Thesis (Ph. D.)--University of Missouri-Columbia, 1999. / Typescript. Vita. Includes bibliographical references (leaves 163-169). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 1999. / Typescript. Vita. Includes bibliographical references (leaves 163-169). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri--Columbia, 2000. / "May 2000." Typescript. Vita. Includes bibliographical references (leaves 56-72, 152-166). Also available on the Internet.

Thesis (Ph.D.) - University of St Andrews, November 2008.

Thesis (M. Nursing)--Montana State University--Bozeman, 2007. / Typescript. Chairperson, Graduate Committee: Jean Shreffler-Grant. Includes bibliographical references (leaves 44-48).

Around 20% of America’s population lives in rural communities; however, only 9% of all physicians practice within these rural areas. Consequently, there is a consistent shortage of healthcare resources for these populations.1 To help this shortage, medical institutions should reach out to their local youth because a majority of the physicians who practice medicine in rural areas experienced their childhood in similar communities.2,3 The simulated Medicine in Action camp at Quillen College of Medicine provided an opportunity for local, rural high school students to learn more about the healthcare field in the hopes of eventually playing a role in alleviating the rural healthcare deficiencies. Twenty-one high school students from rural Appalachia with an interest in the healthcare field were recruited by the Simulated Medicine in Action camp to participate in a five-day medical simulation experience developed by the Quillen College of Medicine Center for Experiential Learning. The program employed interactive simulation platforms to provide education to students about various aspects of patient centered care, including communication skills, physical exam skills, technical skills, and integrative clinical reasoning skills. Through a lecture followed by simulation format, students exercised real world medical skills to assess, diagnose, and treat their “patients” in clinical scenarios. This format challenged the students to work as a team and provided students with the opportunity to experience the role of medical professionals. The curriculum also provided students with the opportunity to listen to a panel of physicians as well as a panel of other healthcare professionals to provide exposure to the breadth of the healthcare. Participants completed two surveys using the Likert scale: an entrance survey on the first day of camp and an exit survey on the final day. The likert scoring scale is as follows: 5=strongly agree, 4=agree, 3=neutral, 2=disagree, and 1=strongly disagree. Students responded to the following prompts in both of the entrance survey and the exit survey: (1) I have had enough exposure to the medical field to know that I am interested or not interested in the field; (2) If I decide that I want to be a physician, I believe that I am capable of achieving that goal; (3) If I decide I want to be a physician, I think I know enough about the educational process to pursue that career. Entrance survey had an average of 3.8, 4.5, and 3.7 respectfully. Exit survey had an average of 4.2, 4.7, 4.2 respectfully. Students also responded to the following prompts exclusively in the exit survey with the respected results: The Simulated Medicine in Action Camp improved my desire to pursue a career in healthcare (4.8); The Simulated Medicine in Action Camp improved my desire to become a physician (4.5); The Simulated Medicine in Action Camp improved my desire to pursue further education (4.7). Due to the upward trend and the high Likert scores in the exit survey, we conclude that using medical simulation experience with hands on opportunities and exposure to healthcare providers both clarifies and increases interest among high school students in regards to entering the healthcare field. We hope that this interest propels them into their careers where they may potentially serve their local rural community. References: 1Rosenblatt, R. A., & Hart, L. G. (2000). Physicians and rural America. The Western journal of medicine, 173(5), 348–351. doi:10.1136/ewjm.173.5.348 2Easterbrook, M., Godwin, M., Wilson, R., Hodgetts, G., Brown, G., Pong, R. and Najgebauer, E. (2019). Rural background and clinical rural rotations during medical training: effect on practice location. [online] CMAJ. Available at: http://www.cmaj.ca/content/160/8/1159.short [Accessed 18 Sep. 2019]. 3Feldman, Kymm, et al. "The difference between medical students interested in rural family medicine versus urban family or specialty medicine." Canadian Journal of Rural Medicine, vol. 13, no. 2, 2008, p. 73+. Gale Academic Onefile, Accessed 18 Sept. 2019.

The purpose of this project was to identify the current status of education/training of rural health care providers and identify gaps in training/education to better prepare rural providers to care for victims of disasters. A survey was conducted and distributed to 21 physicians, nurse practitioners, and physician assistants employed at rural clinic/critical access hospital. The survey consisted of quantitative and fill in the blank questions. The survey was distributed through the electronic survey engine “Qualtrics.” Participation in the survey was voluntary and responses were anonymous. The survey addressed/identified: basic demographic information, knowledge of disaster/emergency preparedness and care of victims as a first receiver, experience and education related to disasters/emergencies, perceptions of emergencies/disaster types most likely to impact their facility, future education/training preferences, and barriers to participation in disaster/emergency education/training. The survey also assessed the providers’ comfort level with suggested disaster/emergency core competencies put forth from professional emergency/trauma organizations. The response rate to the survey was 57.14%. Of those that responded 41.67% reported experience in caring for victims of disaster. Participation in previous disaster education/training was reported by 83.3% and these same respondents were familiar with their role according to the facility’s Emergency Operations Manual (EOM). The providers perceived that natural disasters were most likely to affect their community (83.33%) in relation to events from the facility’s Hazard Vulnerability Analysis (HVA). Respondents that reported having not participated in disaster education/training indicated a lack of time and new employment as barriers. For future training 66.66% of those that responded would prefer hands on training and were willing to spend one hour per year on disaster training/education. In regard to their ability to care for disaster/emergency victims, participating providers considered themselves novice (25%), advanced beginner (25%), competent (16.67%), proficient (25%) and expert (8.33%). Overall, results indicate that most respondents had experience and are currently participating in education/training. However, the majority still consider themselves novice or advanced beginner in their ability to care for disaster/emergency victims. Most felt that there was little likelihood for most disaster events to occur in their community other than natural disasters.

Adverse childhood events (ACEs) are associated with poor mental and physical health outcomes, and youth in rural Appalachia have been shown to experience disproportionately more ACEs compared to youth elsewhere. During the spring of 2020, our community partners in Johnson County, Tennessee expressed concern for the mental health of youth and educators in their community and identified a need for information on coping skills and stress reduction. With input from local stakeholders, we created a Calm Corner Kit and a Coping Skills Resource Guide with specific coping strategies, stress reduction techniques, and support programs for students, parents and caregivers, and school personnel in the community. An IRB-approved survey of school personnel who utilized our tools found them to be useful, convenient, and easily accessible resources. These positive results warrant future studies to investigate student and parent perceptions of the value of similar interventions in supporting their mental and emotional health.

Interprofessional teamwork is being adopted as the best way to care for patients, but it is also important to determine how future healthcare providers view this model of patient care. What are their attitudes and beliefs after having the opportunity to work in an interprofessional team? The primary objective of this study was to determine changes in health profession students’ attitudes toward interprofessional collaboration through participation in a Remote Area Medical (RAM) event in rural Appalachia. Researchers hypothesized that working in interprofessional teams positively impacts students’ attitudes toward interprofessional practice. To explore these variables, RedCap was utilized to collect demographic information, generate a pre/post survey matching code, and administer previously validated interprofessional education (IPE) questionnaires to RAM clinic student volunteers (representing five ETSU health sciences colleges and various undergraduate programs) before and after the event. Students were allowed to voluntarily complete the pre-survey online prior to participating in the event or at sign-in and the post-survey at sign-out or online after the event. The Student Perceptions of Interprofessional Clinical Education-Revised Instrument, Version 2 (SPICE-R2), which is validated for use in pre- and post-surveys, utilized 5-point Likert-type questions (strongly disagree to strongly agree) to evaluate students’ perceptions of their role on the team and the team’s impact on healthcare and patient outcomes. The Interprofessional Collaborative Competency Attainment Scale-Revised (ICCAS-R), which is only validated for use in post-surveys, required students to simultaneously evaluate their ability to perform tangible interprofessional team skills before and after the event using 5-point Likert-type questions (poor to excellent). At the event, students were placed into interprofessional teams to provide care to patients. Faculty members from a variety of professions provided leadership to the teams and guidance as needed. The pre-survey had 107 responses and the post-survey had 108 responses. However, after matching the pre- and post-surveys with student-generated codes, there were 70 valid matched responses. Data analysis was conducted using SPSS version 25. There were no statistically significant changes in SPICE-R2 IPE constructs from the pre-survey to post-survey. However, high pre-survey scores indicated that this student cohort already had a high level of appreciation for interprofessional teams, with mean scores of 4.5 out of 5 for teamwork, 4 out of 5 for roles and responsibilities, and 4.36 out of 5 for healthcare outcomes. The mean overall composite score on the ICCAS-R increased from 3.65 out of 5 on the pre-event portion to 4.03 out of 5 on the post-event portion (p < 0.001) , indicating that students increased their self-evaluated ability to perform tangible skills used in the interprofessional team through participation in the RAM clinic. Findings of this research may allow educators in both classroom and healthcare settings to better understand how hands-on IPE experiences influence students’ interprofessional attitudes and beliefs.

Insulin is a necessary, life-changing medication for patients living with Type 1 or Type 2 Diabetes Mellitus. Yet, a recent study at an endocrinology clinic in New England indicated that one quarter of patients experienced cost-related suboptimal insulin use. A new study based out of a primary care clinic in the Appalachian region looked at the prevalence of cost-related suboptimal insulin use within this region. The hypothesis is cost-related insulin suboptimal use is higher in the Appalachian region than as reported in the New England area. Surveys were administered to patients who were 18 years of age or older, diagnosed with Type 1 or Type 2 Diabetes Mellitus, and who had been prescribed insulin in the last 12 months. The survey instrument used was adopted and modified from the previous New England study. The survey instrument included 28 items and was administered in person prior to the start of the COVID-19 pandemic from July 2019 to April 2020. Following the start of the COVID-19 pandemic, in person recruitment was suspended. Beginning November 2020, a revised telephonic recruitment began and continued through December 2021. Interested participants were mailed the survey and consent form along with a postage paid return envelope. After the COVID-19 outbreak, the original survey instrument was revised to include 12 additional items designed to measure the impact of COVID-19 on the participant’s diabetes management and on insulin utilization. The primary outcome was cost-related underuse of insulin within the past year. This was measured by a positive response in the questionnaire to at least 1 of 6 questions: did you… (1) use less insulin than prescribed, (2) try to stretch out your insulin, (3) take smaller doses of insulin than prescribed, (4) stop using insulin, (5) not fill an insulin prescription, or (6) not start insulin… because of cost? Descriptive analysis was conducted using SPSS software. The East Tennessee State University Institutional Review Board approved the study protocol. Ninety respondents completed the survey. The average age of respondents was 68 years. The majority were diagnosed with type 2 diabetes (83%), Caucasian race (99%), male (59%), retired or disabled (76%), and had Medicare Part D prescription benefits (63%). The average monthly out-of-pocket cost for insulin was $84.10 (range $0-$566). For the primary outcome, results indicate 44.4% of participants in the Appalachian Mountain community experience cost-related suboptimal therapy. Forty participants completed the revised survey measuring the impact of COVID-19 on their diabetes self-management. From this group, 85% of participants reported their income and job did not change during the pandemic. However, increased dosing of insulin (30%) and increased insulin cost (27.5%) was reported. Respondents also reported increased stress (57.5%), worsened diet (25%) and worsened exercise (40%) as a result of the pandemic. Overall, a higher proportion of people with diabetes in the Appalachian region reported cost-related suboptimal insulin use compared to a previous study. The COVID-19 pandemic also has reportedly contributed to increased insulin requirements in one-third of the surveyed participants.