Family Medicine Residency of Idaho (FMRI) has received numerous grant awards to augment resident education and improve patient services for at-risk populations. Grant funds make it possible to expand curriculum to include special programs to enhance the resident experience and to better prepare him/her for practice in rural communities. In addition to grant-funded programs, residents and faculty have independently undertaken ambitious research, such as Dr. Clay Roscoe's Denali research on carbon monoxide toxicity at high altitudes.
Investigating Carbon Monoxide Exposure in High Altitude Mountaineering
Investigating Carbon Monoxide Exposure in High Altitude Mountaineering, an original research project conducted by Caitlin Gustafson, M.D. and J. Clay Roscoe M.D. during the month of May 2004 on Denali in Alaska. The goal of this project was to gain a better understanding of the risk of positive carbon monoxide exposure and toxicity in high altitude mountaineers. Climbers especially, but hikers, campers, and other outdoor enthusiasts included, may be potentially exposing themselves to carbon monoxide on a daily basis while operating portable stoves used to cook food and melt snow for drinking water. The risk of CO exposure is widely suspected in outdoor activities, but limited research has been performed to support this suspicion. This research project was unique in several ways and we believe worthy of consideration for the AAFP Resident Scholars Competition for the following reasons. First, the entire project, from conception to gaining funding, to institutional review board application and review, to the actual research on the mountain was carried out by Dr. Gustafson and myself, both currently family practice residents. Second, this research is the first project of its kind to assess carbon monoxide levels in climbers on the mountain using point of care technology at high altitude. Previous projects have primarily tested subjects in controlled environments at lower altitudes with results needing to be extrapolated to the environments encountered by climbers. Third, wilderness medicine is a growing field in medicine that is well represented by family medicine physicians who serve in positions of leadership, both in research and education, in this rapidly developing field.
Rural Training Track Development
FMRI has been requested by Governor Otter and JFAC to expand and solidify its work in training excellent family medicine physicians for the state of Idaho, and in particular, rural Idaho. The specific purposes are to: 1) expand rural family medicine training; 2) increase rural family physician workforce; 3) improve the support of infrastructure for rural family physicians; 4) expand efforts to prevent smoking and substance abuse; and 5) expand efforts of treating smoking related illnesses and substance abuse disorders. Rural Health Director Dr. David Schmitz has, within the last two years, added a rural training track and numerous rural rotation sites.
Rural Practice Research
FMRI Rural Director, Dr. David Schmitz, is actively involved in several research projects to find out more about the needs and scope of practice of rural physicians, the determinants of a satisfying rural practice, and ways FMRI can better train residents for the challenges of rural practice. Dr. Schmitz works closely with Boise State University and the Idaho Office of Rural Health and Primary Care. He also receives grant funding from the RGK Foundation out of Austin, Texas. Part of Dr. Schmitz’ ongoing work includes gathering information from interns about their attitudes toward rural practice, then tracking their decisions upon graduation with regard to practice choices. He is also designing a study to determine the defining characteristics or traits of those physicians who obtain great satisfaction from rural practice.
Reproductive Health Education In Family Medicine (RHEDI)
FMRI received a two-year grant from an anonymous source to expand residency training in reproductive health services, including family planning, options counseling, prevention and treatment of sexually-transmitted infections, miscarriage management, and early abortions. FMRI works closely with Planned Parenthood of Idaho in this area. This expanded training program, with opportunities in all three years of residency, is an opt-in program for residents.
Federal Training Grant: Group Model of Maternity Care: Innovative Training for Rural Family Physicians
FMRI has received a succession of grants from the federal Health Resources and Services Administration (HRSA). The purpose of the latest HRSA-funded project is to train primary care residents to implement a group model of maternity care while they gain experience and knowledge to accurately and effectively diagnose and treat prenatal and postpartum depression and gestational diabetes mellitus (GDM) in a medically indigent, predominantly Hispanic patient population. Depression and diabetes are problems faced by pregnant women within minority populations, particularly among the medically indigent in those populations. The negative impact on the patient and family of untreated mental illness is substantial, if undiagnosed and untreated. The negative impact of untreated diabetes to the mother and the newborn is significant and almost always avoidable. The economic impact of these conditions, if not recognized and treated, include the high cost of emergency room visits, additional costs for at-risk births.
FMRI will implement a group model of patient care called “Centering Pregnancy.” The model extensively uses a multidisciplinary team to provide enhanced education, clinical assessment, discussion and support to the target population. The target group consists of uninsured Hispanic women and their families; services will be provided in Spanish.
Healthy Communities Access Program (HCAP)
As part of our mission to serve the underserved, FMRI and other safety net providers established a Consortium with the goal of coordinating and expanding efforts to meet the needs of the uninsured and underinsured populations of Ada County, Idaho. Ada County is an urban county in Southwestern Idaho comprising of the communities of Boise, Meridian, Eagle, Kuna, and Garden City, with a total county population of 300,904 residents.
The HCAP project has eight projected activities, each one a building block in increasing access to care, increasing quality of care and chronic disease management, building community linkages, and increasing sustainability, effectiveness and efficiency of the healthcare safety net in Ada County.