West Virginia Rural Health Education Partnerships/Area Health Education CentersWest Virginia Rural Health Education Partnerships/Area Health Education Centers

What IS WVRHEP/AHEC?

WVRHEP/AHEC is a robust community based health professions training system throughout West Virginia funded by both state and federal funds.  Our students and medical residents learn to become highly qualified rural health professionals while they serve rural communities. We are a partnership of rural community leaders, practicing health professionals, higher education schools and programs and state policy leaders. Our mission is to exercise our social responsibility to the state's citizens by increasing the number of WV trained health professionals in practice in rural underserved communities in our state. We are the only statewide publically funded system of higher education to create degree required rural health rotations for all state supported health sciences students.

Chronological History and Background

The foundation for community based training can be traced back to roughly 30 years of development and advances in medical and health professions education in the state.

The Infrastructure

Critical to this partnership are the local rural health agencies, organizations, and community leaders with compatible missions, goals and objectives, who, with the health sciences centers, are willing to provide faculty/preceptors, learning resources and technical support for the students and trainees.  Also, WVRHEP enters into contracts and affiliation agreements with community providers and organizations to support student and resident training.

WVRHEP/AHEC infrastructure:

For a complete guide to WVRHEP Consortia and WV AHEC Centers, please refer to http://www.wvrhep.org

(The above figures were updated February, 2009)

Policies Overview

The Panel oversees all policy development and implementation through its various committees.  A standard policy and procedure format is used for all policy statements.  All approved policies are listed chronologically on the web site, http://www.wvrhep.org/policies/97_02.html.  All documents are in PDF with adobe reader necessary to review the documents. Any partner, panel member, school, or staff member can initiate the process to develop a policy.  All policy statements must however, initiate within a committee, then be sent to relevant committees for review, and then finally approved by the Panel.  The policy process specifies the group or person responsible for implementation and oversight of each policy.  Policy areas include: fiscal management, structure and roles of Panel and local governing/regional consortia boards, the rural health curriculum (including roles of field faculty, designation of training sites, faculty development, definitions of students for tracking purposes, definitions of community service learning, etc). The Panel committees’ roles and functions are:

  1. Advisory Panel (State Rural Health) is charged in legislation to advise the Vice Chancellor for Health Sciences of HEPC in the conduct and oversight of the WV Rural Health Education Partnerships program.  In 2002, the Panel also took on the oversight responsibility for the WV Area Health Education Centers grant program in an advisory capacity to the grantee institution.
  2. AHEC Center Directors’ Group is responsible for maintaining communications between the Centers and the state program office.  This group meets monthly and discusses: current status of AHEC grant funding and reporting requirements, Centers’ progress toward meeting program objectives, other funding opportunities for Centers, announcements regarding pertinent training, workshops and conferences, partnership opportunities, including joint projects with RHEP, and individual Center updates. The AHEC Center Directors’ Group and the Site Coordinators’ Groups meet jointly three to four times per year.
  3. Curriculum and Outreach (Clinical and Community Service-Learning curricula) The Joint Outreach and Curriculum Committee is comprised of school representatives, community members from local consortia boards, RHEP site coordinators and AHEC center directors, and state level staff.  This committee works closely with the Schools’ Committee in reviewing community service and service-learning projects and makes recommendations on any and all outreach activities in which students participate.  This committee develops curricular requirements related to the RHEP/AHEC Programs and recommends and reviews policy in the areas of service learning, outreach and curriculum.
  4. Evaluation is responsible for establishing the evaluation plan and policies for the program which includes coordinating all data collection and information that describe the performance and impact of WVRHEP, the feedback of this information throughout the partnership system, and overseeing the data analysis for the annual report and the HEPC legislative report card to the legislature.
  5. Faculty Development oversees the annual Faculty Development conference held each year for WVRHEP/WVAHEC faculty.  The committee gathers feedback from field faculty on development of teaching skills and other needs in continuing education and faculty development.  The committee also provides support to the On-Site Clinical Directors and the implementation of this role within each consortium.
  6. Finance The Finance Committee of the WVRHEP/WVAHEC reviews and recommends to the full panel the annual budge.  The committee also works with the WVRHEP/WVAHEC staff in formation of fiscal policies and advises on all other fiscal matters as appropriate.  The membership of the committee of the WVRHEP/WVAHEC shall consist of the following: a lead agency site Administrator, two Site Coordinators, an AHEC Center Director, four community members, a representative from the Schools’ committee, one annually rotating slot for each of the three fiscal agents from the schools to serve as a resource person, not as a voting member, and one member of the LRC committee to serve as a resource person, not as a voting member.
  7. Information Technology supports the WRHEP/WVAHEC in all technical matters, reviewing new technologies for improving communication, student education and overall productivity.  This committee also overviews WVRHEP’s web resources and TRACKER as the programs resource for data collection and evaluation of students rotations.
  8. Recruitment and Retention coordinates state, campus and community efforts to recruit and retain primary care providers in rural underserved areas.  The committee identifies problems and gaps and coordinates policies, activities and program development and plays a key role in state-funded incentive programs-one administered by the HEPC and the other by the Division of Rural Health and Recruitment in the Bureau for Public Health. 
  9. RHEP Site Coordinators’ Group comprised of field site coordinators from each of the 8 regional consortia.  meets once per month to discuss joint projects/program, curriculum requirements, evaluation data, committee reports/requests and any and all other business that affect the partnership program.  The group also host speakers at their monthly in order to receive updates and information on other statewide collaboratives.  Coordinator meetings allow coordinators to share ideas and network with colleagues to continually monitor quality improvement of the partnership, educational requirements, and all other aspects of student education and rotation management.  State level staff members attend these meetings to keep coordinators informed of statewide program goals, objectives, challenges and accomplishments and to communicate state level policies and procedures crucial to program improvement.
  10. Schools’ Committee is comprised of school representatives from all institutions involved in the RHEP/AHEC Program and reviews policy and procedures that directly affect school curriculum and the RHEP curriculum components.  This committee works closely with all Panel committees and works as partners with the regional consortia to problem-solve issues and continually improve rural rotation experiences for health profession students.

Evaluation and Research

The evaluation system of WVRHEP/AHEC includes three basic areas of assessment: 1) the influence that RHEP/AHEC training has on students' attitudes and career plans, 2) the students’ experiences in RHEP/AHEC as a means to improve the curriculum and management of the program, and 3) the tracking of practice locations of graduates to gage the numbers recruited to rural and/or underserved areas of the state. The database is also used to record the types of community service learning activities of students and the number of people impacted by these student provided services.

An electronic (web-based) WVRHEP evaluation was initiated January 1, 2001 and includes a Baseline Data Questionnaire for medical, nursing, and dental students and a post-rotation evaluation, the Student Evaluation of Rural Field Experience, for all RHEP students.  Prior to that date, evaluations were conducted by paper questionnaires.  In 2003 and 2004, questions regarding the AHEC IDTs were added to the post rotation evaluations. In addition to the RHEP/AHEC evaluation each school also conducts their own assessments of field faculty and other elements of the community based rotations many times as part of their accreditation requirements.  The RHEP/AHEC staff members cooperate fully with all schools needing evaluation data for these purposes.

Student questionnaires confidentially solicit narrative and quantitative (e.g., Likert formatted questions) information on student attitudes and career plans, including feelings of self-efficacy toward a variety of rural-relevant issues, such as their knowledge of the quality of care in rural settings, and attitudes about rural lifestyle and caring for poor populations. Questionnaires also solicit suggestions from students on how to improve the rural training experience and draw on findings from other evaluation data currently in use such as the Evaluation Form for Students Participating in Interdisciplinary Teaching Sessions. The benefits of this evaluation are numerous and include the opportunity to:

We also periodically conduct research on program effectiveness by surveying WVRHEP/AHEC graduates in rural practice. Rural practitioner surveys were conducted in 2003 and 2005, and 2008. These surveys have included assessment of practitioner attitudes about the influence of rural health training for and selection of rural practice choices, factors contributing to practice site selection, accessibility of practice to the indigent, payment demographics of patient population, time in rural practice and active preceptor status. For respondents of the various disciplines, a significant percentage reported that WVRHEP/AHEC had an influence on rural practice selection and that the academic and community curriculum aided in preparation for this. Rural physician respondents have reported that the majority of their patient clientele has Medicare, Medicaid or no insurance. For physicians, a statistical correlation has been made between time in rural practice and active WVRHEP/AHEC preceptor status. Presentations involving these survey results have been given to PERD members, to WVRHEP/AHEC committees, and at the 2006 conference of the Southern Group for Educational Affairs.

Research is conducted in the WVRHEP/AHEC partnership in oral health, coronary artery disease, and other areas.  The partnership, with its training mission and inclusion of research opportunities for students and faculty, offers a platform with access to research problems and potential subjects in rural communities.  Many peer-review journal articles have resulted from these collaborative research efforts.

Journal Articles

We keep track of all professional, peer reviewed journal articles, and presentations in which WVRHEP is described and attributed as the support system for the content of the article.  Some of these articles are specifically about health professions community based training, recruitment and retention, and others are about specific research that has been and/or is being conducted through the WVRHEP/AHEC community base infrastructure and training system.  Copies of these articles can be provided upon request.

Overall Partnership Outcomes

From 1999 to 2008, the number of physicians who participated in the WVRHEP/AHEC program and are now in rural practice increased from 88 to 289, an increase of 228%, or at an average annual rate of 14.1%.  As of the fall of 2008, WVRHEP has helped recruit 1,072 health professionals in rural underserved areas of the state.  These health professionals include:

WVRHEP/WVAHEC trainees provide a myriad of health care services in the local communities, with the goal of promoting health promotion and disease prevention activities.  These services, such as tobacco cessation, diabetes support groups, nutrition and life style education, health fairs, etc; average over 125,000 participants per year since 1999.  In 2008, WVRHEP/AHEC students completed 1,259 rural rotations for 7,794 weeks of training.
WVRHEP began tracking these services in 1999 and since that time a total of 1.25 million rural West Virginians have been served. In July, 2002, WVRHEP began connecting these services to the West Virginia Healthy People 2010 Objectives.  Since 1999, WVRHEP/AHEC dental preceptors along with dental and dental hygiene students have provided over $13 million in uncompensated care to rural patients.

(The above figures were updated February, 2009)

The Rural Health Curriculum

The rural health curriculum is based on degree required rural rotations in each of the participating schools curricula and contains objectives for discipline specific clinical and community service learning. These rotations must take place in the designated rural health training sites or sites that serve an underserved population.  While students may do clinical rotations throughout the state, students can only get credit for their rural rotations if these rotations take place in rural areas, communities, small towns, and/or sites that serve an underserved population.  All data is collected on these rotations and is driven by student activities in these locations.  There is a list of restricted cities in the state in which a student may not receive credit for these rotations. These cities (including their suburbs which may or may not have the same zip codes) are: Charleston (including South Charleston, Dunbar, Nitro, Institute, Cross Lanes, Kanawha City, and St. Albans); Clarksburg (including Bridgeport and Nutter Fort); Fairmont; Huntington (including Barboursville), Martinsburg, Morgantown (including Little Falls, Sabraton, Star City, and Westover); Parkersburg (including Vienna), Weirton, and Wheeling.  Ridgeley is also restricted.  It is across the river from Cumberland, MD just across the WV line and is considered part of the city.

 The percentages of the curriculum devoted to clinical objectives and community service learning was established by the Panel in policy following a year of research, debate, and compromise among the campus and community partners of the partnership. The students spend 80% of their time completing the clinical objectives for the discipline specific objectives of their degreed program, i.e. if the student is completing an ambulatory pharmacy rotation they do so in the rural setting completing the same objective they would have if the rotation was at their respective campus; if the student is completing a family medicine rotation the same is true for these objectives and so on.  Students and residents then spend up to 20% of their time in community service learning consisting of one or a combination of the following: community service learning projects, interdisciplinary educational experiences, and/or community based participatory or translational research.

Students may develop their own project or select from a number of on going projects in the geographic region in which they are placed.  The AHEC Interdisciplinary teams consist of at least one medical resident, who serves as the team leader, and a team of RHEP students from other disciplines.  This Interdisciplinary Team (IDT) chooses one project that all learners work on together.  These projects address public health issues in the region or a specific county and students are required to develop written goals, objectives, and strategies as well as a final report.  All students completing the community service-learning portion of the curriculum are required to develop a written reflective report consistent with their learning objectives for the experience.

The Partnership

The partnership consists of community volunteers, campus and field faculty, state level agency administrators, lead agency personnel, RHEP/AHEC staff, students and residents, and legislators some of whom serve on local boards. Our partners are also programs with similar mission focus including the pipeline programs in the state of which RHEP/AHEC is one.  There are many levels within the partnership and these are too many to describe.  For example there are partnerships at the local level that may be unique to one region, one county, or one community.  We track the collaborations and partnership work at the state level when we work on our mutual missions. These partners are statewide health promotion and disease prevention initiatives which utilize the RHEP/AHEC infrastructure and human resources to further our mutual missions.  Examples of these projects include: the Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project which has two components, a school-based surveillance and intervention initiative, and a targeted individualized approach toward identification and referral for treatment of those individuals with the most severe genetic cause of death from premature CVD: familial hypercholesterolemia (FH). Over 50,000 school aged children have been screened since 1998 and many and their families have engaged in interventions through the CARDIAC-RHEP/AHEC partnership to reduce their risks of heart disease, diabetes, and obesity.  

WV AHEC/WVRHEP also works with such programs as the Recruitable Community Project (RCP) of the West Virginia Department for Public Health that focuses on helping medically underserved rural West Virginia communities recruit health care providers and offers rural clinical experiences, and some funding, to medical residents, physician assistant and nurse practitioner students.  RCP empowers communities by involving pro-active community members in local economic development, screening and selection of health care providers, the recruitment process, increased familiarity of rural sites, opportunity fairs, etc.

RHEP/AHEC works closely with the Health Sciences Scholarship Program administered by HEPC to add financial incentives and the rural health curriculum as a means to maximize recruitment and retention strategies.  The Recruitment and Retention Committee staffed by Alicia Tyler is a committee of the Rural Health Advisory Panel and was specified in code in 1998.

WV AHEC/WVRHEP works with the Health Sciences and Technology Academy (HSTA) in the 26 counties where HSTA clubs and students are located. Our AHEC Centers frequently work with HSTA clubs and our WVRHEP/AHEC students make presentations on health careers at middle and high schools throughout the state.

The extensive WVRHEP/AHEC educational network provides the platform for a host of disease prevention and health promotion activities and other state and federal grant programs as well as research projects. The local communities and health sciences centers have used the state funded RHEP system to successfully compete for these sources of funding. For the AHEC grant program, the WVRHEP dollars are used as cost share match to secure receipt of the federal funds.  Examples of some of these grants, which average $5.07 million per year, are:

For more information, please contact: 

Office of Rural Health
P.O. Box 9003
Morgantown, WV
26506-9003
304-293-4996