Internal Medicine - Rural Health Track Program is Making a Difference in West Virginia

The Rural Health Track provides a dedicated track to residents with a desire to practice in a rural health setting and become leaders and advocates for rural healthcare. Residents learn how to function in resource limited areas and navigate the difficulties of practice in rural settings. The Rural Health Track stresses the development of comprehensive practice skills in several outreach sites in the heart of Appalachia.

Jessica Thayer, MD is the first graduate of the Rural Health Track and Associate Director of the Program. Dr. Thayer gave insight into the program including what to expect as a participant and discussed how the Rural Health Track is impacting the state of West Virginia. 

• Please tell me a little bit about yourself and your journey within the Rural Health Track.

My interest in Rural Health began during my clinical years in medical school here at WVU. It was then that I was introduced to the multiple healthcare barriers facing our Rural Appalachian patient population. I quickly noticed that regardless of the healthcare specialty, discussions of healthcare access and socioeconomic factors were integrated into the medical discussion of treatment and prognosis. When I chose to pursue an Internal Medicine residency, I was excited to find out there was a rural scholar opportunity and designated rural health track so that I could gain knowledge on how to best tackle these unique challenges facing our patients. I have enjoyed learning about innovative solutions to provide high quality care to rural patients, but also the culture and traditions unique to those living in Appalachia. As someone born and raised in the Northern region of Appalachia, it wasn't until participating in the rural track that I came to understand my own cultural lens and how that has come to shape my experiences and understanding of medicine. 

• Please briefly describe the areas in which you have been placed throughout your time in the program. What can you tell me about each one in terms of differentially? How do they compare to each other and how do they compare to a non-rural setting?

The Internal Medicine Rural Scholar program allows fourth year students to tailor their rotations to their unique interests in rural medicine. For my rural elective, I had the amazing opportunity to travel with our Nephrologists providing rural care at satellite clinics throughout the state. I participated in dialysis rounds in Moorefield, saw routine follow-up appointments in Keyser, and new patient referrals at the critical access hospital in Webster Springs. It was there that Dr. Beth Pellegrino gave me advice I follow to this day, 'Never refuse an admission from a critical care hospital no matter the reason.' This rotation taught me the importance of recognizing the difference in accessible resources for a hospital system in a non-rural setting compared to those in a rural setting. 

My start as a resident in the Internal Medicine Department coincided with the beginning of the COVID-19 Pandemic which limited travel to distant rural sites in my first and second year. However, with the pandemic came the rapid implementation and expansion of telemedicine providing me a unique clinical opportunity. During my second year in the rural track I participated in telemedicine appointments in our specialty and subspecialty clinics. This included rotations in the Infectious Disease chronic hepatitis C clinic which had been providing telephone visits prior to the pandemic, Endocrinology clinics seeing new diabetic patients with video visits, the Medical Weight Loss clinic using both forms of virtual visits to provide follow-ups and dietician appointments, as well as our own primary care clinics using telemedicine services for patients unable to be seen in person due to the pandemic. This experience gave me a fast education to the multiple applications of telemedicine as a tool to increase access as well as its clinical limitations. Comparing these two rotations I found the importance of using multiple methods when addressing healthcare access barriers as a way to ensure that all patients regardless of age or location had the opportunity for timely clinical follow-up. 

As a third-year resident I had decided to pursue a career as a generalist with a focus on inpatient medicine. My last rural rotation took place at Garrett Regional Memorial Hospital where I worked with Dr. Margaret Kaiser. She has worked in the community for the last 40 years as an internist providing whatever care was most needed for her patients. Early in her career she worked as a primary care provider seeing her patients both in the clinic and the hospital when they were admitted. Over time she noticed demand for inpatient medicine consults, palliative care, and subacute rehab services for which she gained the additional training and certification and then helped start all those programs. During the pandemic, she noticed the effect required PPE had on nursing care and the time it took to enter a room even for simple things like finger stick checks. So, she approached continuous glucose monitoring manufacturers to provide CGM devices for diabetic patients in the hospital in order to reduce the number of finger stick checks needed during an admission. After this rotation I was inspired by her relentless pursuit of improving rural patient care and expanding available healthcare services for her community. I gained a valuable education on how to approach inpatient challenges facing rural patients with innovative initiatives.

• In your own opinion, how has/is this program impacting the state of West Virginia?

As someone coming from outside West Virginia for my medical education I was not sure where I would end up practicing following my training. The rural scholar program and residency rural track not only provided multiple physician mentors who took a sincere interest in my career but exposed me to a patient population I genuinely love caring for. I feel through external rotations and distant clinical sites, residents working in different rural areas gain not only educational experiences but valuable connections with communities throughout the state. Therefore, whether residents go on to practice as generalists or pursue additional fellowship training, these connections remain and hopefully, bring their skills and qualifications back to communities most in need of them. Furthermore, because of the rural track's focus on quality improvement projects and research initiatives I feel our graduates are uniquely qualified to provide actual clinical solutions to the challenges of practicing rural medicine. All of this together creates opportunities for highly qualified physicians to continually improve healthcare here in West Virginia. 

•  You recently presenting on a research project at the West Virginia RHA and Nation RHA Conference. Can you tell me about your experience?

One aspect of the rural track I was not expecting was the impact on my clinical research opportunities. During residency with help from Dr. Jenna Sizemore and Dr. Spoorthi Sankineni, I applied for an Innovation grant awarded by the Department of Medicine with the goal of improving patient's transition after hospital discharge back to ambulatory care. The funds from the grant went to provide patients with home monitoring devices used to improve control of their chronic medical conditions which were often contributory to their hospitalization as a way to reduce readmissions and improve clinical outcomes. We also provided frequent follow-up telemedicine appointments through the established Transitions of Care Clinic which uses a multidisciplinary team to provide patients with discharge follow-up to address post-hospitalization problems. We found reductions in our pilot cohort's A1c and improvements in systolic blood pressure control through this project as well as significant cost savings due to travel and provided devices for our patients. I was fortunate to have the opportunity to present our findings as a speaker at the 2022 West Virginia Rural Health Association meeting. Additionally, I was selected for poster presentation at the National Rural Health Association meeting in both 2021 and 2022 for the findings of Dr. Kaiser's use of CGM's in the inpatient setting and our Intensive Telemedicine Follow-up project respectively. Without participating in the rural health track I doubt I would have had the opportunities to participate in multiple projects and create my own quality improvement initiatives.  

For more information on the Rural Health Track, click here!