Before Vanessa Maycumber started her first year at the UW School of Medicine, she spent two weeks shadowing a family physician at Blackfeet Community Hospital in Browning, Mont.

While her soon-to-be peers were packing and spending time with friends, Maycumber was acquiring clinical experience, meeting the family physician who would be her preceptor, and learning about a community she would repeatedly return to over the course of her medical-school career.

The TRUST program
Maycumber is one of a select group of UW School of Medicine students who are part of a four-year-old program called TRUST (the Targeted Rural Underserved Track). TRUST offers a comprehensive curriculum, a support network and clinical experience for students interested in practicing rural medicine.

Started in Montana in 2008, the track is now also available for rural-focused students in Western and Eastern Washington, with plans to expand the program to Idaho and Alaska. Suzanne Allen, M.D., MPH, co-director of TRUST and vice dean for regional affairs, explains that TRUST’s aim is to increase the number of primary-care physicians working in rural or underserved areas.

“The notion was to create a special track… that would really encourage students to go into rural medicine,” says Allen.

As a second-year TRUST student, Vanessa Maycumber spends a great deal of time learning about medicine in her home state, Montana, where she will return to practice. In the background of this photo: St. Mary Lake, Glacier National Park, Mont.

Medical student and TRUST program participant Hans Hurt helped treat patient Sharon Mills after she slipped and fell while holding a screw.

Strength in continuity
The program seeks interested students, especially those from rural and underserved communities. Once accepted, students spend up to two weeks prior to entering medical school, as Maycumber did, in their “continuity community,” a rural health site to which they are assigned for the duration of medical school.

A TRUST student’s continuity community — along with receiving consistent mentoring at the site — are cornerstones of the TRUST experience. “For students to be able to go back to that same community for all four years of medical school is extremely important,” says Allen.

It gives them a taste of the kinds of relationships doctors can form with patients, given time. “The students see patients when they are having a new child and they see that same family when someone is diagnosed with cancer,” Allen says.

Students visit their community at least two other times during their first year and for their four-week R/UOP experience. (R/UOP is the Rural/ Underserved Opportunities Program, which takes place during the summer between the first and second year.) During third year, students return for their most in-depth experience: a 20-week WRITE rotation (WWAMI Rural Integrated Training Experience), which includes clinical experiences in most elements of primary care, from family medicine, to psychiatry, to pediatrics.

Other components of TRUST include required rural health electives, participation in the School’s Underserved Pathway program, career counseling and residency assistance.

In the community
Maycumber says that working alongside family medicine physicians in Browning is helping her understand the daily decisions and challenges of rural medicine. “One of many things I’ve learned is the importance of networking with other physicians in neighboring towns,” she says. “Even if you don’t have all the resources, you have colleagues in other towns that you can call.”

Part of the student experience is learning about a community. During Maycumber’s R/UOP experience, for instance, she attended a Blackfeet sweat lodge, a traditional cleansing ceremony. “It helped me experience some aspects of their tradition,” she says.

KayCee Gardner, a fourth-year student and one of the first TRUST students to graduate, will start a family medicine residency in Billings next year. She says that the decision to apply to TRUST was one of the best choices she’s ever made.

“I’ve learned so much,” she says. “I’ve been able to have this continual experience with one community, have established relationships with patients, gotten more hands-on rural training than the average student, and had extra classes in rural medicine.”

It’s clear the students value TRUST — and the program’s administrators will be evaluating its progress.

“We don’t have a lot of data points yet,” says Allen. “But we’re very hopeful that it will accomplish what we plan — the production of a larger rural healthcare workforce across our five-state region.”

By Elisa Murray