Establishing Roots in Rural Regions

Helping Rural Communities Thrive

The relatively new rural health track at the Washington State University (WSU) College of Pharmacy and Pharmaceutical Sciences launched in late 2021 thanks to a $2.2 million gift from an anonymous donor. The program has a three-pronged approach, according to Dr. Angela Stewart, professor and associate dean for rural health. “First, we want to improve access to healthcare for rural residents in Washington state. Most counties in the eastern part of the state are considered medically underserved. We want to develop pharmacists as primary care providers and keep pharmacies open to serve their rural communities,” Stewart explained. “Second, we want to develop pathways into health sciences and into pharmacy for residents from those rural counties. Graduates are more likely to return to practice in those areas if that’s where they have roots. We want them to be successful and then return. Third, we want to foster economic development in rural communities. It’s about keeping those pharmacies open and providing job opportunities for residents.”

A hub-and-spoke model allows faculty and students to work from the main campus in Spokane, the second-largest city in the state, and the extension campus in Yakima, to reach out to rural communities, tribal communities and smaller towns that rely on critical access hospitals. Stewart emphasized that a key aspect of the rural health program is interprofessional engagement. “WSU’s nursing, medicine and pharmacy programs all make rural health a priority. We partner with our colleagues to work together as teams on service learning and clinical experiences in communities right from the beginning.”

The college has a strong network of rural pharmacies and is working to build new relationships. “We’d like to have a well-rounded representation of types of practice sites: some Federally Qualified Health Centers, ambulatory care, critical access hospitals,” Stewart said. “We need to show support for independent community pharmacies knowing that those businesses are really being threatened right now. That’s also a terrific place to grow post-grad training. We’ll get those graduates circling back to those communities to set up practices. The ideal situation would be one of our rural track students working in a community pharmacy on a capstone project that leads to a relationship and them working for that pharmacy and eventually working into a part-ownership situation. We’ll be watching for those opportunities.”

The track’s first cohort of five students completed community IPPEs this summer in underserved areas. A specialized elective course this fall will provide them with background information on what it means to be a care provider in a rural community, and additional electives will focus on supporting rural health delivery. “Students need to complete 10 elective credits and we expect them to do half of those with courses consistent with rural health,” Stewart added. “We are developing a research-based capstone course that will be longitudinal. Students will identify an issue and work with faculty or preceptors to identify a solution and get that implemented. This is an important way to impact these communities really early on in a meaningful way and students will get to publish a manuscript.”

To augment post-graduate training opportunities, the college is working with several community-based organizations to place a clinical faculty member at the sites. “We will embed faculty at those sites with the expectation that they support the development of innovative pharmacy care models,” she said. “They will develop additional training sites and post-graduate residency sites. For example, there are no post-graduate behavioral health training programs for pharmacists in Washington. So one of our priorities is placing a faculty member at a facility that provides mental healthcare for the medically underserved.”

On the other end of the spectrum, the university partners with local school districts to engage with their STEM programs and promote pathways into health sciences careers. “The College of Medicine has a relationship with one school district where they start with 7th graders with a progressive curriculum that introduces them to all of the health professions and prepares them to take the right courses to be able to matriculate in,” she noted. “We’re looking at how to better engage with and extend that program. We have also been able to bring some students to campus to experience pharmacy and develop a relationship with faculty and students. We expect our rural track students to be mentors for prospective students from their communities.”

A Solid Foundation

The University of Illinois Chicago College of Pharmacy also takes a decidedly interprofessional approach with its Rural Pharmacy Education (RPHARM) Program, which started in 2010 when the college teamed up with the rural medical program at its Rockford campus. Four years ago, students from the nursing program also joined the rural track. The program emphasizes interprofessional collaboration and teamwork.

“We do team building at the beginning of every academic year to help students get to know each other and be comfortable working on teams,” said Dr. Heidi Olson, assistant professor and RPHARM Program director. “We have guest lecturers who come in to talk about their role in healthcare to give students a better idea of the roles and responsibilities of other professions. They get to see who they could be partnering with in a rural community.” Students also participate in three rural shadowing experiences (which must include a pharmacist and someone from another healthcare profession).

“A lot of the content is public health-based content that is specifically looking at things from a rural perspective,” she continued. “Population-based health, social determinants of health, community-based research is all part of the curriculum.” To learn how to assess and meet a community’s health needs, second-year students work in teams to create interactive sessions that simulate community health interventions for local students. “This half-day event usually focuses on 4th and 5th graders,” Olson explained. “They prepare educational activities for a local school we partner with and that is their first experience assessing a community and doing an intervention in the form of education.”

During the third year, “each student picks a rural community in Illinois, does an assessment of the health needs and creates a research project, which can include creating a survey or other small intervention. In their fourth year, they implement the research project, do data collection and analysis and present their results at Research Day.” The curriculum emphasizes that pharmacists serving rural populations will probably have limited resources, so they need to be used efficiently. “You might only have two people on a team,” she pointed out, “so communication is important, teamwork is important. Some patients will have needs that aren’t typically a pharmacist’s bread and butter, but you help. One of the ways we teach this is with simulated patient cases. Students are put on small interprofessional teams and they interview a standardized patient and then develop a care plan together.”

For APPE rotations, the college works with rural communities that have enough resources to support both a pharmacy student and a medical student at the same time. “We’ve seen our graduates end up practicing where they’ve done their fourth year projects and APPEs,” she noted. “We require them to do three rural rotations in the same community where their project is based. We’ve seen more than a handful of students go back after graduation to the community they were originally from or where they did their research project.”

The RPHARM program does conduct outreach efforts aimed at sparking younger students’ interest in a pharmacy career. The event geared toward 4th and 5th graders focuses on medication safety and gives students an idea of what pharmacists do. “We have our student pharmacists get involved in the community and provide needed education to the community we live in. Kids are getting exposed to content they might not get otherwise,” Olson said. “We also partnered with the University Extension office to create pharmacy 4-H projects and kickoff events to get local kids interested in pharmacy. The UIC College of Pharmacy also does a summer pharmacy institute, which is focused on pipeline development for college students. A local group does a health careers camp for rural high school kids, and our student pharmacists participate in that by creating an interactive pharmacy activity for the campers to do.”

A key message they want to convey to younger students in rural areas, she emphasized, is that pharmacy is a career option that offers variety in what you can do. “That awareness is the biggest key. We’ve seen that if you get students that are from a rural area, they are more likely to go practice in a rural community and stay there for an extended period of time. We want to get the message out to rural communities that pharmacy is a good career option.”

As WSU’s Stewart noted, “when you are a provider in a rural community, you may be the only person and the most accessible site for healthcare. Pharmacists have to be problem solvers, critical thinkers, excellent communicators and team players, as well as able to lead and engage others. They have to triage problems, maybe some that aren’t typical for pharmacists. They will be trained to implement therapy to save a patient from making a trip an hour away. They need to be aware of their community resources and do efficient handoffs of care, and we want them to be familiar with public health concepts and tools.”

Rural pharmacy care presents myriad career options and a chance to learn skills that are important in any setting, she added. “It’s an opportunity to really make a difference. To be the care provider in that community, you are making a difference for patients every day.”

Jane E. Rooney is managing editor of Academic Pharmacy Now.