Connecting Rural and Public Health Across Hawai'i: A New Rotation for Family Medicine Residents
Date
2025
Authors
Contributor
Advisor
Department
Instructor
Depositor
Speaker
Researcher
Consultant
Interviewer
Narrator
Transcriber
Annotator
Journal Title
Journal ISSN
Volume Title
Publisher
Volume
Number/Issue
Starting Page
Ending Page
Alternative Title
Abstract
Context:
The COVID-19 pandemic demonstrated the importance of local public health working with local health care providers. Yet public health professionals and community clinicians frequently have limited practical understanding of each other’s roles and how to collaborate. In rural communities, this interdependence is arguably more pronounced, as these areas experience disproportionate health care workforce shortages and may be subject to worse health outcomes without a robust primary care and public health safety net. To increase the connection between public health and primary care as well as to incorporate rural health care in Graduate Medical Education training, the authors developed a Rural and Public Health Selective that combines experience working with the local health department and a Federally Qualified Health Center (FQHC).
Objectives:
Develop an educational experience that provides learning in rural and public health for resident physicians.
Evaluate the impact of the experience on residents’ knowledge of the island’s community health landscape, understanding of health equity, and desire to practice in a rural setting after graduation.
Description of Innovation:
The authors along with community preceptors at local FQHCs collaborated over a period of six months to develop a four week Rural and Public Health Selective for third year Family Medicine Residents. This experience is the first official collaboration between a GME program and a district health office in Hawaii. Starting in Fall 2023, all residents must complete this rotation and have the option to choose between rotating on O‘ahu or Kaua‘i for their experience. Residents spend half of their time at an FQHC (Ho‘ola Lahui Hawai‘i on Kaua‘i or Waimanalo Health Center on Oahu) working under the supervision of primary care physicians to provide direct patient care. The other half of their time is spent at the local district health offices working alongside and learning from public health frontline staff. Learning experiences here include a combination of foundational public health readings, community health needs assessments, and field experiences with public health staff.
Specific rotation objectives upon completion include for residents to:
Identify a policy issue that may have unintended health consequences and describe at least one way advocacy could address those consequences
Describe at least 3 ways in which primary care and public health intersect
Participate in at least 3 public health field activities
Residents spend time with the physician DHO, attending local, statewide, and national meetings and workgroups. Specific field activities are driven by program schedules tailored to resident interest and have included mosquito surveillance, leptospirosis testing and data review, Hansen’s Disease clinics, and many more.
Evaluation of Innovation:
The authors gathered evaluation data and feedback from the residents through a confidential online survey distributed upon completion of the rotation as well as informally through an exit interview. As of this submission, ten residents have completed the rotation with an even mix between those who rotated on Kauai vs Oahu. Seven residents have completed the evaluation survey thus far (70% response rate). Resident feedback has been generally positive, particularly for the Kauai experience, with comments reporting an improved understanding about DOH operations. 85% of respondents expressed they had improved knowledge about the community health landscape of the island where they worked and 85% also expressed increased or strongly increased understanding of health equity. 43% of respondents stated this experience increased their interest in practicing in a rural area after graduation. The remainder (57%) expressed no change in interest though comments suggested that many of them already had an interest in rural practice. 71% of respondents reported an increased interest in pursuing opportunities for advocacy at the local, state, or national level.
Discussion:
This collaborative initiative has enriched public health staff and Family Medicine resident training. Resident comments, written assignments, and final presentations indicate goals and objectives of the experience are well met. Residents strongly prefer experiential activities: “Let us join you while you do your work; don’t just tell us about it.” Regarding disease reporting, one resident commented, “I’ve been a bad doctor; I’ll do better from now on!”
This work may be applicable for others working to enhance cooperation between public health and health care providers. Future directions include replicating aspects of this experience in other district health offices and including more structured experiences for advocacy or longitudinal projects. Limitations include the small sample size and reliance on self-report; future evaluations can measure graduates’ practice location and application of knowledge gained from this experience.
Key Message:
A first of its kind Rural and Public Health Selective in Hawaii has been a valuable experience for resident physicians with improvements in knowledge about the intersection of rural health and primary care.
Target Audience:
All health professions educators, trainees interested in rural and/or public health
Description
Keywords
Citation
Extent
Format
Geographic Location
Time Period
Related To
Related To (URI)
Table of Contents
Rights
http://rightsstatements.org/vocab/InC/1.0/
CC BY-NC-ND
CC BY-NC-ND
Rights Holder
Local Contexts
Collections
Email libraryada-l@lists.hawaii.edu if you need this content in ADA-compliant format.