Partnerships to Establish and Sustain Rural GME: Q and A with Glenn Gookin, MD, PhD, FAAFP of the Sierra Nevada Family Medicine Residency Program
This interview is part of a series featuring Sponsoring Institutions and programs providing rural graduate medical education (GME) experiences. The series was initiated following the 2022 ACGME Annual Educational Conference presentation on Medically Underserved Areas/Populations: Partnerships to Establish and Sustain Rural GME, available in the ACGME’s digital learning platform, Learn at ACGME. Note: an account (free to create) is required to access most content in Learn at ACGME.
The Dignity Health Methodist Hospital of Sacramento/Sierra Nevada Memorial Hospital Family Medicine Residency Program (SNFMRP) is a rural training program. The Sponsoring Institution, Dignity Health Methodist Hospital, also sponsors an urban/suburban community-based program in South Sacramento, California. Both programs are committed to serving underserved patient populations. The urban program is based in one of the most diverse cities in the country. The diversity of Sacramento is reflected in the program’s residents, faculty members, and staff members. The urban program is the first in the country to have a medical safe haven providing full spectrum trauma-informed primary care for victims and survivors of human trafficking. The program has strong inpatient training, with nearly one-third of graduates working as hospitalists and an additional 10 percent working in a hybrid inpatient and outpatient role. Dr. Glenn Gookin is the founding program director of the rural SNFMRP. He is a volunteer clinical faculty member at the University of California Davis (UC Davis) School of Medicine and Touro University School of Medicine.
ACGME: What drew you to academic medicine and to rural GME specifically?
Dr. Gookin: I was a chief resident, and I always enjoyed teaching my junior peers. My personal experiences with mentorship have been so important to my professional development, and that led me to want to share my learned knowledge with developing physicians. During my second year of residency, I met Randy Longenecker, MD who took me out to dinner at a conference and told me about his experiences and rural GME. He encouraged me and stoked a kernel of an idea that I had about a new rural training program in the Sierra Foothills. With the support of many physician and non-physician colleagues, we applied for a HRSA [Health Resources and Services Administration]-sponsored grant that started our rural residency program. Participation in this grant program introduced me to many rural family docs. The Rural Medical Training Collaborative has also been a huge source of knowledge and mentoring and encouraged my rural passion. I hail from a small mountain community in Southern California, so a smaller community has always drawn me back.
ACGME: Describe the rural GME experiences within your program (e.g., types of sites, structure, curriculum).
Gookin: About two-thirds of our program is in a rural setting. Residents complete their intern year at Methodist Hospital and Mercy Family Medical Clinic in Sacramento, California. In their second and third years, residents learn and train in the beautiful historic town of Grass Valley, California at Chapa-De Indian Health Clinic, a Tribal federally qualified health center (FQHC); Sierra Nevada Memorial Hospital; and local subspecialty outpatient offices. Our mission is dedicated to training well-rounded family physicians in underserved rural communities. We have a block schedule with two- to 4-week rotations. Additionally, we have longitudinal experiences in medication-assisted therapy for Opioid Use Disorder, primary care in tribal communities, and soon, street medicine. Residents have access to wilderness medicine training, point-of-care ultrasound, and lots of community engagement. They are critical to providing sports physicals for our local high school students, and lead walking events with members of the community to engage with them outside of the walls of the clinic. We have a robust inpatient experience in our rural sole community hospital with obstetrics, intensive care, adult medicine, and emergency medicine.
ACGME: How did your Sponsoring Institution and program become involved in establishing rural GME experiences?
Gookin: As a HRSA Rural Residency Planning and Development grant recipient, our Sponsoring Institution was positioned to support our rural hospital. Being in the same system (Dignity Health) lowered barriers. The support of the designated institutional official (DIO) was key – Dr. Chambers (our DIO) hails from rural Northern California, so he was a very supportive program champion.
ACGME: Describe the internal and external partnerships that have been important in establishing and sustaining these experiences.
Gookin: The most critical partnership has been between the rural community hospital, Sierra Nevada Memorial Hospital, and Chapa-De Indian Health, the continuity clinic. Chapa-De is a Tribal FQHC with an independent tribal board that, prior to this partnership, was GME-naïve.
ACGME: Describe the challenges you have experienced in developing and sustaining rural GME partnerships and experiences; and explain how you have overcome them.
Gookin: Relationship-building between the organizations and regular discussions on governance have been key. The leadership of the CEO at Chapa-De Indian Health, Lisa Davies, and the hospital CEO, Dr. Scott Neeley, have been critical to our success. Forming affiliation agreements that are respectful to the mission of each organization was time-consuming and critical to ensure each partner is being heard and respected. Most of our challenges have been overcome by regular communication. Most barriers were due to finances and knowledge gaps, so regular meetings are key.
ACGME: Describe some of your program’s outcomes since establishing rural GME experiences, including the impact to the surrounding community.
Gookin: We are a new program welcoming our third class of residents this Match cycle. In the hospital, our patients have been giving high praise to the care residents are delivering. One of our residents is publishing a case report on a multidisciplinary case that had a great but unexpected outcome. Our residents have participated in multiple community events with strong positive feedback from community members, as well as in multiple committees, improving our code blue and quality committees specifically.
ACGME: What advice do you have for those interested in establishing rural GME experiences?
Gookin: Ensure your mission statement is thoughtful and reflects the needs and goals of the community. I hear from community members every week about the shortage of primary care physicians in our region. Our mission is to build that workforce, but do it thoughtfully with retention of these physicians. Any program built only for labor will not be successful. You need to be training physician leaders who will participate and improve the community they live in. That requires regular engagement and modeling by your faculty members and residents.
ACGME: Describe the resources that have helped your program to establish rural GME experiences.
Gookin: The resources and networking from the Rural Medical Training Collaborative have been invaluable. I attend their webinars and annual meeting every year. Ruralgme.org is a free resource to which HRSA and countless rural physician GME leaders have contributed. Their toolbox has many great resources, so you do not have to recreate the wheel. The American Academy of Family Physicians and their arm focused on residency program director education, AFMRD, have also been key in training our faculty members. You are not alone in this effort; reach out to other physicians. There are so many great leaders who will mentor you in establishing your program.
ACGME: Is there anything else you would like to add we haven’t asked about?
Gookin: Our mission is service to underserved rural communities in line with our urban program. Every time my urban faculty members come up for meetings or presentations, they are astounded by the community support we receive. Living in a rural community means less anonymity, but more engagement. Our community is the reason our program exists and it has supported GME with open arms.
Email muap@acgme.org if you want to get in touch with Dr. Gookin. Is your Sponsoring Institution/program already providing rural GME experiences and would you like to be featured in a future post in this ACGME Blog series? Email muap@acgme.org to share what you’re doing. Visit the MUA/P web page to learn more about the ACGME’s efforts.