Heritage College of Osteopathic Medicine introduces immersive rural medicine training program

It’s a slightly overcast Friday afternoon–humid, as Ohio Julys tend to be. Some sunlight finds its way through the clouds into the O’Bleness Family Medicine Residency Program waiting room, casting across its gray walls and the dozens of informational pamphlets placed on tabletops throughout the seating area. Toward the back of the room, standing beside the patient check-in window, is Dawn Mollica, administrative director for Heritage College of Osteopathic Medicine’s Office of Rural and Underserved Programs (ORUP).

“We’ll just wait a few more minutes for some of the others to get here,” she says to the door operator, smiling politely. “I think I see them pulling in now.”

A few moments later she’s joined by fellow Heritage College of Osteopathic Medicine faculty members Tracy Shaub, D.O., dean of the college’s Athens campus; Sherri Oliver, executive director of Community Health Programs and the Area Health Education Center (AHEC); and Sharon Casapulla, Ed.D., director of education and research for ORUP. These women, along with Dawn Graham, Ph.D., associate professor of instruction for the Department of Social Medicine, are the forces behind REACH–or the Rural Experience in Appalachian Community Health program–the most recent addition to the list of experiential learning opportunities for Heritage College students interested in rural health care. They, along with some O’Bleness faculty members and residents, are gathering to attend a presentation by Sydney Lingerak, Heritage College’s first student to complete the four-week REACH program.  After all are seated, Lingerak smooths her white coat and begins sharing all that she’s learned about public health and community resources; about working in a clinic and quality improvement; and about the rural Southeast Ohio region and the people in it.

Lingerak spent the month of June splitting her time between the family medicine clinic at O’Bleness and several public health services throughout the region.

“I spent time at various HAPCAP [Hocking-Athens-Perry County Community Action] sites, witnessing programs in action, sitting in on appointments, going on site visits with community health workers and participating in a transportation training,” she explains in her presentation. “I traveled to surrounding counties–including Perry and Meigs–to visit health departments, Integrative Services and Hopewell Health sites.”

REACH is a program available to Heritage College students between their first and second year of medical school. The program is meant to immerse students in community health in Southeast Ohio through clinical experiences and engagement with local non-profit social support organizations. By serving the region through both lenses, the goal of REACH is to instill in participating students a first-hand knowledge of the barriers to care patients experience in rural Appalachia, and an understanding of the connection between public health and their role as medical care providers–a necessary link that often goes overlooked.

“Through these experiences, I was able to get a unique understanding of what resources are available in this region and the impact they have on our neighbors,” Lingerak said, continuing her presentation. “To do this is to really immerse yourself in community health and rural medicine–actually be a part of it, not just be on the outside of it.”

The second-year medical student is originally from the Hocking Hills area, but Athens came to feel like home while she was completing her undergraduate degree at Ohio University. She chose to attend Heritage College for this reason–not wanting to stray from the community that’s been so welcoming to her–and has nothing but positive things to say about the supportive faculty, staff and students who have embraced her since starting medical school.

“It’s just a happy place,” she said.

But while she’s grateful for Athens and the opportunities that have met her here, she’s also aware of the circumstances many throughout the county are up against. A 2023 community needs assessment found that the poverty rate in Athens County is twice the national average. On top of this, many living in the area face food insecurity, little access to transportation and high rates of unemployment.

“Often, patients are having to choose between gas, food or medicine,” said Charles Fisher, D.O., director of the O’Bleness Hospital Family Medicine Residency. “And let’s be honest–medicine is often the first thing to be sacrificed.”

Growing up in Southeast Ohio, seeing these health disparities firsthand, instilled in Lingerak the desire to give back.

“I’m very passionate about rural medicine,” she said. So, she joined the Rural and Urban Scholars Pathways Program (RUSP), coordinated through the Office of Rural and Underserved Programs. For more than 10 years, this Heritage College program has provided students with a specialized education on the complexities of rural health care. Through leadership development workshops, community engagement initiatives, immersive mentorship opportunities and clinical practice experiences, RUSP trains future physicians to be versatile, adaptable health leaders in medically underserved areas. It was also through participating in this program that Lingerak first heard of REACH, the brainchild of Dean Tracy Shaub.

“I used to do home visits all the time, taking students out with me and their eyes were opened by being out in the community, in homes and seeing what was happening from a social determinants of health perspective,” Shaub said. After seeing the benefits just one venture into the community yielded for students, Shaub began to ask herself, “How can we do this on a bigger scale?”

In the fall of 2023, she shared this vision with Dawn Graham, who then pulled in Sherri Oliver and Community Health Programs/AHEC; and Sharon Casapulla, Dawn Mollica and ORUP. Together, they began shaping what would become REACH.

“It was this really nice bit of synchronicity, where we all had a desire to make the same thing happen,” Oliver said. “We knew from the start that we wanted a really heavy emphasis on community experience…so it was looking at what would be the best experience for our students and would really show them the widest swath of our community. That's when we decided to reach out to HAPCAP.”

HAPCAP has more than 30 programs offering services to community members in need of assistance in areas such as career development, transportation, housing, health care and more.

“They touch so many different aspects of community life, and are a major player in the social safety net in Southeast Ohio,” Oliver said. This made the nonprofit the perfect partner for REACH.

At HAPCAP, Lingerak–usually accompanied by Casapulla, Graham or one of REACH’s other program coordinators–worked in various roles: packing and delivering meals for the Southeastern Ohio Foodbank, shadowing community health workers on home visits to low-income apartments and doing a ride along with some of their transportation services.

“Transportation is a huge barrier for people in rural communities - not only the cost of gas, but the cost of maintaining a car, the wear and tear, the time it takes to go back and forth traveling to and from regular health care appointments. It can be a real burden and a barrier for people,” said Casapulla. “That was one of the things we wanted Sydney to think about and learn about.”

While doing all the tasks, Lingerak was speaking with both those accessing services and those providing them to gain a better understanding of what needs are being met in the community and where there are gaps, and what she could do about it.

“Going out and learning about what exactly patients are facing kind of made me see things through a new lens–really trying to understand their circumstances, rather than assuming things,” Lingerak said.

After these field experiences, Lingerak would step into the clinic at O’Bleness–her favorite part of REACH–where she worked under the supervision of Fisher. Here, her job was to contribute to an ongoing quality improvement project with the goal of providing personalized resource recommendations to patients. This required her to assess the clinic’s current informational handouts about available community resources (which she found needed some updating) and speak with patients about some of their unmet needs.

“That was really daunting, and vulnerable,” she said of her one-on-one discussions with patients. “It’s kind of an uncomfortable question to ask patients. I had patients that would be really upset talking about it, and it was difficult, but also nice to be able to sit with them and empathize with them, meet them where they’re at.”

At the end of the immersive month-long experience, Lingerak developed a list of recommendations for O’Bleness that would help patients connect with necessary community resources, leading to better patient outcomes overall.

“We were able to show there was some benefit to actually having somebody in the office make that connection for our patients,” Fisher said. “Even with the small amount of time Sydney was in the office, we were able to show some improvement–and that gives us hope.”

As the program continues to grow, the team behind REACH is excited to build on the groundwork Lingerak laid with this research. Ultimately, their goal is to eventually expand the program to other sites across the Appalachian region in southeast Ohio–stationing medical students passionate about rural medicine at clinics and community health organizations where they’re needed most. To start, they want to focus on building a strong foundation, Casapulla said.

“Next year we're hoping to have two students work in partnership, so they’ll be able to work together and learn together,” said Casapulla. “But growing slowly is smart–really building those partnerships between Heritage College, O’Bleness and community organizations to create those learning opportunities for students.”

Back in the conference room, as Lingerak wraps up her presentation, she’s beaming, as are her mentors and collaborators. She seems both humbled by and proud of the work she’s done, eager to apply all she’s learned this summer to her next clinical experience and beyond, as she sets her sights on becoming a primary care physician serving rural communities.

“Sydney's a great person, she'll be a great doctor,” Casapulla said. “Maybe she will be my physician someday.”