People living in rural areas are generally at higher risk of disease and death than people living in urban areas. These differences in risk are known as rural health disparities and are caused in part by less access to health care because of fewer providers, environmental exposures, and higher rates of smoking, obesity, and high blood pressure.
Addressing the issue of access to improve the health of rural populations is one of the strengths of the relationship between VP&S and Bassett Healthcare Network in Cooperstown, New York.
The network's anchor facility, Bassett Medical Center, was founded 100 years ago to honor Mary Imogene Bassett, a physician and trailblazing medical administrator who devoted herself to caring for the people of Cooperstown. Bassett's commitment to education and the partnership with Columbia, which includes the unique Columbia-Bassett program, clinical clerkships for medical students, and residency opportunities, are strong elements of the medical center's culture.
"Bassett has an extraordinary legacy of medical education, research, and an interest in supporting clinical care in rural parts of our country. It's a natural partner for VP&S in how we push forward to train the best doctors who thrive on excellence in patient care," says Katrina Armstrong, MD, dean of VP&S.
The impact of the training experience is profound. First-year VP&S student Sidney Saint-Hilaire has wanted to be a psychiatrist since childhood. Saint-Hilaire had already begun his VP&S application when a description of Columbia's unique partnership with Bassett caught his eye.
"Bassett is relationship focused," says Saint-Hilaire. "For me, it's an answer not only for that personal connection, but also that ability to have multilevel thinking and nurturing of a doctor who has an interest in systems change and also an interest in the person."
Monica Lypson, MD, vice dean for education at VP&S, sees the Columbia-Bassett program and other opportunities for medical students as vital training grounds for VP&S students. "Bassett is a great place for our learners to understand and experience what patients throughout the United States experience," says Lypson. "Doctors in training at Bassett learn about the unique challenges of receiving-and providing-rural health care, preparing them for practice in places across the country."
The Columbia-Bassett program combines science-based coursework in Manhattan with clinical education at Bassett. All students study a longitudinal integrated curriculum and follow a panel of patients for a full year, across specialties. Through SLIM (Systems, Leadership, Integration, and Management) modules, students dig into the tools and principles of process improvement. A third track, known as LEC (Life Experiences Curriculum), prepares students to recognize and respond to the roots of emotional trauma underlying physical illness in people who might offer only subtle hints of emotional struggle.
"Outcomes for people who live in rural areas are almost uniformly worse than those of people who live in non-rural areas. There aren't enough training programs of any kind in rural areas to supply the kind of workforce that's needed."
"There is a great need for this kind of training," says Henry Weil, MD, professor of clinical medicine at VP&S, who serves as senior associate dean for the Columbia-Bassett program and chief academic officer and chief clinical officer for the Bassett Healthcare Network. "Outcomes for people who live in rural areas are almost uniformly worse than those of people who live in non-rural areas, cutting across outcomes in terms of opioid use disorder, heart disease, lung disease, a broad assortment of common illnesses. There aren't enough training programs of any kind in rural areas to supply the kind of workforce that's needed."
Cardiovascular care is one specialty area that has been nurtured in the past 10 years and was built on a program created in 1997 by Allan Schwartz, MD, chief of Columbia's cardiology division, and Craig Smith, MD, chair of Columbia's Department of Surgery. Their HeartSource health care consulting and management service develops cardiovascular clinical care programs and supports quality improvement. In the 25 years since HeartSource was created, the service has worked with more than 20 health systems from Miami to Shanghai to develop new surgical and interventional programs; help institutions recruit staff and establish or refine pathways of care; and regularly review patient outcomes to promote quality improvement. The partnership with Bassett Healthcare Network began in 2012.
