Partnerships to Establish and Sustain Rural GME: Q and A with Dustin Beck, DO of the OMECO/Cherokee Nation Family Medicine Residency Program
This interview is part of a series featuring Sponsoring Institutions and programs providing rural graduate medical education (GME) experiences. The series was initiated following the 2022 ACGME Annual Educational Conference presentation on Medically Underserved Areas/Populations: Partnerships to Establish and Sustain Rural GME, available in the ACGME’s digital learning portal, Learn at ACGME. Note: an account (free to create) is required to access most content in Learn at ACGME.
The Osteopathic Medical Education Consortium of Oklahoma, Inc. (OMECO) family medicine residency program is a rural program affiliated with Cherokee Nation Health Services in Tahlequah, Oklahoma. The program, which also has ACGME Osteopathic Recognition, has 24 residents. Dr. Dustin Beck is the program director, and also serves as an adjunct faculty member at Oklahoma State University College of Osteopathic Medicine at Cherokee Nation.
ACGME: What drew you to academic medicine and to rural/tribal GME specifically?
Dr. Beck: I’ve always loved teaching and have a particular interest in clinical teaching. It has been enjoyable seeing the growth of residents over the course of their education, from their intern year through residency completion. Tribal health care facilities lend themselves to being great education and training environments for residents. There is a large volume of patient encounters each year for residents to participate in. In addition, tribes invest significant resources into health care to help take care of their people, which limits constraints typically experienced by residents in other GME settings.
ACGME: Describe the rural/tribal GME experiences within your program (e.g., types of sites, structure, curriculum, etc.).
Beck: All of our rotations take place in Tahlequah, Oklahoma. The majority of them take place within Cherokee Nation Health Services facilities. The residents also have rotations with internal medicine subspecialties (rheumatology, nephrology, etc.) and a Federally-Qualified Health Center clinic in town. Our program is three years in length and grouped into 13, four-week rotation blocks each year.
ACGME: How did your program become involved in establishing rural/tribal GME experiences?
Beck: In Oklahoma, tribal facilities and GME are a natural fit. The majority of Oklahoma is rural, and nearly all tribal clinics are in a rural setting as well. By establishing programs within tribal facilities, this helped alleviate physician shortages within both tribal health care systems and the state as a whole.
ACGME: Describe the internal and external partnerships that have been important in establishing and sustaining these experiences.
Beck: Within Cherokee Nation Health Services, there has been tremendous support from the tribal administration. They have worked extensively with Cherokee Nation Health Services administration to ensure the success of our residency program. Cherokee Nation Health Services also has a strong working relationship with Oklahoma State University College of Osteopathic Medicine (COM). Faculty members from the university also make up my portion of our Sponsoring Institution, which also helps ensure our success as a program. The Health Resources and Services Administration (HRSA) has also been a tremendous resource for helping finance our program, ensuring that we have the financial resources necessary to be successful.
ACGME: Describe the challenges you have experienced in developing and sustaining rural/tribal GME partnerships and experiences; and explain how you have overcome them.
Beck: Initially, funding was a major issue. Our residency program, in the beginning, was largely self-funded. Tribal health care systems are ineligible for Centers for Medicare & Medicaid Services (CMS) funding, which is the major funding source for GME programs. A few years ago, our program received a Teaching Health Center GME (THCGME) HRSA grant, which helped us overcome our funding challenge. Like many rural GME programs, recruitment has been a challenge. In 2020, Oklahoma State University COM established a medical school at the Cherokee Nation Health Services Tahlequah campus. We continue to be hopeful that this will help improve recruitment to our program.
ACGME: Describe some of your program’s outcomes since establishing rural/tribal GME experiences, including the impact to the surrounding community.
Beck: Since the development of our residency program as an ACGME-accredited program in 2020, we have had a total of 17 graduates. Of the 17 graduates, nine have stayed and remain employed with Cherokee Nation Health Services. This not only helped alleviate our physician shortage within our health system but has also helped develop additional service lines for our patients. One of our graduates is providing family medicine/obstetrical services on our campus, and another is providing wound care services that were not previously available to patients outside the care of a surgeon. Our residency program also provides free sports physicals to local school districts in Northeast Oklahoma. In the spring of 2024, our residents performed over 1,500 sports physicals for local athletes.
ACGME: What advice do you have for those interested in establishing rural/tribal GME experiences?
Beck: Tribal health care systems have the potential to provide tremendous education and training experiences for residents. However, there are differences in the way that tribal health care systems are operated compared to the way that a residency program is operated to maintain accreditation. There has to be good collaboration between tribal administration/human resources and the residency program administration. I would encourage new programs to reach out to currently established tribal GME programs as a resource.
ACGME: Describe the resources that have helped your program to establish rural/tribal GME experiences.
Beck: Oklahoma State University COM has provided significant resources to Oklahoma tribal GME programs, including faculty members, professional development, and educational resources. HRSA THCGME funding has helped us develop and maintain our tribal GME programs financially.
Email muap@acgme.org if you want to get in touch with Dr. Beck. Is your Sponsoring Institution/program already providing rural GME experiences and would you like to be featured in a future post in this ACGME Blog series? Email muap@acgme.org to share what you’re doing. Visit the MUA/P web page to learn more about the ACGME’s efforts.