Grantee Spotlight

Rural Northern Border Region Outreach Program  

GHPC recently spoke to David McLellan and Kalli Varaklis, M.D., both from the Maine Rural Graduate Medical Education (MERGE) Collaborative, about innovations the collaborative is making in graduate medical education to help with the recruitment of competent graduates to address rural maternal health care access challenges. 

To date, what has been the biggest accomplishment so far in your Northern Border program?  
Kalli: This grant is helping us think about how we can meet the needs of birthing women in Maine who live in rural areas and need to access care. We incorporated rural community engagement suites with patients to get the patient perspective. We will also be looking at the provider perspective, but we started with the patient perspective and held two of three planned community engagement suites or focus groups, which have been extraordinary. They have been very well attended, with great representation from women across the state who shared very personal stories and perspectives. This information will be invaluable to informing the training curriculum. 

What is a tip you would share with an organization launching a similar program?  
Kalli: I think the big lesson for me, in terms of doing very high-quality work, is aligning with colleagues who have expertise. We are working with colleagues who have expertise in conducting community engagement suites, and their facilitation and planning are very professional and have helped get an accurate reflection of the patient perspective. So, my tip is to selectively engage with content experts to provide a higher level of quality work. 

David: By the nature of the problem we are solving, the providers that are out there in these rural obstetric positions are so busy, and their workload is extraordinary. So, the advice is to remember that it is a long game. It will take time to find the right opportunities to bring that collaborative group together. 

Do you have an example that illustrates the value of planning for a rural health network instead of having a single organization at the helm? 

David: Unfortunately, some birthing centers have closed across the state. When you look at the rural hospitals in Maine, they are a group of independent hospitals and health care systems. Rural communities take their local hospital very seriously, and they trust their physicians and health care providers. So, the MERGE Collaborative really needs to work with those local providers and health care institutions to support the communities. 

How do you see participation in FORHP’s Northern Border program impacting your broader health improvement efforts? 
Kalli: One of the things that HRSA does well is that it demands a sustainability statement in the application, which is completely appropriate. For us, that is the starting point for how this becomes part of the educational infrastructure for obstetrics training in the state. We are currently focused on six partners, which will be expanded as we can. The purpose of this HRSA grant is to cement obstetrics training for physician trainees in rural Maine. At some point, we might add the training of midwifery students or paramedics, who may be doing deliveries on the side of the road, given the distances that we’re talking about. We are in step one, but there is need for an interprofessional infrastructure of teaching and training. 

What is next on the horizon for your grant-funded program? 

Kalli: Initially, the MERGE collaborative was creating elective rotations in all specialties. We were looking for partners who would host residents and fellows for a rural rotation. We hoped that by getting residents up there, they would have such a great learning experience, and they would love living there so that it would increase their likelihood of staying there. We have some preliminary data that says that that does work. For this particular HRSA grant, we are focusing on obstetrics and are thinking about curriculum and training intensives that are more longitudinal, rather than a one-off elective. If we can figure out how to do this well, we can change the topic to other high priority areas that are meaningful to the people of Maine, like geriatrics, since we are the oldest state, and behavioral health, which is a huge need. So, the model that the HRSA grant is funding is an intensive obstetrics curriculum, but it was an a-ha moment to think that we can rinse and repeat, and address even more patient needs in rural settings. 

David: We appreciate HRSA’s continued support over the three years, as we recognize this is a long game. We know that this will not deliver immediate results. We needed a partner that could help support us over multiple years because we have to develop the training, recruit for the training, and then implement the training throughout the resident experience. Participating residents have to finish their residency before we know the outcome, so it will have delayed gratification.