Eastern Mennonite University

Summer 2008

Small is Better: Training Rural Practitioners

By Randall Longenecker '75, MD

Bellefontaine Ohio medical alumni
Bellefontaine, Ohio, medical alumni: Upper row (from left) John Wenger '85, Charles Kratz '88, Rodney Graber '87, Roger Kauffman '73, Winfred Stoltzfus '80. In chairs, Ryan Kauffman '99 (left) and Randall Longenecker '75.

"Medical education is rigorous, but that doesn't mean it is relevant and responsive to the needs of rural communities, not to mention the learners themselves," says family practice professor and practitioner Randall Longenecker '75, founding director of the first "2-2-2" integrated rural-training track in family medicine in the nation.

Here is his account of the founding and growth of Mad River Family Practice in Bellefontaine, Ohio.

EMU alumni designed, implemented, and continue to refine Mad River Family Practice, a program affiliated with Ohio State University to train rural practitioners. Mad River Family Practice – otherwise known as The Ohio State University Rural Program – is what we like to refer to as an "idealized micropractice" in medical education.

In addition to the "2-2-2" configuration (two residents a year for all three years of training – a waiver from the minimum requirement of four residents a year by the Accreditation Council for Graduate Medical Education), The Ohio State University Rural Program has spawned other innovations in medical education. "Clinical Jazz" is an eight-year experiment in group process centered on the doctor-patient relationship, which we consider the core of clinical practice.

"Faculty Jam," a parallel process among program faculty, is our version of continuing faculty development, focused upon the teacher-learner relationships and learning to teach in practice.
The curriculum is a longitudinal experience in small-town group practice covering the full spectrum of family medicine, including an active obstetrical practice. It includes immersion experiences at Nationwide Children's Hospital and University Hospital in Columbus, Ohio, an hour away.

Eleven graduates will have proceeded to rural or underserved initial places of practice in Texas, Georgia, Tennessee, North Carolina and Ohio, as well as Canada. In addition, two faculty have gone on to teach in residency programs in Cincinnati, Ohio, and Portland, Maine.

Mad River Family Practice emerged from Oakhill Medical Associates in 1997. The two practices, both heavily staffed by EMU graduates, share a building and collaborate to offer "a practice with a residency" (as opposed to most residencies with a practice, or model family practice center). They are responding to a wider call for community-embedded, practice-based health professions education. In fact, at this point medical students and residents, nurse practitioner students, and pharmacy students all train here, creating a virtual rural health professions campus.

In addition to the author, alumni involved in this effort include Arland Esch '76, D.O., assistant director until 2006; current assistant director John Wenger '85, D.O.; and these members of Oakhill Medical Associates - Roger Kauffman '73, MD; Charles Kratz '88, MD; Ryan Kauffman '99, MD; Rodney Graber '87, MD; and Winfred Stoltzfus '80, MD, who provides specialty teaching in cardiology and internal medicine. Andy Hershberger '02 is assistant practice administrator for both Mad River and Oakhill.

For more information visit www.madriverfamilypractice.org or contact:

Randall Longenecker, MD
308 E Williams Ave.
Bellefontaine, Ohio 43311
(937) 465-0080

Back to table of contents