WAMI: A New Concept in Medical Education and Rural Health Care

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In the late 1960s and early 1970s, the federal government reported that the U.S. was facing a severe personnel shortage in the health care field that was most acute throughout rural America. Many states and the federal agencies sought to solve this problem by building more medical schools. For example, the state of Ohio, which had three medical schools in 1970, now has seven. Proposals were made in Washington State to build a second medical school and to build new medical schools in Idaho, Montana, and Alaska--states which have never had a medical school.

In 1971, the UW pioneered a new approach to solving the complex problems of rural health care, under the leadership Robert L. Van Citters, then Dean of the School of Medicine, and with the support of UW President Charles Odegaard and Washington State Governor Daniel J. Evans. This experiment, now in its 25th year, created a four-state regional medical education network called the WAMI Program, an acronym for the participating states of Washington, Alaska, Montana, and Idaho.

Medical students from each of the WAMI states stay in their home state universities for the first year of basic studies. Then, they all move to the UW for the second year of training. Finally, the students can spend much of their third and fourth years as well as their residencies in clinical settings and communities similar to those in which they hope to practice.

The WAMI program allows the UW School of Medicine to act as the medical school for nearly one-quarter of the land mass of the U.S.. It has been supported financially by the participating states since its initial year, when it started with grants from the Commonwealth Fund and some federal funding.

The program has spawned a cooperative regional network that extends well beyond education, also encompassing treatment and research. It has been very successful in encouraging young physicians to practice in rural areas where they are critically needed.

Doctors in remote locations are often called upon to diagnose and treat a wide range of conditions, from minor to complex. Preparing physicians to meet those demands is one of several reasons why the UW departed from the national trend of educating specialist physicians at urban medical centers. Instead, it launched new initiatives for preparing general physicians. And the instructors were to include talented physicians in small towns and mid-sized cities throughout the region who would help teach students in methods of day-to-day practice.

In 1971, as part of the WAMI program, Van Citters changed the medical school curriculum, creating a Department of Family Medicine, and appointing Theodore Phillips as its founding chairman. Phillips was a family physician with experience in both rural private practice and academic research in urban settings. Over the years, the faculty have built a department of family medicine that today stands as a model for others around the nation. Phillips is credited with having established the field of modern-day family practice in this country.

The Department of Family Medicine in particular has become nationally recognized for its efforts in training highly capable rural doctors. For the past several years, including 1996, U.S. News & World Report has ranked the UW number one in teaching medical students in the fields of primary care, family medicine, community medicine, and rural health care. In 1995, the prestigious British medical journal The Lancet called the UW program "perhaps the best academic model for addressing the shortage of rural physicians."

As a result of the WAMI program, other notable community-based training programs have been developed to target fields of special need to rural counties: general adult medicine, general pediatrics, women's health care, general surgery, and psychiatry.

One offspring of the program, the Rural Hospital Project, led by UW family medicine professor Roger Rosenblatt, was launched in the late 1970s to work with rural communities that had failing health care systems. The project built on Rosenblatt's earlier work in Nome, Alaska, where he explored new techniques for working with communities to recruit and retain scarce physicians. "Nome provided the first opportunity to tackle the problems of resuscitating a failing hospital," says Rosenblatt, "and led to the creation of new planning methods for determining the precise scope of medical services that made economic and technical sense for a variety of rural communities," he adds. Project findings led to the ongoing Community Health Services Development program, which has helped many towns across the western U.S. strengthen local health care.footnote 1

Rural telemedicine--the use of communications and computer technology to conduct medical consultations in real time over vast distances--began in 1975 as part of the WAMI program. The endeavor has continued to the present, with rural physicians and UW experts consulting each other about patients via interactive computer videoconferencing. Current systems allow physicians at geographically distant sites to share x-ray images, stethoscope sounds, and other medical data; and the systems allow UW physicians in Seattle to see and talk with patients in rural settings. The medical school and its affiliated hospitals are connected to four rural towns in the demonstration project.

The telemedicine project is but one example of the many that have evolved from WAMI. "Over the past quarter decade, there have been hundreds of faculty and thousands of medical students and residents who have participated in the WAMI program. Most of them have a success story to tell about their involvement," notes Dr. Jack Lein, Director of Federal Relations for the UW, former Vice President for Health Sciences, and one of the founders of the WAMI program.

"Looking back, the WAMI Program has met all of its original goals of training medical students and residents," says Lein. "More than 50% of WAMI graduates become primary care physicians--nearly double the nation's average--and many practice in rural areas. No new medical schools were built," he emphasizes. "At the same time, and for over 25 years, the UW School of Medicine has ranked in the top ten of all medical schools in receipt of competitively-awarded research dollars," demonstrating that it is possible both to train primary care physicians and to conduct biomedical research on a world-class scale.

  1. We thank Dr. Jack Lein, Director of Federal Relations, UW Health Sciences Center, Leila Gray of UW Health Sciences Medical Affairs, News & Community Relations, and Dr. Roger Rosenblatt for information and assistance they provided in the preparation of this vignette.

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