its purpose was to improve the supply, distribution, retention, quality, utilization and efficiency of health professionals in order to provide primary care services in medically underserved areas. An important ingredient in the AHEC structure is a partnership with a medical school. This links the academic resources of university-based health professions training to the clinical training opportunities available in underserved communities.

Legislation and federal support since the 1970's have created 45 AHEC programs in 43 states. All are dedicated to bridging the gaps that exist between primary health care and the population.

The Pennsylvania State University College of Medicine established the Pennsylvania AHEC program in 1994. The NEPA AHEC was incorporated as a 501(c)3 in July 1999, becoming the sixth AHEC in the state. It serves nine counties: Bradford, Lackawanna, Luzerne, Monroe, Pike, Sullivan, Sus-quehanna, Wayne and Wyoming.

The need for AHEC's in Pennsylvania is clear. According to Status Check II Pennsylvania Rural Health Care, prepared by the Pennsylvania Rural Health Association in October 1999, "there is a shortage as well as a maldistribution of primary care providers in Pennsylvania. In 1996, rural Pennsylvania had roughly one physician for every 655 residents. In urban areas, the ratio is one physician for every 325 residents. This gap widens even further when focusing on primary care physicians.

"According to the most recent data, there are nearly 11,680 primary care physicians in Pennsylvania. Only 13% practice in rural areas ... Furthermore, nearly 25% are aged 55 or older, indicating many may soon retire. While some progress is being made in alleviating rural Pennsylvania's critical physician shortage - from 1994 to February 1996, the number of physicians in rural areas increased by 3% - the problem remains significant."

In response to that need, the Pennsylvania AHEC advances four strategic objectives, as follows:

• Increase access to primary health care services.
• Recruit and retain primary health care providers.
• Promote workforce diversity for health care professions.
• Advance community education and public health initiatives.

To Increase Access to Primary Health Care Services, the AHEC model works with all types of colleges, schools and training institutes, plus a wide variety of health science students, such as doctors, nurse practitioners, physician assistants, dentists, pharmacists, social workers, public health students, therapists, etc. The goal is to have students placed at an AHEC site for their clinical rotation/internship, with the hope that they will then choose to practice in these areas upon completion of their studies.

Recruitment and Retention is Promoted Through Innovative Practice Support Programs and Community Resource Development. The NEPA AHEC will be looking for all types of health care practitioners in the nine counties to serve as preceptors for students during their clinical rotation/internship. The AHEC, in parrtnership with other institutions and organizations, offers preceptors continuing professional education, faculty development, technological support and school affiliations for their efforts. AHEC's also support all practitioners in the region by offering continuing professional education programs in a wide range of subjects and disciplines.

Workforce Diversity for Health Care Professions is Promoted by Linking With Existing Workforce Development Programs to Recruit and Retain Under-Represented Populations for Health Care Professions in Local Communities. Health career opportunity programs are important vehicles for identifying individuals interested in returning to their "home" community as practicing health care professionals. All AHEC's work to encourage a wide range of students to enter the various health professions and return to practice in medically underserved areas. Among many potential activities, the NEPA AHEC, in collaboration with local and regional educational institutions, works to expand math and science readiness, enhance health career awareness, and mentor potential health science scholars.

To Advance Community Education and Public Health Initiatives, the AHEC also strives to identify regional health risks. Efforts are made to partner with existing local, state and federal programs as a means to address identified health risks. The AHEC actively encourages health promotion and disease prevention through community education and public health initiatives.

Board Chair Sees Opportunities

A blank sheet of paper ... We've all heard that expression. To some it's an extremely daunting vision, to others it's the ultimate opportunity. As the Board Chair for the Northeast Pennsylvania AHEC, I know that our Board sees it as the ultimate opportunity. We've spent more than two years getting to this point and we are still working to refine our priorities and our long-term direction.

For the short term, we have accomplished a great deal. We have completed the initial organizational work of articles of incorporation, by-laws, bank accounts, budgets, personnel policies, payroll, benefits and much more. We brought together an excellent Board that is committed to the best of health for all of Northeastern Pennsylvania. We hired a staff ... a very talented, enthusiastic and dedicated staff that knows Northeastern Pennsylvania. They are professionals in every sense of the word. I know you'll be hearing much more from Pat, Vera and Nancy as time goes on. We welcome them and look forward to many accomplishments in the years to come.

We've put some pencil to the paper and have begun to develop the plans that will be the framework for our future. They are not, by any means, complete or final. More work needs to be done. Any ideas that you have for us to consider are welcome. Please contact Pat or me. We'll be happy to discuss them with you.

Meanwhile, let's all rally and put Northeast PA AHEC in the forefront of a healthy region!

Michael Stershic, Board Chair

AHEC's, in their effort to positively impact recruitment and retention, have traditionally supported numerous school age programs. Math/Science readiness, health career awareness and basic health habits are just some of the areas of interest for the NEPA AHEC. The NEPA AHEC, in partnership with the Intermediate Units 19 and 18, regional school districts and community partners, offers the following programs:

GREAT HOSPITAL ADVENTURE PUPPETS

Designed for Preschool through fourth grade, this multi-media presentation includes a live puppet show, video coloring book, classroom poster and interactive question and answer session. The program promotes health career awareness and encourages healthy behavior for children ages four to nine. The classroom materials and activities emphasize non-traditional gender roles and multi-cultural images.

MY HEALTH, MY WORLD

The award-winning "My Health, My World" project has developed educational materials on current environmental issues for students in grades K-4. The goal of this project is to promote a deeper understanding of the relationship between the environment and health, while conveying the excitement of "doing science." Project materials engage students and their families in environmental issues as they learn fundamental physical and life science concepts and acquire problem-solving and decision-making skills. To date, three "My Health, My World" units have been developed, tested and finalized. Units include "My World Indoors," "Water and My World," and "My Home Planet Earth."

BRAIN LINK

Developed by Baylor College of Medicine, the BrainLink Project's exciting ACtivities, Explorations, and Adventures "link" students, teachers and parents to advanced knowledge of the brain and nervous systems and to vital science and health information. BrainLink is designed for third through sixth grades, but can be adapted to all age and grade levels.

BRAIN BEE

In conjunction with this year's University of Scranton's 15th Annual Psychology Conference on February 26, the region's first annual Northeast Regional Brain Bee was held. High school students were quizzed on facts about the brain. The winner, Tom Burke of Seton Catholic, can compete in the International Brain Bee. Sponsored nationally by the Society of Neuro-Science, the Regional Brain Bee was moderated by J. Timothy Cannon, Ph.D., University of Scranton. Get ready to participate in next year's Brain Bee.

Schools Surveyed on Health, Science and Health Careers Programs

Surveys were mailed to 239 principals of elementary and secondary schools in the region to determine their current programming in health, science and health careers awareness, and their interest in enhancing those programs. A response rate of 48%, representing 114 principals, was obtained. Most respondents represented medium-sized schools (300-800), but 22% of elementary schools were classed as small (under 300), and 31% of secondary schools were classed as large (over 800). Slightly over half the schools are classed as rural, with 32% suburban and 11% urban. Most schools (71%) in the sample do not have a significant minority population. Only 4% of schools have greater than 25% minority populations, and these are in urban and suburban areas. However, over one-third of schools with minority populations between 5 - 25% lie in rural areas. Rural schools are also not necessarily small; 42% of the large schools are rural secondary schools.

Nearly all schools offer both basic science and basic health classes. Most (89%) supplement basic courses with additional programs such as special units, science enrichment, science clubs and fairs, and/or health fairs. Just over half the schools provide career-oriented programming such as career days or health career programs.

Although a few schools provided lengthy lists of community organizations with which they partner to enhance health, science or health careers programming, most schools (61%) indicated that they did not have such partnerships. The majority of partners were found in nearby hospitals and colleges/universities.

Well over half (64%) indicated an interest in providing additional programming in health/science enrichment or health careers education. Health and science enrichment opportunities, desired by about half of respondents, appeared to be of greater interest than health careers enrichment, which was of interest to 39% of the principals. About half the schools which expressed interest in providing additional programming also expressed interest in additional training in health, science and health careers programs.

Surveys Conducted by Rutgers Student Intern

Kate Germershausen of Scranton, a student intern in public health from Rutgers University, spent over 100 hours in December 1999 conducting the above survey of elementary and secondary principals regarding how they prepare students in health, science and health career awareness. She also conducted a corresponding survey of health science institutions in our region regarding the preparedness of students entering post-graduate programs. The NEPA AHEC will use the results in facilitating projects to help the K-12 schools and health science institutions meet their expressed needs. The results of the health sciences survey are found on page 6. If you wish to obtain more detailed information on survey methods or results, or if you wish to suggest or participate in any potential projects, please call the NEPA AHEC. Your input is much appreciated.

In January 2000, the NEPA AHEC mailed surveys to 42 program directors of health science institutions. Thirty-two responded (76%), sharing their thoughts on secondary school preparation for their programs. The respondents considered only about half their students to be prepared to undertake their programs, which included the range of health sciences from technicians to advance practice nurses. The following observed preparation levels were reported for specific areas (poor=1, satisfactory=2, good=3, excellent=4):

Critical Thinking/Problem Solving= POOR to SATISFACTORY (1.8)

Written/Oral Communication= POOR to SATISFACTORY (1.8)

Knowledge Base in Science= SATISFACTORY (2.0)

Knowledge Base in Math=POOR to SATISFACTORY (1.7)

Interest in Acquiring New Knowledge= SATISFACTORY to GOOD (2.6)

These responses indicated the student's ability to meet minimal standards, which was a primary irritant to many reposndents, exemplified by the comment, "Most are satisfied to perform at mediocre levels instead of striving for excellence." There were also comments related to students' high school preparation, such as, "Standards and expectations at the high school level need to be raised."

Most of the health science institutions place students in community settings, called variously clerkships, clinical practica, internships and rotations. Fifteen of the institutions (47%) would like the assistance of the AHEC in placing students in community experiences at this time, and an additional 12% suggest that such help would be desired in the future.

AHEC Co-Hosts "Race, Class & Health" Videoconference

The NEPA AHEC and Luzerne County Community College hosted a videoconference in January 2000 entitled "Race, Class & Health" and presented by PBS and George Washington University. The two-hour discussion was led by a national panel active in research,planning and community action for racial and ethnic minorities and for those living in poverty. Interspersed throughout the discusion were film clips of programs throughout the country that are successfully dealing with these issues. Videotapes of the program are available in the lending library of the Peace Center in WIlkes-Barre and from the NEPA AHEC office.

Each AHEC in Pennsylvania has a sponsoring medical school. While AHECs work with all health professional schools, the sponsoring school has made a special commitment to the support of the regional AHEC. The NEPA AHEC's sponsoring medical school is Thomas Jefferson Medical College of Thomas Jefferson University.

The Carnegie Commission on Higher Education realized the value of community-based teaching, and AHECs were established to decentralize the education of health professionals. The NEPA AHEC will be looking for preceptors and practice sites throughout the nine-county region to assist in the education of health professional students. Many of the regions's practicing health professionals have unique skills and experiences which can offer a rich learning environment to the student. (The following is an excerpt from the Penn State College of Medicine Preceptor Manual. While it refers to medical students, it can easily be modified to apply to all health professionals):

What do preceptors get from working with students?

Clearly, students take time and energy. Yet most preceptors value their teaching experience. The most common mentioned benefits are:

~ the joy of watching a student develop

~ the opportunity to be challenged about how medical decisions are made

~ the intellectual stimulus a student provides to "keep up" with the literature

~ reintroduction to the basic sciences and how they are involved in disease and illness

~ the opportunity to influence a student's career

~ the opportunity to share one's knowledge and experience

~ increased prestige with patients

What do preceptors offer students?

Although few patient encounters result in hospitalization, the bulk of clinical training occurs in the inpatient setting. For family medicine and other primary care specialties, educators believe that community-based practices present a more realistic view of family medicine and the family physician's role. Among the unique goals that a preceptor can offer students are:

~ modeling a community physician's role

~ illustrating the attitudes of a primary care physician and demonstrating comprehensive, person-centered -- not disease-centered -- care

~ modeling the skills required to provide effective patient care in time-limited encounters

~ helping students acquire knowledge about common problems often overlooked when specialists teach medical students

~ teaching students to effectively use community resources in caring for patients

~ allowing students to evaluate patients first and gather data independently

AHEC Joins Beck Circuit Library

In order to better support preceptors and students in the northeast region, the AHEC has joined the Beck Library Circuit. This system will allow unique access to an extensive database for AHEC preceptors and students right in their office.

The online database service contains over 200 full text journals and 31 full text medical reference books. The library also houses extensive links to associations and organizations, databases and direct-ories, education and personal development sites, health in-formation sites, and statistics of interest to the health professional student and practitioner in our region. In addition, there is an online request form with a one day or less turn around for all types of health care information.