Episode 99 – Innovation in Higher Education: Lessons Learned: The SUU Rural Health Scholars Program

President Scott L Wyatt and Steve Meredith sit down with Rita Osborn, executive director of the Center for Rural Health to discuss Southern Utah University’s Rural Health Scholars Program. The program prepares students for graduate-level healthcare programs through academic and non-academic experiences.

Full Transcript

Steve Meredith: Hi again everyone, and welcome to Solutions for Higher Education, a podcast featuring Scott L Wyatt, the president of Southern Utah University in Cedar City, Utah. I'm your host, Steve Meredith, and I'm joined today in-studio, as I always am, by President Wyatt. Scott, it's good to see you again.

Scott Wyatt: It's good to see you, Steve. Thanks.

Meredith: We are sitting far away from each other to be COVID compliant, and I think that's appropriate for today's discussion. We…in our '20-'21 series, we've been talking about innovations and what has gone right for some of the innovative things that SUU has done, and maybe some things that didn't go quite the way we had hoped. And one of those has everything to do with healthcare, so that's certainly a topic on everybody's mind right now. Why don't you introduce our podcast guest?

Wyatt: I will. We are so delighted to have Rita Osborn joining us today. Rita is the Executive Director of the Center for Rural Health. Welcome, Rita.

Rita Osborn: Thank you so much President Wyatt and Steve.

Wyatt: Well, you have one of our university's most fascinating innovations, and it's one that I quickly go to when someone asks me the question, "Tell me something really amazing about Southern Utah University." [Laughs]

Osborn: Well, thank you.

Wyatt: And that's a teaser, so I'm not going to answer the question yet about the actual elevator speech that I give people when I talk about it, but…OK. So, tell us what the Center for Rural Health is.

Osborn: Sure. So, the Utah Center for Rural Health started out in 1997 on this campus with a federal grant from…based at the University of Utah, it's called the Area Health Education Center. So, AHECs are national, almost every state in the country has an AHEC centered at a medical school, and each of those AHEC grants then sparked regional centers. And the goal is to work with the healthcare pathway to recruit and retain more healthcare professionals in rural and underserved communities. We do that by bringing external industry partnerships into the internal education process. We listen to industry, we let them kind of guide the direction of where the needs are, and then we determine how to connect our emerging workforce to those career opportunities. So, you can imagine that healthcare has for decades just had incredible shortages, especially when it comes to rural and underrepresented communities. It's really challenging to find physicians and nurses and pharmacists to go to work in Panguitch, Utah for example or Beaver, Utah or some of our even more frontier counties. So, AHECs around the country have been given the charge to work on this issue and develop pathways that would start with high school students, getting them excited.

The literature shows that a high percentage of the students deselect from choosing a healthcare career field very early on in junior high school/middle school. So, we want to keep that student motivated through high school and get them to one of our universities, especially Southern Utah University, so that they're career goals can manifest themselves, and then hopefully return them to practice in a rural community where they've grown up and served. And so, here at SUU, like I said, our center started in 1997, we weren't doing much with undergrad students at the time, we were working with high school students. We cover 19 counties in rural Utah, I say from Nephi south on the western side of the state and border to border on the eastern side. So, I get a lot of windshield time as you can imagine. [All laugh] I love seeing beautiful rural Utah at its finest, and it's very exciting to get out to those communities and visit and talk with folks out there and listen to the challenges that they have as well. So, at SUU, there wasn't a lot going on with pre-med, pre-professional advising back in those days, and we would get maybe two to three students into medical school each year. So, we approached our program office at the University of Utah at the Medical School and we said, "You know, what can we do to carve out some seats for our rural students?" Many med schools across the country have designated rural seats, which is exciting for students coming from rural or underrepresented backgrounds. And they said, "Well, we're just not there right now." But the Dean of Admissions at the time became a fantastic mentor for me at the end, and still is, and he said, "You know, though, you kind of hit on some things. We're just changing the way we look at things, we're looking at students more holistically." He said, "I'll help you build a program." And he helped us build the Rural Health Scholars Program. We looked at what some other states were doing and we looked at what was going to fit for our students and we created the Rural Health Scholars Program. So, it's a program here for students entering into a healthcare career field. I daresay over 50% every fall want to become pre-med or go to medical school. We work with them very closely through that pipeline. As you can imagine, some of those classes are very challenging for students, so we provide support for those students in the early days with tutoring and mentoring and coaching along the way. It's a very daunting process for many of our students who are first-generation college students coming from backgrounds where just coming onto a college campus is challenging. That was my upbringing. I had never been on a college campus, I was first-gen.

And so, I really relate to these students and it's just been wonderful to create a program where we can have a nurturing environment for students like that. When they join our program, they hopefully join as freshmen, but they can join at any point in time when they decide they want to go into a healthcare career. We have many students who come back as non-traditional students and say, "I've always wanted to do this, but I didn't know how." So, we help them throughout that process. They take specific classes. Some of our classes are taught by our local healthcare professionals. We have a local ophthalmologist that teaches for us, we have a local optometrist, several local dentists. So, we bring in professionals from the community to help coach our students as well. So, the student's in the program for the whole time that they're here at the undergraduate level and we coach them through their entrance exam, we help teach them how to interview and how to do that onerous application and the secondary applications that come with it, and then hopefully we get to celebrate their acceptances once they find out they've been accepted at a healthcare graduate program. So, that's our elevator pitch.

Wyatt: So, the Utah Center for Rural Health has a whole series of programs, and the Rural Health Scholars is one of those programs, and you started it as kind of the pitch to the University of Utah Medical School that, "Why don't you keep a few spots open for rural students, because a student that grew up in a rural town is more likely to go back there," right?

Osborn: Exactly. The literature shows that.

Wyatt: Yeah.

Osborn: And we know that if their family is from that rural community, they're going to fit in that rural community. Our federal government has a loan repayment program, and that's been the band-aid solution. It's great, but I will tell you we had a physician in Kanab and she was fantastic, she worked there for eight years, but she was from Tennessee and she paid back her loans by doing the federal loan repayment program, and then she went back to Tennessee. And so, the long-term solution is finding those from those communities and getting them back. They can still get loan repayment while they're back in their rural community, but guess what? They're going to stay there, and that's the solution. We track our alumni and over 30% of our primary care physicians in rural Utah trace their roots to our program here, which is pretty cool.

Wyatt: That's amazing. What's interesting to me about this story is that you went to the University of Utah and said, "Can you keep some spots open for us?" And they said, "Sorry, we can't do that." So, then you said, "OK, let's figure out how to get our rural students admitted not based on where they grew up, but based on pure qualifications."

Osborn: Exactly.

Wyatt: And then between you and the Dean of Admissions, you carved out or you created this program that allowed you to prepare students precisely for what it was that that University of Utah was looking for, and that ends up being what other medical schools are looking for.

Osborn: Exactly.

Wyatt: So, what starts out as, "Can you give us an exception?" Ended up becoming a program where the rural students are actually as prepared or more prepared or more qualified to get in. I think our listeners would be fascinated to hear the results.

Osborn: Yes. The results have been amazing. Even if we…when we went two decades ago to the University of Utah Medical School and asked for seats, we would have been happy to have five seats carved out for our rural students. At the end of last year, we had over 30…well, 32 students gain acceptance to medical school.

Meredith: Wow.

Osborn: So, we've far surpassed I think any dream that we could have had back in those days. And by using the rubric that the University of Utah Medical School has for its students, we have found that when our students attain that level of maturity in their process of preparing for medical school that they do exceed what other medical schools are looking for, and that certainly has contributed to our students' success with medical schools. But then the other piece of that is those many, many students that come in that door as freshmen thinking they want to go to medical school and finding out that that may not be the best fit for them. Our program also, then, allows them to explore other health careers. So, the physician's assistant career field, optometry, podiatry, dentistry, pharmacy, the whole gamut of healthcare careers are then open to them, and we also pipeline students into those programs. So, last year in total, we had about 90 students that did gain admission to healthcare graduate programs.

Wyatt: And before this program started, it was two to three? Or five?

Osborn: Yes, two to three that were getting into medical school each year.

Wyatt: [Laughs] Those are stunning numbers.

Meredith: Yeah.

Wyatt: that's like from two to three to 23.

Osborn: Yeah…

Wyatt: Or 32…32. Ten times. You get ten times the admission.

Osborn: Yes, and it is just wonderful to see students achieve their goals. As you know, many, many of our students choose to come to SUU because we offer some things that our larger counterparts don't offer. We offer engaged learning, experiential learning, we offer small class sizes, and our students benefit by that, especially when they come from a rural or an underrepresented background. And similarly, in our program, we offer…I joke that we're concierge advising. [All laugh]

Wyatt: Yep.

Osborn: We take care of our students the whole way and we get to see those students grow through that process. And I'll be honest, I just had a student this semester who was in our beginning class and approached our instructor of that class this semester and said, "You know, after sitting in this class for a couple of weeks, I realize I don't want to do this." And guess what? We're just as excited about that as for the student that does get into medical school, because so many students are maybe pressured into choosing a healthcare career or going to a graduate program, and it really does have to come from within. You need a lot of fire in your belly to get through medical school and our healthcare graduate programs. So, we're just as excited that they're not wasting their educational experience and time and money and they can move on to something that is going to do them better.

Wyatt: What's been impressive to me about this program is that—and you've described these pieces, that you're advising, tutoring, all of these kinds of things that help students know if medical school or dental school or whatever it might be is for them, and to help them be successful along that track. But a student who comes in as a freshman and signs up for your Rural Health Scholars program isn't just being helped to graduate and know what their career path ought to be, but you're actually helping them create their resume from day one.

Osborn: Exactly. We focus on experiential learning…

Wyatt: Graduation…normally at a university, we think of graduation as the outcome, but that's not really your outcome because graduation is just a means to the end. It's a step.

Osborn: Mhmm.

Wyatt: Because graduation says that you can now apply to get into medical school, so it's not done until you've completed your graduate program and then passed your boards and now you're working.

Osborn: And then your clock starts over for residency if you're in the physician realm. But most pre-med students need to have about 15 different distinct activities or experiences on a successful application for medical school. So…

Wyatt: 15?

Osborn: 15 activities, yes. Each lasting perhaps over 25 hours. We're not talking about, "Oh, I just volunteered at the Utah Summer Games for five hours." They need to be a commitment., and that includes things like research, patient exposure, job shadowing, service, and leadership.

Wyatt: If a student starts getting their resume prepared as a junior or senior…

Osborn: Oh, yeah.

Wyatt: It's almost too late, isn't it?

Osborn: It's almost too late. If their goal is medical school, that becomes a challenge. We call that double timing it. [All laugh] We will work with that student to double time it, but oftentimes they have to stretch out their career in undergrad a little bit to achieve some of those things.

Wyatt: When I was an undergrad, and Steve, I don't know what your experience was, but as a freshman, I wasn't thinking about graduate school even though I knew that was my goal. I was just thinking about being successful in my undergraduate experience.

Meredith; Yeah.

Osborn: Exactly.

Meredith: I think that's pretty common.

Wyatt: "I just want to be successful as a freshman and then I want to be successful as a sophomore, and then…"

Meredith: Right.

Wyatt: "Oh, I need to start thinking about…? Oh, I've got this and this to do to prepare for graduate school." But that's…when you're 18 years old, four or five years down the road, that's like an eternity.

Meredith: Yeah.

Wyatt: It's like a quarter of your life. That's so far ahead.

Osborn: Right. Well, you think by your junior year if you're headed to med school, you've got to spend most of that junior year prepping for your dreaded entrance exam, the MCAT.

Meredith: Yeah.

Osborn: And that in itself takes hours every day for those students to do well on that standardized test.

Meredith: Yep. I have a son-in-law that has just gone through this entire process, is now in his second year of residency in El Paso, Texas, and it has been very interesting to watch him in his…as he married our daughter while he was still an undergraduate student, and you are exactly right. In fact, he in many ways fits the bill for what we've been talking about today, from a rural community and so forth. And it is an astonishing amount of work just to get ready to go to med school.

Osborn: It is, and really uncovering, "Is this the right fit for me?" Appreciating each of our students' journey. You know, I have students all the time who say, "Oh, I want to be just like so-and-so. He got in at the University of Utah, I want to do exactly the same service he did, exactly the same research." But each student has their own journey in this process and they have to find the experiences that fit for them. Many of our students aren't able to do service Monday through Friday at all. They're committed. They've got classes, they've got work; they might find that service needs to be going to visit care centers with their family in tow on a weekend. [All laugh] And we help them think through that to find those right fits.

Meredith: Rita, we live in a rural community here and we all love it, I know the President and I grew up in larger communities as we were going through school, but I guess my question is: in my program in music technology, we frequently had to do what we called the "reprogramming process," where students would come in thinking one thing about themselves. You know, "I'm a bassoon major and that's what I am, that's what I got my undergraduate degree in." And the reprogramming part was, "No, you need to think of yourself differently." Is there a mindset challenge for students that come from rural communities regarding their ability to get into med school? Do you have to work with students on that mindset?

Osborn: Sure. We do some presentations on the "imposter syndrome."  Many of our students just don't know that they've got what it takes to do this, and so we come from this with an asset-based approach. "These are the things that you bring to the table, and if you truly have the passion to do this, you can." I encourage my students all the time who come from rural Utah who…you know, I always ask a question in our application workshop where we help them write their personal statement, and I'll say, "How many of you started work before the age of 18?" And almost the whole class raises their hand.

Meredith: Right.

Osborn: And I say, "How many of you had a farming/ranching experience? You may even have helped your grandparents do farming and ranching?"

Meredith: Yep.

Osborn: And usually half of the class raises their hands. And I say, "Do you realize that you are unique? That sets you apart as unique. You think about the typical medical admissions team that's reviewing an application, they don't get to read about the student that gets to cut out [inaudible] of the cattle. They don't get to read those things, so they keep reading your personal statement and they get to learn more about you." And we try to encourage students to bring out that which is unique within them. And for everybody, that's very different, especially if they started work before the age of 18, if they contributed part of their income to the family support, if they had to help buy their own school clothes. Do you know that's unique in the audience of who is applying to medical school?

Meredith: Interesting.

Osborn: We do often have to have those conversations where we have to share with a student that they traditional path they chose, which might be four years at university and then hopping into medical school, may not happen. But we also look for the way to get there, and that might be doing a post-baccalaureate program or choosing an alternate career, but we coach them through that process as well.

Wyatt: What do you think…so, if one of our listeners was dialed into this today and said, "This is really an amazing program, I'd like to do something like it or something different, but what can I learn from this experience?" What do you think the lessons that you've learned over innovating on this Rural Health Scholars program over the last almost 20 years?

Osborn: Mhmm. You know, at the counterpart institutions that I'm sure you all attended and I hail from a more suburban environment as well, we have a pre-health advising office that is pretty "flat." That they hand you a checklist and you check off the boxes. In fact, we call those students "box checkers" because their applications often look similar. It's digging in and allowing these students to tell their story and finding time to listen to that story and then help them craft their personal experience into who they're going to become. You know, our students have so many multiple stressors on them right now, especially at a rural school like ours. We have a lot of first generation students, we have students that need to work to keep their debt low, we do experience a challenge with our students committing the time and energy, so helping them find that time and energy to get through these things is good. Our lessons learned? We wish we would have created some things earlier on to make it easier for students to stay in touch with us. One of our goals now is to build an app so that our students…getting in touch with students is very challenging, so keeping students connected is the secret, too. And that evolves as each generation moves through this process, I think. And of the things we've learned is to develop collaborations with our industry partners. So, we have an amazing relationship with our large healthcare employers throughout the state, places where our students can achieve unique opportunities. We could not do this in just the vacuum of our academic institution. We rely on those partners to provide opportunities for our students out in the community. So, developing those partnerships is key as well.

Wyatt: What's one thing you wish you knew when you started this?

Osborn: Uh.

Wyatt: Something that you know today that you wish you'd have known when you started.

Meredith: I heard that sound. [All laugh]

Osborn: [Sighs] Well, personally it's the responsibility I feel for helping the students achieve their goals and having those conversations. Umm, I also think it's important to appreciate where we are. I love our SUU marketing team and they have done a fantastic job at running our acceptance statistics up that flagpole, and our acceptance statistics for our group is, on a five year basis, anywhere from 80% to 98% of our applying group gets accepted at least to one healthcare graduate program, and that's pretty significant.

Meredith: Yeah.

Osborn: Most schools our size do hover around the 65% to 75% range because they have small groups, and our larger institutions really only have about a 45% to 50% acceptance rate, so our wonderful marketing team loves to raise those statistics up the flagpole. So much so that I've had parents contact me and say, "You know, we're deciding to send our student to XYZ school," an urban counterpart of ours, and I have to really educate them about who we are and how we are different. We are not an R1 institution.

Meredith: Right.

Osborn: Our students struggle to get research, and our students typically matriculate to…actually about 60% to 70% of our matriculating group each year matriculates to an osteopathic medical school. So, osteopathic medical schools are a little bit different than allopathic medical schools. Osteopathic schools produce DOs, doctors of osteopathy, and then allopathic medical schools are MD. Anymore in the practice environment, you wouldn't even know the difference. We have medical practices here in Cedar City where you have an M.D. practicing side-by-side with a D.O. They're doing exactly the same thing; they make exactly the same money.

Meredith: Right.

Osborn: It's a little bit different pathway and traditionally focuses on primary care, and it lends itself well to who we are as a rural institution. But when I have a parent call and say, "You know, you've got this 80%-90% acceptance rate, I want my son to go to Harvard Medical School." Unfortunately, we've not had anybody get into Harvard Medical School. We're not…and having those conversations has had to evolve, and it's very challenging with that. So, we've created a document that we give to parents that's called, "Above and Beyond the Statistic" that really does talk about where our students get in. so, that's come from our success but it's a big challenge some days.

Wyatt: Yeah, so you've hit on an interesting point. As we talk about the successes in a soundbite, it doesn't really communicate the full story.

Osborn: Correct.

Wyatt: And sometimes we have to be very careful about managing expectations so that people know exactly what they're getting. That's a very interesting part of this whole thing.

Osborn: Mhmm.

Wyatt: For me, in talking about your success, it's less about recruiting students to get into the pre-med program, and it's more about, "This is an example of an amazing program at a school that has individual attention."

Meredith: Hmm.

Osborn: Correct, yes.

Wyatt: And it feels like two or three or four or these kinds of programs become very illustrative of the institution as a whole and it raises the elevation or the stature of every other program. But you also have a limit to how many students can be in this program, so it's not like…

Osborn: [Laughs] Yes.

Wyatt: It's not like the university can make its future growth based on the Rural Health Scholars.

Osborn: True, true. I think our science faculty would not be very encouraged by that. We have grown the number of students who do come here and we have several hundred students in this program, but you have to realize they're in…that's across four to five years. And so, our matriculating group each year is about 90 to 100 that ends up matriculating to a healthcare career program.

Wyatt: Well, and biology, which is a typical pre-med major, is our largest major.

Meredith: Right.

Osborn: Mhmm.

Wyatt: So, it's clear that a lot of students are coming here for this program and this type of experience, even if it's not the program.

Osborn: Correct. And the interesting message is you can have any major you want. You could be a music major and get to medical school. Many healthcare graduate programs appreciate that you diversified a lot of your undergrad experience exploring something that you're passionate about. We have Spanish majors, psychology majors, nutrition majors, the whole gamut…business majors. So, as long as they're doing well in their sciences and achieve their science pre-reqs, then they're fine.

Wyatt: Well, thank you very much. This has been a lot of fun. Sometime, we should talk about all of the other innovations that you've done. There just is not enough time in one show, but this is one of many programs and something else that's impressive about it is that you haven't taken this Rural Health Scholars program and just kept it kind of as the secret sauce for Southern Utah University, because you've shared it with other schools.

Osborn: Definitely…

Wyatt: And it's at multiple schools.

Osborn: I've presented about this nationally and we're excited to share what works here and we've had other states adapt it to their states. And we're able to build, like I said, collaboratives. Our center is nimble enough to be responsive to community needs. And so, when a need comes up, we can hopefully address that and utilize our students in those opportunities. And that really has been part of that secret sauce.

Wyatt: So, one last question for you Rita, and thank you so much for joining us today. Here's the last question, and that is, "If I was an entrepreneurial spirited or innovation minded person at another institution or at Southern Utah University in different programs, what is the one piece of advice that you would give?" What would you give me as I'm trying to start something? What's the one piece of advice?

Osborn: I think it's build those partnerships. It's really important, you can't do this in a vacuum. And rely on your student successes. Our alumni are our greatest champions. If I have a student thinking about our program, a parent thinking about our program, I can easily tap into our alumni network and build our credibility and our quality, keep the quality there. We never scrimp when it comes to our students.

Meredith: You've been listening to Solutions for Higher Education, a podcast featuring Scott L Wyatt, the president of Southern Utah University in Cedar City, Utah. We've had as our guest today via phone Rita Osborn. Rita heads up the Utah Center for Rural Health and the Rural Health Scholars program here at SUU, both terrifically innovative programs. And Rita, thanks for joining us.

Osborn: Thank you.

Meredith: And thank you to our listeners for listening, and we'll be back again with another podcast real soon. Bye-bye.