RURAL HEALTH EDUCATION
ECU health sciences prepare its graduates to lead the rural workforce
The college and schools on East Carolina University’s Health Sciences Campus share a mission produce top-notch health care professionals to serve North Carolina.
A key component of that commitment is innovation in delivering education and patient care in the most rural and underserved communities, as well as rural health-focused courses, field work, research and programs that emphasize the need for better access across the state
ECU’s innovative rural health focused education is taking place across North Carolina, from nursing students caring for Alzheimer’s disease patients in the East to the rotations dental students complete community service learning centers in the mountainous western portion of the state.
Here’s a look at how the colleges and schools on ECU’s Health Sciences Campus are addressing North Carolina’s rural health care needs and challenges through education.
College of Allied Health Sciences
In the College of Allied Health Sciences, patient care includes valuable learning experiences for students on how to provide care in rural settings and for patients from rural communities. Rural health care is central to the school’s mission.
“Our students learn about the importance of transforming health care, promoting wellness and increasing access to health care for the people of eastern North Carolina,” said Dr. Leigh Cellucci, associate dean for academic affairs. “Students spend time with patients and clients from rural areas. They learn firsthand the importance of access to health care.”
Bilingual and Mexican-American Graduate Assistant Rocio Vega enrolls a patient into the Fresh Start program at the W.A.T.C.H. Clinic in Goldsboro, North Carolina. (Contributed photo)
ECU’s College of Allied Health Sciences is North Carolina’s largest allied health sciences college at a four-year institution. It has a fall 2022 enrollment of 1,481 students and boasts more than 10,000 alumni. Close to 75% of its graduates remain in North Carolina to work, with more than half of those working or living in eastern North Carolina.
The school’s clinics, including the Speech Language and Hearing Clinic, the student-run Physical Therapy Clinic, the new dtudent-run Occupational Therapy Clinic, and the Navigate Counseling Clinic see patients from rural areas of eastern North Carolina. Other initiatives created in the college are aimed at addressing health care challenges for special populations.
Rural health is a key component across the school’s departments in order to prepare students for careers anywhere they are needed.
“It is of critical importance that small hospitals in eastern North Carolina employ highly-qualified clinical laboratory science professionals to work in their labs to provide better health care,” said Dr. Guyla Evans, chair of the Department of Clinical Laboratory Science. “The people of eastern North Carolina deserve this, and we accomplish this.”
Dr. Paul Bell, professor in the Department of Health Services and Information Management, said preparing students through curriculum and experience will enable them to better understand the importance of access in improving health care services.
“Health care administrators serve an important supportive role to ensure better health for the people who live in our rural communities, and our understanding that access to primary care, particularly preventive care, will improve our health is central to our mission of transforming health care delivery,” he said.
Physician Assistant Studies student Allision Priest said the college not only prepares students but provides them invaluable resources to assist patients that will be relevant into their future careers.
“(Our faculty are) not only inspiring us to work in those rural fields, but they’re also giving us resources to be able to help the people that are living in those places,” Priest said. “We’re really diving deep into health inequities and understanding food deserts.”
The Brody School of Medicine
The East Carolina University Brody School of Medicine educates students about the obstacles patients in underresourced must overcome to receive health care.
“The majority of the counties in this state are rural, so if we are going to proclaim to improve the health status of eastern North Carolina we have to be prepared to do so in a rural environment,” said Dr. Matthew A. Rushing, family medicine clinical assistant professor and assistant residency director.
The school values recruiting mission-fit students with a rural background, experience with underserved populations and a track record of community and service engagement.
Brody medical students learn in the Clinical Simulation Lab. (ECU Photo by Cliff Hollis)
Brody is over the 90th percentile nationally in graduates practicing in rural areas with 12% of graduates practicing compared to a national median of 4%, according to the Association of American Medical Colleges Mission Management Tool. Brody also has the highest retention of graduates practicing in rural North Carolina counties five years after graduation among other medical schools in the state, according to the Sheps Center report on 2022 Outcomes of NC Medical School Graduates.
With more Brody graduates practicing in the state than any other medical school it is a testimony to the school’s mission, Rushing said.
“This work is more than important — it’s necessary, and this is where Brody education truly shines,” Rushing said.
Training for service in rural areas starts as early as the first year of medical school for Brody students, with a series of standardized patients whose stories are set in the rural communities of eastern North Carolina that first-year students encounter as they learn to conduct patient interviews as a first step in diagnosing patients.
First and second-year Brody students are offered a course on Society, Culture and Health Systems that included a research project that focused on county health systems. Students gathered data on one county health system and population, used the data to examine the county’s COVID-19 response, and developed and answered a research question related to the health system as it related to course concepts.
“The purpose of this project is to bring the topics and concepts covered in our course to life a real and local way,” said Dr. Sheena Eagan, course director and assistant professor. “The project highlights the vast differences between rural, urban and suburban counties, reinforcing the idea that counties can be adjacent and yet have vastly different health systems contributing to disparities in health status.”
The course helps students examine the barriers to optimal health that residents face in rural North Carolina.
“Students examine the health care systems currently in place and determine if there are better ways to deliver quality health care to populations that are in these settings,” said Dr. Cedric Bright, interim vice dean and associate dean for admissions.
Second-year students also examine how to better address the lack of access from hospitals closing as well as private practices, and how that impacts preventive medicine and population health.
As they move into the third and fourth years, Brody’s Family Medicine Clerkship places students in community clinics where they see first-hand how rural physicians care for their patients. Students on their Family Medicine and Pediatric clerkship rotations spend up to half of their training in a rural, community setting. Medical students are assessed on their ability to communicate with patients in a caring, compassionate, and effective manner.
Students choose from elective courses to gain exposure to a variety of medical specialties and explore individual interests. Students can participate in an elective led by BSOM faculty to serve rural communities in Zambia, which allows students to serve the needs of an international community. Students can also complete a combined Internal Medicine/Pediatrics Acting Internship at ECU Health Duplin Hospital or ECU Health Edgecombe Hospital.
“Rural medicine requires an element of ingenuity — patients living in rural areas have health care needs that are shaped by the resources they are (or aren’t) able to access easily in their communities,” said Emmalee Todd, a third-year medical student. “Even for those of us who will end up at large tertiary-care centers, understanding what goes into rural medicine can help us better serve patients coming from those areas.”
In the fall of 2021, Brody and ECU Health Medical Center, formerly Vidant Medical Center, launched a new Rural Family Medicine Residency Program to equip physicians with specialized training in caring for patients in rural and underserved communities.
Residents spend a majority of their first year of training at ECU Health Medical Center and ECU’s Family Medicine Center in Greenville before spending the next two years training in rural health care centers in eastern North Carolina.
The complete Brody experience provides an integrated curriculum focused on health systems science for all four years, adding to students’ foundation for practicing rural health by using an authentic, embedded approach to patient safety, population health and team-based care.
“Ultimately, we hope that from this curriculum, the next generation of leaders will arise to meet the needs of the people in eastern North Carolina,” Bright said.
Department of Public Health
The Department of Public Health at the Brody School of Medicine provides a strong foundation of understanding the challenges of rural health.
“The needs of rural people are distinctly different than those in urban or more urban communities,” said associate professor Dr. Ruth Little. “In order to successfully facilitate rural health improvements, this population has to be first understood.”
The department requires Master of Public Health students to take a course on Interdisciplinary Rural Health, which includes topics from the concentrations of epidemiology, health policy and leadership and community health and health behavior.
“In epidemiology, we lay the groundwork for rural and urban comparisons, ultimately demonstrating that for many health indicators rural communities suffer a higher burden of disease than their more urban counterparts,” said Dr. Nancy Winterbauer, associate professor. “In health policy and leadership, we examine reasons for these disparities, including the impact of race, access to health services and policy on rural health. Finally, the community health and health behavior concentration focuses on rural health improvement, especially in the areas of health behavior, community engagement and advocacy, evidence-based interventions and public health practice.”
Little said rural communities in the East have a bleaker health outlook than the regions in the middle and western portions of the state.
“It’s important to help our students not only understand this, but in addressing these health disparities, engage students with rural communities, providing opportunities for us to work together to improve population health,” Little said.
Student Brandon Stroud said the curriculum in rural health is preparing him to be able to think critically to solve problems in rural communities.
“Often, these counties have a much lower median income compared to their urban counterparts, there are fewer healthy food resources, recreational spaces, less health care providers and limited access to specialty care,” he said. “All these factors simultaneously cause higher incidence of chronic illnesses and poor health outcomes. That is why it is so critical we learn about these issues, how rural health care systems are working to address them and urge more public health practitioners and health care providers to serve them.”
The College of Nursing
ECU’s College of Nursing graduates close to 79% of nurses employed in North Carolina, with 39% serving eastern North Carolina. Nearly 60 graduates chose to work in one of the state’s 40 most distressed counties, as designated by the North Carolina Department of Commerce.
Specific nursing courses and programs encourage students to gain exposure to health care settings where they will care for patients from every life situation.
“In community health, we ensure that our students are prepared to take care of patients in all environments,” said Lesha Rouse, clinical instructor. “In this course, the student will complete a community service learning project (CSLP), expanding perspectives of ‘health care’ from the individual, acute care focus to a population-, community-based focus.”
Nursing students at every level receive instruction and experience caring for patients in rural settings.
Nursing students listen to instructions during the standardized patient training. (ECU photo by Rhett Butler)
“Students are training in a number of ways, including traditional lecture and course content as well as through experiential and simulated learning,” said assistant professor Dr. Stephanie Hart. “This is particularly important relative to practice in rural areas, where students are exposed to the realities of the social determinants of health — the primary drivers of population health outcomes.”
Hart said undergraduate students prepare to enter clinical rotations in rural areas by learning about the social determinants of health and the unique needs of rural communities.
“They build upon their knowledge of rural health through their participation in a windshield survey of an eastern North Carolina county, which provides them with the opportunity to drive around the county making observations of community members and their environment,” she said. “From there, they continue to explore these communities in detail through review of the county community health needs assessment and engaging with community members and key stakeholders to gather insight into community strengths and needs.”
The majority of undergraduate students, including those in traditional BSN and accelerated BSN programs, complete an 85-hour clinical rotation in community health or community-based settings to further add to their experience in rural areas.
“They are able to successfully integrate into the clinical learning environment, where they not only learn more about the unique needs of the individuals and communities served by these agencies, but they are afforded several opportunities to apply course objectives in practice,” Hart said.
She added that ECU’s College of Nursing and one of its partnering clinical agencies, 3HC Home Health and Hospice Care, Inc., received funding from the Hospice and Home Care Foundation of North Carolina to participate in a pilot project designed to address the shortage of home care nurses across North Carolina, particularly in rural areas.
“This project resulted in new approaches regarding the training, recruitment and integration of newly graduated RNs (registered nurses) into home health and hospice agencies,” Hart said.
The college has also received funding from Eastern AHEC for the last several years to develop new clinical training sites for nursing students, most of which are situated within rural, underserved Tier 1 or Tier 2 counties.
Hart said these programs and curricula offer students exposure to prepare them to work in those same settings as professionals.
“When we train health care professions students to work with and understand community health and rural health care, we aim to eliminate these gaps by facilitating recruitment and retention efforts of health care professionals in rural areas, reduce workforce shortages and increase diversity in our workforce,” she said.
The college also has a Health Resources and Services Advanced Nursing Education Workforce grant that allows the college to train a select number of advanced practice registered nurse students to care for patients in rural and underserved areas, including patients who are farmers, loggers and fishers — occupations prevalent to North Carolina that also present industry-specific health hazards. The program, APRN Rural and Underserved Roadmap to Advance Leadership (RURAL) Scholars Program, includes a graduate-level course in agromedicine with practical experiences with the farming community.
“Students are provided generous stipends to participate in the program, which includes instruction in rural health and health disparities, clinical practice in rural and underserved communities and training in telehealth and telepsychiatry,” said Dr. Pamela Reis, associate professor and interim Ph.D. program director in the College of Nursing.
So far, 47 students have graduated from the program and are providing care in these communities across North Carolina; there are 17 students in the current cohort.
Dr. Michelle Skipper, director of the doctor of nursing practice program, said educating nurse practitioners to the needs of rural patients is critical for the transformation of the region’s health care delivery.
“We can recruit nurses from rural communities, train them as primary care clinicians, and return them for long-term service to the community which already trusts them,” Skipper said. “Receiving care from a nurse practitioner is ultimately an ideal choice in small towns, not simply a ‘consolation prize’ because other health care professionals don’t want to live and work there.”
Dr. Donna Roberson, professor and director of the Alzheimer’s Disease and Related Disorders, Carolina Geriatric Workforce Enhancement program grant, said it is crucial to educate nurses about the aging population and some of the diseases that are more prevalent among older adults.
“As our eastern North Carolina citizens age, their risk for dementias like Alzheimer’s Disease increase,” she said. “Most are living in their communities and are cared for by family caregivers. Their health care providers (medical doctors, nurse practitioners and more) need to have a good understanding of what the person living with dementia experiences and what their family has to manage.”