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One Neurologist Is Taking Specialty Care to People 400 Miles Away and Many In-Between

Dr. Lyden’s collaboration with RUUTE has led to a number of useful projects in diverse areas.

One Neurologist Is Taking Specialty Care to People 400 Miles Away and Many In-Between

Made up of Nevada, Utah, Idaho, Montana, Colorado, and Wyoming, the Mountain West region is home to many people who live in areas without major hospitals. In fact, a 2017 study estimated that almost 30 million US residents do not have access to an emergency room within an hour from their homes. Vascular neurologist Dr. Stephanie Lyden experienced the difficulties and expensive nature of growing up far from medical care firsthand when she would watch her family members plan extensively to take off work to travel from their hometown of Casper, Wyoming, for treatments.

Dr. Lyden came to realize that she was not alone in such experiences as she traveled the five-state WWAMI region (Washington, Wyoming, Alaska, Montana, and Idaho) in medical school, served as the interim director of the University of Utah’s Mountain West TeleStroke program, travels to Jackson Hole, WY—population 10,800—to run an outreach clinic, and serves as a faculty director for the Rural and Underserved Utah Training Experience (RUUTE) and Regional Affairs Program at the University of Utah.

RUUTE is a University of Utah School of Medicine–run program that aims to improve health care access and medical education/training for the rural and underserved communities of Utah and the Mountain West region by expanding interest, awareness, and placement of students and physicians. Dr. Lyden’s collaboration with RUUTE has led to a number of useful projects in diverse areas.

Leading Students to Community Engagement Experiences

In the summer of 2022, Dr. Lyden and her team (Lucy Hansen, MD; Madelyn Carter, MPH; and Elise Longnecker, BA) helped launch the RUUTE Community Engagement Experience (CEE), a five-week course that allows students to get to know a rural or underserved area on a more personal level. The program goes like this: a participating student gathers public health data around a rural area, spends three weeks in that community, practices with local providers, conducts interviews, and then develops a deliverable to support that community’s specific needs.

First-year medical student Madeline Bernardo was placed in Cascade, Idaho. Bernardo volunteered at the food pantry in Cascade’s Pride of Community Garden and worked with Dr. Camarata, a family medicine physician in the Cascade Medical Center (CMC).

“Within my first week at CMC, it became evident that accessing fresh, affordable healthy food is quite challenging in Cascade,” said Bernardo. As a result, she created a pamphlet that contains current nutritional recommendations as well as local and national resources to access and enjoy healthy food.

Another participating student, Bridget Brocksmith, was placed in Jackson, Wyoming. Her community project focused on gun safety in Teton County: “I made infographics with local mental health resources and guidance for reducing risk of suicide by firearm. To accompany these infographics, I also designed magnets for gun safes [that] include instructions for secure storage practices and the new 988 suicide hotline.”

Nadia Reiher reflected on her CEE experience by noting, “It was valuable to see the many roles a community provider might be expected to fill and the challenges that come from being responsible for such a diverse patient population. I ended the experience with an altered perspective of what it means to be a ‘rural/underserved’ provider. Before, I had a pretty standard view of rural locations being small, isolated towns. Now I have experienced that rural medicine can be about the strong community and connections within a town, region, and even state. As opposed to being isolated, it feels more like, as a rural provider, I would be providing connections between different communities with varying assets and challenges.”

Dr. Lyden hopes this program will continue to be mutually beneficial: trainees will gain experience in rural care centers and communities, and rural care centers and communities will benefit from working with the region’s upcoming talent, having higher rates of future recruitment, and developing partnerships with academic centers. “It’s widely popular,” Dr. Lyden said. “We had four students last year, and we’ll have thirteen this year, with possibly thirty next year.”

Madeline Bernardo
Bridget Brocksmith
Nadia Reiher
CEE participants presenting on their community engagement projects.

Exposing Trainees to Rural Neurology

Telemedicine Course Simulation 1
Telemedicine Course Simulation 2
Telemedicine course simulation.

Dr. Lyden and neurology residency director, Dr. Jana Wold, also helped pilot a program to help neurology residents get experience and exposure as rural neurologists. Last year, this rural elective consisted of three neurology residents completing rotations at Dr. Thomas Buchanan’s practice in Vernal, UT.

One of these three residents, Amanda “Mandi” Ellgen, was considering rural neurology when she came upon this opportunity. During her time at the Ashley Regional Medical Center in Vernal, she worked closely with hospital staff (Dr. Buchanan, the ER staff, the stroke coordinator, Dr. Lyden, and the stroke team at the University of Utah) to revise their stroke protocol and develop a new triage algorithm and process. She was involved in an educational outreach day with educational lectures and mock stroke codes. Dr. Ellgen is currently putting together a report about the hospital pre-intervention and post-intervention, and the results are encouraging.

Dr. Lyden is excited to expand these types of efforts in 2023, as she feels that exposure to different health care settings in medical school and residency can enrich the education of trainees and enable them to become more well-rounded, conscientious providers. She feels strongly that a rural training track for neurology residents be developed to help encourage their return to rural and underserved communities, where there is a huge shortage. However, this is a large effort that requires an allocation of funds, infrastructure development, and a new mindset in what defines “rural” for neurology. At present, many of the definitions for a rural track program designation are based off statistics for primary care and are currently only offered to family medicine, internal medicine, pediatrics, and psychiatry.
Dr. Lyden also teaches a TeleHealth course for medical students. It equips students with an operational skill set that will better prepare them to practice in the evolving world of TeleMedicine. Students participate in lectures that discuss ways different specialties use TeleMedicine. Additionally, students complete simulated, emergent and outpatient cases in which they are each given the opportunity to be the consulting provider, the TeleProvider, and the patient. This method allows for hands-on learning. A section on medical innovations also requires trainees to critically analyze the impacts of new technology.

RUUTE Needs Your Help: How You Can Help More Communities Get Better Access to Neurology Care

RUUTE’s work is never finished, and they welcome your support! Dr. Lyden had three ideas on how you can get involved:

  1. Spread the Word
    Do you have any social media accounts? Consider using them to like, share, and comment on RUUTE projects. Word of mouth works too; tell your friends over dinner or your co-workers over the water cooler!
  2. Live in a Rural Area? Contact RUUTE!
    RUUTE programs such as the CEE are constantly seeking out members of rural communities for interviews and insights into volunteer opportunities. If you’re interested, consider sharing your perspective with some medical students! They’d love to pick your brain.

    Additionally, community members often know the needs of their communities better than outsiders. If you have knowledge of any volunteer opportunities, projects, or other priorities going on, consider letting RUUTE know.

  3. Are You a Teacher? Can RUUTE Visit Your Students?
    RUUTE is currently increasing its outreach to K-12 schools in hopes of interesting students in the health sciences. If your school may be interested, consider coordinating with the RUUTE team to have some medical students and/or other specialists come and give a presentation!

Contact the RUUTE team:

I Live in a Rural Area: Can I Access Neurology Care Without Traveling to Salt Lake City?

Dr. Lyden has an interest in developing ways to improve access to specialty care in rural settings and likes the idea of using new technology, such as TeleMedicine, to help achieve this. The University of Utah maintains a competitive TeleStroke program, hosting a network of twenty-six hospitals that spans six states.

Those participating hospitals are provided with 24-hour on-call neurologists to help with diagnosis and treatment of patients, especially in times of emergencies, like a patient experiencing a stroke. Through this technology, a neurologist at the University of Utah can connect with patients in emergency departments as far away as Bozeman, Montana!

No matter where you’re from—rural Utah or the big city—everyone deserves access to specialty health care. Trainees need exposure to the full spectrum of health systems, ranging from academic centers to rural and underserved clinics in order to understand how to work with varied access to resources and the communities they are serving. This is the heart of Dr. Lyden’s and RUUTE’s work—why they do what they do.

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