Wisconsin AHEC
Summary Progress Report
1999-2002

This Summary Progress Report is organized as follows:

1. Part I, Goals 1 through 5, are the specific goals and objectives outlined in last (1999) grant application.
2. Part II covers special statewide initiatives which are determined annually by our statewide Board and undertaken primarily with state funding.

Introduction
Wisconsin's four AHEC centers meet their objectives through direct service delivery by AHEC staff to training sites and communities and through contracts with sites and academic programs for specific projects. Maps in the appendix provide information on the distribution of training sites throughout the four AHEC regions.

A total of 322 community-based training sites are now active that were originally developed, supported or assisted by Wisconsin AHEC. These sites served over 1606 health professions students in 2000-2001, providing an estimated 10,472 student-weeks of community-based training. Please see the Program Data tables for comprehensive data.

Part I: Wisconsin Model AHEC Grant Goals and Objectives
Although the funding received for our Model AHEC projects for 1999-2002 was lower than our original proposal budget, we chose not to abandon any of the objectives we had set out in that proposal. Rather, we delayed the timetable for implementation of several projects and a few projects will be carried forward into the next proposal, as noted below.

Goal 1: Enhance the learning experience for all health professions students at community-based sites, with an emphasis on interdisciplinary programs, developing cultural competence, and technology support.

1.1 Develop new interdisciplinary training experiences at community sites (community health centers, school programs, rural elderly sites, agricultural safety sites, community dental programs).

Eastern AHEC provided S.A.N.E. training for 12 BSN students and developed the interdisciplinary potential of a dental hygiene program in school-based clinics in Green Bay. Current projects in progress include technology support for practice/teaching sites and nurse practitioner site development in northeastern Wisconsin.

Milwaukee AHEC developed new curriculum at 2 sites. In collaboration with the UW Medical School's Milwaukee Clinical Campus, an urban training option for family practice and internal medicine residents was developed, enhancing both curriculum and training sites as part of a 3-year longitudinal experience in community health. Ten family practice residents were involved this year. In addition, Milwaukee AHEC collaborated in the development of three curriculum modules to enhance the Primary Care, Medicine and OB/GYN experiences for 3rd year UWMS medical and physician assistant students training in Milwaukee.

During the 2000-2001 year, MAHEC collaborated with other Milwaukee area organizations to establish and operate a "Free Dental Clinic". The clinic provides completely "free" services to uninsured dental patients, many of whom are indigent, unemployed or homeless. The clinic also provides community based training opportunities for dental and dental hygiene students. The clinic treated 2,100 patients between October 2000-September 2001. Approximately 11 dental residents and 90 dental hygiene students trained at the site during this period.

Milwaukee AHEC also assisted in the development of a culturally rich health care site for the education of nursing students and speech pathology students in partnership with El Centro de Salud, a nurse-managed health center operated by Columbia College of Nursing (CCON) at the United Community Center (UCC). UCC is a neighborhood center serving a primarily Hispanic population on the near south side of Milwaukee.

New in 2001-02 at Milwaukee AHEC will be a collaboration with the Medical College of Wisconsin (MCW) Center for the Advancement of Urban Children to continue to develop Multi-Dimensional Education Program (MDEP). MDEP is designed to develop training skills in communication, identifying problems for impoverished families and problem solving in multi-dimensional teams. The program is community-based. The MDEP prepares trainees from different professional disciplines, or dimensions, to work as team members to provide culturally competent, family-centered, coordinated, community-based care that supports child/family resiliency and generates community leadership. The participating professional dimensions are education, law (including law enforcement), medicine, nursing (including public health nursing), and social welfare. Consumers or community representatives are also included as a dimension for education. The use of the term "dimension" in place of "discipline" emphasizes that consumers are full partners in all program development and delivery processes. The Milwaukee AHEC assists in administration of the program with the consumers and community-based partners. This program is fully funded by MCW.

Northern AHEC updated an interdisciplinary program offering 16 students opportunities at 10 sites in northwestern Wisconsin and explored potential for interdisciplinary programming with three new partners in northeastern Wisconsin. Beginning in 2000-01, the Northern AHEC Interdisciplinary Project provided interdisciplinary health education programming to the Hmong community through radio, television and group classes. Nursing, social work, and medical students provided the education in consultation with students from other disciplines such as communications and education. Through this project, interdisciplinary students worked in teams to provide educational programs to the Hmong community.

In 2001-02, the new "Interdisciplinary Cultural Diversity Site Experiences Across Northern Wisconsin" will combine activities from previous projects, including Interdisciplinary, Cultural Diversity workshops, WisTREC, and the Wisconsin Express. Five sites across northern Wisconsin will be available, focusing on Hmong and Native American populations. The week-long experience offers an opportunity to an interdisciplinary group of students to learn more about Wisconsin's diverse communities.

Southwest AHEC conducted a rural health care delivery course for pre-professional health students and developed new rural health care delivery course for health professions students.

Medical students in the Southwest region worked on a variety of community projects including: 1) administering a needs assessment survey to 300 patients at a clinic serving a large uninsured population to better understand what their needs are and to organize informational sessions for patients, faculty, residents, and medical students regarding those needs; 2) setting up a specialty care clinic for underserved patients; 3) continuing to develop a free dental clinic at a clinic serving the underserved by working with local community dentists and the Marquette Dental School, and 4) assessing the financial burdens on schools in Madison for treatment of asthma of un- and underinsured children.

Nursing and nutrition students working at a Salvation Army site delivered health care education and counseling services to 625 persons, did 404 blood pressure screenings, did 210 screenings for diabetes, cholesterol, vision, hearing screenings, and mental health, and made 45 medical referrals for follow up care due to abnormal findings. New relationships were developed between the project partners, and between faculty, staff, students, and residents of the facility. Other health care professionals are interested in becoming a part of the project, including mental health and social work professionals.

Students in nursing, respiratory therapy, occupational therapy assistant, health information, and radiography programs worked collaboratively in a rural county and learned about the role that health care delivery in a rural setting plays, particularly before transfer to a tertiary care facility. They also addressed issues related to health care access, population health, cultural diversity, and recruitment and retention.

Projects in progress for 2001-2002 include Project PEACE with the Grant County Health Department to increase awareness between the Amish population and the Grant County Health Department. Nursing students from Southwest Technical College and health education Students from UW-La Crosse will assess and evaluate the current status of access to care for the Amish and identify what services have been and need to be provided. Amish elders will be consulted.

1.2 Develop new interdisciplinary programs to extend students' cultural competence in providing health care to diverse populations, with emphasis on non-English speaking programs and expansion of Community Cultural Rounds.

Eastern AHEC supported site development and design of a 3 year community curriculum for family practice residents in Elkhorn.

Milwaukee AHEC supported new curriculum development at 2 sites; provided up to 60 community cultural rounds presentations each year and organized a conference on providing health care in an urban setting with 260 attendees.

In collaboration with the University of Wisconsin Medical School-Milwaukee Clinic Campus (UWMSMCC), MAHEC implemented a multicultural curriculum for medical students. The curriculum was designed to enhance the medical students' awareness of cultural issues related to providing health care to a diverse urban population and to introduce them to specific cultural traits that may impact on clinical relationships. Other programs that provided students with interdisciplinary experiences with diverse populations included: Urban Health Preceptorship, Urban Training for Primary Care Residents, Community Medicine and Urban Experience in Student Clerkships, and the Urban Health Preceptorship.

The Milwaukee track of the AHEC-sponsored Wisconsin Express program provided 6-12 students each summer with an opportunity to learn about the strengths and challenges of Milwaukee's diverse communities. The students participated in activities at two inner-city clinics: the Madison Street Outreach Clinic and Aurora Healthcare Medical Clinic located in a Pick N' Save grocery store. Students interviewed Hmong, Hispanic, African American and homeless consumers for health care services, as well as health professionals from a variety of areas, including public health and mental health services.

Milwaukee AHEC will continue to support these programs outlined in 2001-02, with an emphasis on increasing the number of CCR presentations and student participation in AHEC sponsored clinical experiences.

Northern AHEC sponsored a two-day cultural immersion experience in the summer of 2000 for 35 health providers with Native American and Hmong communities; through Wisconsin Express, NAHEC provided a summer experience for 9 students in Hmong and Native American communities. In summer 2001, 47 health providers participated in the two day cultural immersion experience. One diabetes and cultural competence conference (two days) was conducted for 176 participants. Continuing education credits were given for nurses, dietitians, and pharmacists. Breakout sessions focused on four major cultural groups in Wisconsin: Hmong, Native American, Hispanic, African-American.

The Wausau Area Hmong Association hosted 5 students this past May for their Wisconsin Express experience. All of the students were enthusiastic about the experience. They particularly enjoyed the immersion in the Hmong community. The hosts were very pleased that students had an opportunity to talk with the Hmong Youth Association about health career possibilities and to show them NAHEC's Health Careers website. The Hmong site coordinator MeLee felt that the most important thing that the students learned was that what seems to be going on with Hmong patients may not be what is actually happening. They developed a deeper understanding of the importance of the family and the clan in Hmong culture.

Northern AHEC's activities for 2001-02 will include an expanded version of the Interdisciplinary Cultural Diversity Site Experiences.

Southwest AHEC developed a new training opportunity for residents at a Migrant Health Center in the Southwest region.

Medical and social work students interviewed Spanish-speaking patients at a clinic with a large underserved population to find out their experiences and perception of access to bilingual and appropriate care in Dane County and interviewed 67 health care providers/organizations to find out their perception of as to current levels of bilingual health care. Several community cross-cultural rounds were presented to students and health care providers, and several formal presentations were delivered at professional meetings.

Through the Wisconsin Express program, Southwest has provided an opportunity for 7 health professions students to visit health care delivery sites within the Ho Chunk nation to observe and listen to providers and consumers, for 3 health professions students to visit hospitals and clinics in the second-poorest county in the state to observe and listen to providers and consumers, and for 8 health professions students to spend four days at the Beloit Area Community Health Center, an FQHC, learning about health care delivery at that site.

In 2001-02, Southwest will be working with the Community Links project at the Beloit Area Community Health Center to maintain and enhance Spanish translation and interpretation services by pairing Beloit College students of Spanish with EvenStart Program Health Educator and EvenStart participants who are learning English. A project with the Dodge/Jefferson Healthier Community Partnerships will train nursing and medical students to be more culturally-sensitive to the growing Hispanic population in these counties. This project will improve primary care for Hispanic residents by making it easier for them to utilize existing community resources. At the Madison Community Health Center, the a new project will develop a Cultural Competency for Primary Care curriculum. Health professions students in nursing, pre-med, pre-PA, internal medicine and pediatric residents will be affected by new curriculum which reflects most recent practices and theories of cultural competency research.

Statewide programming included the Wisconsin Express program, which provided a summer experience for a total of 39 students in 2000 and 29 students in 2001 at sites throughout the state. AHEC's academic calendar for health professions students provided information on Wisconsin's Native American populations and other underserved communities. The calendar is distributed to first and second year medical students at both medical schools, physician assistant students at 3 programs, advanced practice nursing students at five programs, and pharmacy and dental students. In 2001 the calendar was revised to include expanded Wisconsin population health data.

1.3 Develop enhanced services for access to Internet, telehealth and distance education resources at training sites

Eastern AHEC funded a new web based curriculum design for Concordia nurse practitioner students. In 2001-02 , Eastern plans to support the establishment of distance technology to link field based dental hygienists to a supervising dentist with oral cameras and computers in Northeastern and Southeastern Wisconsin for a preventive oral health project.

Milwaukee AHEC collaborated with Marquette University (MU) College of Nursing and Milwaukee Public Schools (MPS) to develop an Internet-delivered program focusing on promoting the benefits of a low fat diet and healthy exercise for middle school students. The materials developed included a four-session Internet program and four short videos. Videotapes were produced based on scripts written during the summer by AHEC community health interns working with faculty from MU College of Communications and staff from the City of Milwaukee Health Department. The educational materials were evaluated at Grand Avenue Middle School. In partnership with Marquette Dental School, Milwaukee AHEC also supported development of teledental resources for use by 260 dental students and is developing, an oral health website for Wisconsin grade schools.

Marquette University School of Dentistry and WAHEC collaborated to establish Statewide "tele-dentistry" sites. These sites will be linked to MUSOD through a telecommunication system. The "tele-dentistry" program will support off campus oral health training for dental and provide access to continuing education programs. In addition, the site will enable MUSOD an opportunity to provide consultation for practitioners and community groups and to promote oral health. The first year (2001) focused on establishing the three pilot sites: MU School of Dentistry (primary) and two remote sites at the Johnston Community Health Center and the Madre Angela Free Dental Clinic. The remote sites will be established using portable equipment allowing movement of staff and students. The project will expand to additional sites in subsequent years. Students and staff are currently at the pilot sites and MUSOD computer personnel can easily access and maintain the sites.

In 2001-02, the tele-dentistry project continues with ongoing pilot testing of equipment and training of staff. It is anticipated that the equipment and staff will be fully operational by early next year.

Northern AHEC offered seven workshops on basic and intermediate computer and searching skills for 77 health providers; eight community health support groups provided via distance for 72 facilitators and community members; and infrastructure for distance education case conferences for rural residency training programs was developed. In 2000-01, the technology support project provided 5 workshops on basic and intermediate computer and searching skills for 87 health providers.

In 2001-02 NAHEC will continue to access hardware and training needs of community-based faculty and facilitate meeting the hardware needs and provide technology for practice/teaching sites in northern Wisconsin. NAHEC will enhance the serve for access to the Internet and distance education resources for students/residents and preceptors.

Southwest AHEC provided Internet health information search training to 12 sites, with 285 participants. Support was also provided for development of a distance education course for medical lab tech students. Beginning in the Fall of 2001, students were able to participate in the lecture portions of their program online; modular design of curriculum allows employment as phlebotomist after only 8 weeks in program; continuing education skills are being developed for online delivery, and program allows rural students to stay in their local communities for more of their training instead of traveling to a campus that is far away. The program also provided for improved documentation of patient care, student performance of patient care and profiling students' experiences, and patient education.

In 2001-02 Southwest will continue to provide staff assistance to prepare quarterly meetings of Wisconsin Rural Training Track Study Group and will help coordinate web-based community rounds accessed by all six RTT sites.

Statewide programming supported development of three new web-based courses/information sites. A joint project, funded in part by the Wisconsin Advanced Telecommunications Fund was developed with the Dept of Family Medicine to fund telecommunications equipment for residency and primary care training sites. The WisTREC program funded development of 7 courses for the nurse practitioner distance education program.

1.4 Develop interdisciplinary training sites in Northeastern Wisconsin. This region is specifically targeted because of underserved populations and the continued need for health profession training site development not addressed during the basic AHEC program period.

Eastern AHEC partnered with an agency with a four county service area to develop a training site anchored in Sheboygan county for nurse practitioners and continues to develop a rotation site for residents.

Northern and Eastern AHECs collaborated on several projects to serve this region, described elsewhere in this report. Progress was limited due to funding constraints. Proposals for the next funding cycle will address this area of need, especially the growing elderly population in the region.

Goal 2: Support health careers recruitment programs in underserved rural and urban areas, focusing on recruitment and retention of minority and other populations underrepresented in the health professions.

2.1 Enhance outreach efforts to recruit minority and underserved students to health professions programs through WisTREC program collaboration. (WisTREC is an RWJ Foundation funded Partnerships for Training program.)

All four AHEC Centers provided staff and organizational support for the WisTREC program, which provides training opportunities for health professionals in underserved communities who wish to pursue nurse practitioner, physician assistant or nurse midwife training while maintaining their current employment. AHEC staff assisted the WisTREC program with student recruitment, technology support, and outreach to employer partners. They also provided some support for minority providers serving an mentors to WisTREC students.

Additional funding for recruitment was procured from a FIPSE (Fund for the Improvement of Post-Secondary Education) grant, and AHEC Centers participated in the interviewing of community liaison staff. Education Coordinators from the four Centers participated with the WisTREC community liaison staff in the "Community Connections" committee effort to recruit qualified students from underserved communities and underrepresented populations. These efforts extended to address "pipeline" issues in concert with other AHEC health careers initiatives. The WisTREC program now counts 8 graduates (4 NP, 1 PA and 3 CNM) and 19 current participants (14 NP, 4 PA and 1 CNM) in its program. Many other PA, NP and CNM students benefit from the distance education courses developed by this project.

AHEC will continue to assist the WisTREC program in its student recruitment efforts and in identifying communities that could be served by WisTREC program students.

2.2 Increase health career awareness activities for high school and college students through collaborative programming

Eastern AHEC supported the Doctors of Our Community program and the IHELP program providing minority students with instructional and hands-on experiences to stimulate pursuit of a career in health care.

Milwaukee AHEC increased the number of its health careers programs in 1999-2000, reaching 200 grade school students, 1748 high school students, 500 college students. In 2000-01, approximately 180 middle school, 1,500 High school and 500 college students were provided opportunities to participate in health careers programs and activities sponsored by MAHEC. The following MAHEC partners participated in MAHEC Health Career Programs: University of Wisconsin-Milwaukee-School of Allied Health, Sinai Samaritan Hospital-Milwaukee, UW Health Profession Partnership Initiative (HPPI), Marquette University School of Dentistry and College of Health Sciences, WI Department of Public Instruction and the Milwaukee Public Schools. The activities included classroom presentations and visits to health profession schools. MAHEC support the cost of coordinating and implementing the program and activities, which included approximately 47 classroom presentations and 22 field trips. MAHEC hosted an annual picnic in July for students who participated in Milwaukee Area Summer Enrichment Health Programs. Milwaukee will be maintaining the full scope of their health careers activities in 2001-02.

Northern AHEC formed the Health Careers Consortium, which quickly grew to statewide organizations of 63 members from technical colleges, universities, hospitals, clinics, CESAs and community organizations. A health careers speakers and mentors bureau was established with 54 participants and a survey was sent of all middle and high school counselors to assess health careers programming needs. A health careers web page was created (www.wihealthcareers.org). The education coordinator attended numerous HOSA meetings and career fairs..

In 2000-01, the Wisconsin Health Careers Consortium grew to 87 members The speakers and mentors bureau had 134 individuals participating. The health careers web page was updated, expanding its scope to include the speakers, mentors, career descriptions and school links, Consortium members, and other program information. Two newsletters were published and distributed to high school teachers and counselors.

In 2001-02, the Wisconsin Health Careers Consortium will assist in the recruitment and retention of students into any one of the health care fields. Communication between members will improve by the continually updated health career web page as well as a newsletter, both of which will include up-to-date information about career fairs, speakers, mentors, and health career programming as well as links to professional associations, academic programs, and potential employers in northern Wisconsin. A conference for health professionals, academic faculty/staff, and high school teachers and counselors is planned as well as parent workshops and the formation of additional health careers clubs in middle schools.

Southwest AHEC facilitated student tours, shadowing and practical experience through youth apprenticeship programs and school presentations (50% staff position) in 1999-2000, reaching approximately 583 students from grade school through high school and college. In 2000-2001, 238 college and technical school students were exposed to career opportunities through staff attendance at career fairs, mentorships and job shadowing at a rural hospital, and through clinical rotations at the hospital. Over 600 elementary, middle, and high school students were exposed to career opportunities through on-site visits to schools, by working with Youth Apprenticeship programs, and orientation tours at a rural hospital. In 2001-02, Southwest staff will be presenting health career programs and opportunities at high schools and colleges, such as HOSA, job fairs, Career Days events.

Statewide programming developed increased capacity for recruitment and retention statewide by providing support for health professions student organization. Health careers programming reached 200 grade school students, 1750 high school students and 500 college students statewide in 1999-2000. These activities continued in 2000-01. The Health Careers Manual was completely revised, a toll-free health careers information phone line was established and the Health Careers website was upgraded. See Healthcare Workforce under Statewide Initiatives, below, for further information on activities in this area.

2.3 Increase intensive programs for pre-college students, including summer programs and test prep courses

Eastern AHEC supported an intensive summer program in Kenosha for 8 minority students and a health careers introduction for 16 minority students in 1999-2000.

Milwaukee AHEC started the community health internship program in 1999-2000, providing summer experiences for 12 students; and provided test prep (DAT, MCAT and SAT/ACT) courses for 43 students. In 2000-01, three test prep courses were offered, serving 53 students. MAHEC, University of Wisconsin-Milwaukee's School of Allied Health Professions, University of Wisconsin-Medical School, Medical College of Wisconsin, Marquette University School of Dentistry and College of Health Sciences and Marquette University's Educational Opportunity Program collaborated to provide a unique opportunity for disadvantaged and minority students to prepare for the MCAT, DAT, and ACT/SAT. MAHEC supported the consultants and administrative cost of developing and implementing the courses.

Through a Health Professions Partnership Initiative (HPPI), a health career program supported by the Association of American Medical Colleges and the Robert Wood Johnston Foundation and administered through the UW Medical School, Milwaukee AHEC worked with the Milwaukee Public Schools (MPS) to increase the pipeline of minority students entering into the health professions by implementing academic enrichment programs. MAHEC participates in the initiative as a community partner providing resources and services. During the 2000-2001 year, MAHEC support enabled the program participants to visit local health profession schools. Approximately 180 high schools participated.

Milwaukee AHEC also continued its participation in the MEDAL program (Medicine, Engineering, Dentistry, Architecture and Law), a joint project between the Milwaukee AHEC, Wisconsin's Department of Public Instruction, Milwaukee Public Schools, Milwaukee School of Engineering, University of Wisconsin-Milwaukee, Medical College of Wisconsin and Marquette University. MEDAL provides minority high school students with an opportunity to participate in a series of highly informative and motivational career workshops conducted by experienced professionals and college students. The MEDAL series consists of five consecutive Saturday workshops implemented in February and March. Each Saturday morning a workshop is hosted at the site of a participating college or university. The workshops are informational, motivational and involve hands on activities. Approximately 46 high school students participated in MEDAL in 2000-01. MAHEC supported program materials, postage, and transportation cost and staff time. The program was well received by the students and parents.

Milwaukee AHEC will offer its test prep and MEDAL programs in the coming year. MEDAL is expected to double in enrollment for the 2002 series.

Northern AHEC continued planning in 1999-2000 for a summer opportunity program for middle school students. Three pre-med students participated in an eight-week interdisciplinary summer experience in at least eight departments within Wausau Hospital and Wausau Family Practice Center each year.

Northern will continue to support the pre-med summer interdisciplinary experience and will be working to develop some intensive summer experiences, particularly for Hmong students.

Southwest AHEC assisted in providing sixteen minority and underserved middle school students with observational experiences in nursing practice setting and the opportunity to spend time at the university during the summer. Students were exposed to nursing activities and given 'hands-on' experience, as well as programming in writing and study skills.

Support was provided for the Nursing Pre-College Program for minority/disadvantaged middle school students which seeks to acquaint students with nursing profession opportunities, develop an awareness of the importance of advanced education and training beyond secondary school, and develop an awareness and appreciation of the richness of resources and activities on a college campus. Southwest staff also developed short programs designed to acquaint elementary and middle school students with health care careers.

Statewide programming provided support for summer health careers programs at UW Medical School and UW School of Nursing.

2.4 Develop increased capacity for recruitment and retention efforts through development of new program materials and new grant initiatives.

Eastern AHEC plans to support the Kenosha long term care worker continuing education and recruitment/retention project as well as development of the Longterm Care Workforce Alliance's Image Campaign.

Milwaukee AHEC provides support for health professions student organizations, such as the National Student Dental Association and the Hispanic Student Dental Association at Marquette University School of Dentistry, and the Black Student Nurses Organization at UW-Milwaukee and Marquette University.

Southwest AHEC participated in development of a proposal to develop a new dental residency program in an underserved area and worked to enhance volunteer experiences at South Madison clinic to include a health careers awareness component. In 2000-2001, staff developed 6-minute health care recruitment video, and a 30 second TV spot, and health care brochure pre-paid tear off card for students, parents, and teachers requesting more information about health care career and educational opportunities in Wisconsin. They also staffed the toll-free health careers information line (1-877-WIS AHEC). In 2001-02, the health careers video will be distributed to 1250 Wisconsin middle and high schools

Goal 3: Support faculty mentors/preceptors at rural and urban FQHCs, CHCs and other community-based practice sites in underserved areas, including school-based and free clinics, to provide more student placements at these sites.

3.1 Increase capacity for trainee education at community sites in the Eastern AHEC region

Eastern AHEC developed capacity for student training at 6 local public health departments (Sheboygan, Marinette, Oconto, Manitowoc, Kenosha and Walworth) and 4 other sites (Fort Howard/Jefferson Neighborhood Family Resource Center, Ripon Medical Center, Racine Correctional Institution and Howe Family Resource Center in Green Bay) during the grant period.

In 1999-2000 training opportunities were provided for 18 medical residents, 3 medical students, 57 nursing students, 4 NPs, 1 pharmacy student, 1 social work student, 1 physical therapy student and 2 dental hygienists. Planning grants were provided for 2 school-based clinics, a diabetes center and a women's health center that will provide training opportunities for additional students. Planning grants were also provided for two new sites in Door County that will provide training opportunities for residents, medical students and physician assistants.

In 2000-2001, Eastern AHEC programs provided training opportunities for 33 BSN students in the Next Generation Now Early Childhood Health Care Project and BSN students participated in the School-Based Health Services in Fond du Lac program school-based health services program and provided preventive services under the direction of preceptors. A program with the Racine Correctional Institution partnered 12 BSN students from UW-Parkside with content experts on various health topics. At the Shalom Health Fair 17 nursing students presented a series of five children's, preventive, primary care, community health fairs for 93 children. The Community Outreach Health Clinic-Nurse Practitioner Practicum provided two student practicum experiences.

3.2 Increase capacity for trainee education at community sites in the Milwaukee AHEC region

Milwaukee AHEC developed capacity for student training at two new sites during the grant period. In 1999-2000, training opportunities were provided for 86 students at CHCs and 321 students at other community-based sites: 120 medical students, 76 dentistry students, 132 nursing students, 36 NP students, 9 social work students, 68 dental hygiene students, and 32 other health professions students. In 2000-01, training opportunities provided for 13 students at CHCs and 408 students at other community-based sites: 120 medical students, 79 dentistry students, 32 nursing students, 1 NP student, 9 social work students, 90 dental hygiene students, and 77 other health professions students. Continuing support will be provided to the sites in development during 2001-02.

3.3 Increase capacity for trainee education at community sites in the Northern AHEC region

Northern AHEC developed capacity at five new sites during the grant period: Marinette County Health Dept. (Marinette), Sacred Heart Hospital (Eau Claire), Osceola Commission on Aging (Osceola), Burnett Co. Senior Center (Siren) and Barron Co. Senior Center (Barron).

In 1999-2000 training opportunities were provided for 34 health professions students (6 nursing students, 4 NP students, 1 PA student, 1 social work student and 22 other health professions students), in addition to the medical residents and UW Medical School 3rd and 4th year students training at sites in the northern region.

In 2000-2001, Northern AHEC offered 5 workshops on basic and intermediate computer and searching skills to 87 health providers. In 2001-2002, NAHEC will be providing community-based technology and library resources support, and will continue to assess hardware and training needs of community-based faculty and facilitate meeting the hardware needs and provide technology for practice/teaching sites in northern Wisconsin. NAHEC will enhance access to the Internet and distance education resources for students/residents and preceptors.

3.4 Increase capacity for trainee education at community sites in the Southwest AHEC region

Southwest AHEC developed capacity for student training at seven new sites during the grant period: Beloit Community Health Center, Ho Chunk House of Wellness, Salvation Army Homeless Shelter(La Crosse), Scenic Bluffs Community Health Center Dental Clinic, Three Rivers Dental Clinic(La Crosse), BriarPatch (Madison), and Harambee Dental Clinic(Madison).

In 1999-2000, training opportunities were provided for 50 residents, 76 medical students 325 nursing students, 18 NP students and 98 dental hygiene students. A proposal for a new dental residency program and new dental clinic was developed which will provide training for 24 dental hygiene students per year. A residency training opportunity at a Migrant Health Center was developed and a new community-based training site for nursing students was opened which will provide training opportunity for estimated 90 students per year. Three externships and several clinical projects were carried out by nursing students in 5 counties with significant underserved population. A Wisconsin Express experience for 8 students was provided at Beloit Area Community Health Center.

In 2000-2001 Southwest supported improved documentation of patient care, student performance of patient care and profiling students' experiences, and patient education. Nursing and nutrition students working at a Salvation Army site delivered health care education and counseling services to 625 persons, did 404 blood pressure screenings, did 210 screenings for diabetes, cholesterol, vision, hearing screenings, and mental health, and made 45 medical referrals for follow up care due to abnormal findings. New relationships were developed between the project partners, and between faculty, staff, students, and residents of the facility. Other health care professionals are interested in becoming a part of the project, including mental health and social work professionals. Dental hygiene students helped provide care to 120 persons that otherwise would not have received services and are learning basic skills and how to work in a community-based setting.

3.5 Support development of community-based sites and curricula for physician assistant, pharmacy and dental programs as needs are identified.

Eastern AHEC will continue to develop the dental hygiene programs outlined above, inlcuding a new program at the NEW Clinic (a CHC) in Brown County.

Milwaukee AHEC provided training opportunities in 1999-2000 for 74 dental students and 22 dental hygienists and preceptor training for 37 physical therapy preceptors and community dental preceptors who will supervise 280 dental students. In 2000-01, training opportunities were provided for 11 dental residents and 90 dental hygienists (both included in totals in 3.1, above) and preceptor training for 37 physical therapy preceptors and 20 community dental preceptors who will supervise 27 dental students. In 2001-02, Milwaukee AHEC will continue to provide for expansion of opportunities for community-based training for dental and dental hygiene students through the Madre Angela Dental Clinic and its partnership with the Marquette University School of Dentistry. It will also participate in the Seal-A-Smile program involving 50 dental students.

Northern AHEC provided pharmacy continuing education credits at the Cross Cultural Exchanges Diabetes conference. The Seal-a-Smile program touched over 244 students and faculty at schools in Price County. Staff assisted with WisTREC's strategic planning, regularly attended statewide meetings, and continued to talk with organization leaders to promote higher education and distance learning for the PA, CNM, and NP programs. Five technology-based workshops on basic and intermediate computer and searching skills were provided to 87 health providers.

In 2001-02, the Seal-a-Smile will continue sealing children's teeth in Price County, and expand to the neighboring counties. Staff will continue to support the WisTREC agenda by talking with organization leaders to promote higher education and distance learning for the PA, CNM, and NP programs. Providing community-based technology and library resources support, NAHEC will continue to assess hardware and training needs of community-based faculty and provide technology for practice/teaching sites in northern Wisconsin. NAHEC will enhance access to the Internet and distance education resources for students/residents and preceptors.

Southwest AHEC, as noted above, assisted in development of a new dental clinic which will provide training opportunity for 24 dental hygiene students per year and developed residency training opportunity at a Migrant Health Center. Dental Hygiene students helped provide care to 120 persons that otherwise would not have received services and are learning basic skills and how to work in a community-based setting.

Goal 4
Expand Rural Training Track residency programs and develop extended training programs in rural areas for residents, medical students and other health professionals.

4.1 Support activities of Wisconsin Rural Training Track Work Group

Statewide programming supported two statewide RTTWG meetings each year, developed the RTT website for more effective student recruitment and supported travel for faculty to national meetings. Funding was also provided for development of a recruitment brochure describing the programs. Northern AHEC facilitated three sessions of virtual rounds with 8 residents, 4 physician faculty, and 11 other staff participating from over 8 different sites across the state. Southwest facilitated RTTWG meetings, allowing the six rural track training sites to share program experiences, discuss ways to enhance web-site based information about the RTT and helped coordinate web-based community rounds that could be accessed by all six RTT sites.

4.2 Develop infrastructure for distance education case conferences

Statewide programs worked with the Department of Family Medicine to a successful grant proposal for funding videoconferencing equipment purchases. It also provided funding for enhanced Internet access at family medicine training sites throughout Wisconsin. Northern AHEC participated in preceptor and coordinator meetings for Primary Care Clerkship and Rural Training Track. Plans were made for enhancing communication skills, including distance education case studies on the Internet.

4.3 Begin development of rural training track program for third year medical students in Northern AHEC region

Northern AHEC participated in five meetings with Marshfield Clinic and UWMS to explore development of a 3rd year "Northern Exposure." It was not possible to implement this program during the grant period. Development will continue as part of the next grant period.

4.4 Expand infrastructure support for rural training opportunities for other health professions as needs are identified by each program.

Eastern AHEC provided planning grants provided for two new sites in Door County that will provide training opportunities for residents, medical students and physician assistants. Projects in development include Fond du Lac Health Department /School Based care training and GuardCare-Dental Sealant and interdisciplinary training. Northern AHEC continues to provide technology support to a variety of sites throughout its region. Southwest AHEC is working to improve accessibility to the medical lab tech program for individuals from rural communities, establishing partnerships between Madison Area Technical College and rural community healthcare facilities, and establishing a mentor program that could serve as model for other healthcare programs at MATC. Statewide programs provided support for dial-in modem banks used by Pharmacy students while on community rotations.

Goal 5
Support faculty development programs needed for implementation of Goals 1 through 4.

5.1 Offer regional faculty development workshops, tailored to the needs of the community faculty and the program elements outlined above.

Eastern AHEC provided funding for development of medical student, resident and physician assistant preceptors in Door County. Milwaukee AHEC offered Community Cultural Rounds (2000 participants), Urban Health conference (260 participants), dental preceptor training (20 participants) and physical therapy preceptor training (37 participants). Milwaukee will continue its Community Cultural Rounds presentations and plans a conference on School Based Health Services in the spring of 2002. Northern AHEC provided seven workshops on building information search skills attended by 77 providers. Southwest AHEC provided training program for 53 providers on health care issues in agricultural populations and continued to develop curriculum around agriculture-related educational needs of health care providers in a three-county agricultural area. Statewide programs supported development of workshops on mentoring for cultural competence; preceptor development workshops for family medicine and physician assistant community faculty.

5.2 Offer telecommunications and library resources support for rural providers. Staff will support individual sites, as needs are identified, for training on telecommunications and electronic library resources.

In 1999-2000, Eastern AHEC provided training in accessing health information via the Internet for 45 public health nurses. Northern AHEC presented three train-the-trainer workshops in three different communities to teach health information Internet searching skills. Southwest provided Internet health information search training to 12 sites and 285 individuals.

In 2000-01, Northern AHEC provided four health information access/Internet access workshops to 40 participants. Southwest AHEC developed and delivered on-site and hands-on workshop for local public health department, clinic, and hospital personnel. Participants were better able to retrieve and evaluate health information they found on the Web.

Northern AHEC has provided leadership to the Wisconsin AHEC System in the area of library outreach services through its National Library of Medicine grant projects which are now coming to a close. In 2001-02, Southwest's new NLM grant librarian will work with 18 project partners to establish and/or upgrade/enhance their ability to use Web-based health care information and training resources. They will also develop web-based education and information referral resources, train 420 health care consumers in underserved rural and Native American communities in SW Wisconsin to use these resources, develop a 'train-the trainer' program for consumer health Internet education and educate at least one local trainer for each partner community.

5.3 Provide regional faculty development workshops on teaching methods

Southwest AHEC is supporting a presentation at the 2002 Society of Teachers of Family Medicine Predoctoral Educaton Conference to speak on outcomes of project designed to increase the observational and listening skills of 17 medical students by using a newly-developed patient-centered, culturally-sensitive curriculum. Title of presentation is "Using Ethnographic Methods to Teach Listening, Critical Observational and Self-reflective Skills in the Community Preceptorship". Students successfully learned how to incorporate the basic skills and attitudes of being a participant observer, learned to appreciate how these skills and attitudes can improve communication with patients and broaden their own perspective on the role of physicians, learned how to keep field notes of observations, and how discussions of alternative treatments, lifestyle counseling, and patient-centered interactions including spiritual discussions may occur in office visits.

5.4 Provide funding for innovative faculty and student projects to develop interdisciplinary and cultural competence curricula and experiences and web-based distance learning projects that enhance community-based clinical experiences.

Nine new projects were developed in 1999-2000. Milwaukee developed a new integrated urban health curriculum at Aurora healthcare sites, enhanced interdisciplinary curriculum at Silver Spring neighborhood center, teledental network, oral health website for grade schools, new internet resource on nutrition for middle school students. Northern completed 2 projects educating providers about the Hmong culture, a workforce planning survey and a health careers symposium. Southwest provided funds for nursing care delivery model for health promotion and prevention presented to 230 practicing health professionals and preceptors and provided funding to a program providing 18 medical students with leadership training and support for innovative community service projects.

Part II: Special Statewide Initiatives

Oral Health Initiative
AHEC's Dental Initiative has been developed and implemented primarily by Milwaukee AHEC in partnership with Marquette Dental School. Components of this statewide initiative included:

• A Medicaid Symposium in the spring of 2001; the symposium introduced students to Medicaid programs.
• An Oral Health Website developed with the Wisconsin Teachers Association.
• Externship Preceptor Conference - a training workshop for dentists interested in serving as preceptors
• Tele-Dentistry Initiative - currently 3 sites are being established. Additional state and federal support will be sought to expand the project to include additional sights
• National Health Service Corps (NHSC) Scholarship - one student has been accepted for the scholarship, and will serve as an ambassador to help recruit future students for the NHSC scholarship.

A variety of other initiatives in the AHEC regions have already been mentioned above

Telecommunications Access for Training Sites
Under this initiative, funding was provided for enhanced Internet access for students and residents at family medicine training sites throughout Wisconsin. Computers and network hardware, as well as support for a dial-in modem pool were provided at a variety of clinic sites (including Belleville, Verona, Wausau, Eau Claire, Richland Center, Monroe, Baraboo and Appleton ) enhancing existing resources and enabling residents and students dial-in access for email, web and library resources. New routers purchased for DFM clinics in Belleville, Verona, Wausau and Eau Claire will allow Family Medicine to upgrade their network connections to frame relay T1 speeds (12 times faster than current connections). This will also enable them to deploy video over the network as part of the soon to begin WATF grant written by DFM, AHEC and UW Med School Academic Affairs.

The WATF grant will use the DFM statewide digital network to conduct medical education and training via video, the web and email. Targeted users include medical students, medical residents, and faculty. The broad goals of the project are to create a community of learning that overcomes the barriers of distance and allows core curriculum and teacher/learner consultation to be available everywhere in Wisconsin. The intent is to serve as a model for distance learning that can be used by other health professions such as nursing and pharmacy, and that will be of on-going use for continuing education of health professionals. The project's technology core consists of a new video technology from Cicso called IP-TV which uses standard Internet protocols to broadcast video to use PC's, the use of personal videoconferencing products such as Microsoft NetMeeting to connect individual teachers and learners, and a dial-in modem pool with a 1-800 number for statewide access to the electronic resources of the UW-Madison regardless of user location.

Innovative Partnerships with Local Health Departments
Work on this initiative began with the October 1999 Wisconsin AHEC annual conference, "Promoting Healthier Communities in Wisconsin," a joint meeting with Wisconsin Division of Public Health attended by 150 people. A number of formal and informal partnerships developed from this meeting.

A follow-up meeting was held in February 2000 at which participants agreed on several areas where AHEC/DPH collaborations would be most fruitful:

1. Conference facilitation,
2. Development of community service learning experiences for health careers students, in partnership with local public health agencies,
3. Continuing education for health care professionals, including public health workforce in the areas of cultural competence, population health, epidemiology and evidence-based practice,
4. Expansion of distance education opportunities for practicing professionals, and
5. Recruitment of young people and adults into the health professions workforce.

AHEC supported a variety of projects under this initiative, solicited through a call for proposals, including:

Community Health Internship Program
This summer program matches students with county health departments for service-learning projects. The first program was developed in summer 2000 by Milwaukee AHEC in partnership with the UW Medical School- Milwaukee Clinical Campus and the City of Milwaukee Health Dept. Students participated in field work, clinical shadowing opportunities, lectures and presentations by medical personnel. Funding provided stipends to the student interns and supplies necessary for their projects. Twelve students did projects mentored by 6 health department personnel and health professions faculty.

Other projects included:
Rural Health and Aging: Expansion of Health Care Services to Underserved Older Adults in Waushara County Extension of Health Services to Underserved Communities by Senior Nursing Students Collaborative Interdisciplinary Discussion Groups on Hmong Culture Caring, Inc.: A Partnership for Public Health

In 2000-2001, the Community Health Internship Program was improved and expanded. Efforts to further develop this program will continue in 2001-2002.

Healthcare Workforce Development
The Wisconsin AHEC system has traditionally focused its activities on development of Wisconsin's primary care physician, physician assistant, pharmacist, dentist and advanced practice nursing workforce. The Healthcare Workforce initiative was designed to take a broader focus on emerging needs for bachelors-prepared nurses, personal care and long term care workers, and public health and allied health professionals at all levels. Our goal is to develop Wisconsin's healthcare workforce at all levels so that it

1. is sufficient in number and training to provide high quality care in all areas of the state,
2. is distributed so that it meets the needs of individual communities, institutional settings and larger geographic areas that are currently underserved,
3. reflects the diversity of the state's population, and
4. is skilled at meeting the needs of patients from various cultural backgrounds.

AHEC's October 2000 annual conference "Developing Wisconsin's Health Care Workforce," provided 150 participants with an overview of Wisconsin's current health care workforce, health status indicators and emerging health needs; current workforce planning efforts and innovative strategies for addressing recruitment, retention, diversity and distribution of the health care workforce.

The Health Careers Consortium (facilitated by Northern AHEC) , is a statewide organization of over 80 health careers professionals from high school, technical college university and provider organizations who meet regularly to develop programs to provide better outreach to schools. Projects include production of a quarterly newsletter, a display board, career information sheets and other materials for distribution to students, as well as development of a web page (www.wihealthcareers.org) to provide better information to students in an attractive format.

Wisconsin Health Careers , a booklet with information on over 70 health care fields intended for use by high school and college students, was revised and updated for distribution in the spring of 2001. It will also be available on the AHEC web page (www.ahec.wisc.edu) .

Workforce Planning for Northern Wisconsin Health Care This focus of this project was to gather factual, direct and focused data from healthcare workers in northern Wisconsin to use as a base for strategic workforce planning. A one-day strategic-planning session was developed in partnership with Northern AHEC for all health career consortium partners. The outcome of the project was a workforce-planning document specific to northern Wisconsin.

Health Care Workforce Coalition
Southwest AHEC and the Wisconsin Health and Hospital Association (WHA) are co-chairing a statewide Healthcare Workforce Coalition focused on

• identifying critical healthcare workforce needs
• promoting health care career opportunities to middle-and high school age students and others
• working with the state Department of Public Instruction and Wisconsin Technical College System to bring more attention to health career opportunities and to better understand the articulation of healthcare courses, degrees, and certification
• working with the Wisconsin legislature to educate our representatives about the critical health care workforce needs facing the state and to gain their support for initiatives to make it easier to enter the health care workforce.

The coalition has, with support from AHEC, WHA, Wisconsin Nurses Association, and the Rural Wisconsin Health Cooperative, produced a six-minute recruitment video that gives students and parents a look at the career opportunities in health care and a 30-second TV spot that will air statewide with information about how to get more details on health career educational opportunities in Wisconsin. Additionally, a brochure about health careers has been developed that will be distributed to schools. The brochure has a tear-off card that can be sent back to the AHEC office for more information about health careers. A toll-free number to call will also be provided. AHEC staff will call back, if requested, and provide more in-depth information and direct students to educational institutions with their specific health care career interests. A liaison list is being developed for all technical college campuses and 4-yr. campuses in Wisconsin with healthcare programs. The liaisons will be contacted by AHEC so that they can follow up with potential students and/or their parents.

The coalition is also drafting material to conduct a legislative briefing during state budget deliberations this spring. Focus will be on the healthcare worker shortage and what initiatives could be initiated to help increase the number of students going into health careers.