New rural-medicine electives give students a first-hand look at a small-town career

‌This wasn’t the journey she envisioned.

She didn’t anticipate becoming Franklin’s only obstetrician, who by now has delivered many of the students at the town’s only elementary school.

“I didn’t plan to practice in a small town,” Dr. Sharon Sheffield says. “It happened upon me.”

Sharon Sheffield, MD (MD ’92, Obstetrics and Gynecology Residency ’97), grew up in Portsmouth and earned her undergraduate degree at U.Va. and her master’s at ODU. She was chief resident at EVMS when an MD student she supervised changed her urban way of life. He suggested that his father, Floyd Clingenpeel, MD, consider hiring Dr. Sheffield for his OB-GYN practice in Franklin — home to about 8,600.

“Dr. Clingenpeel and his partners asked me to come out here,” she recalls. “I didn’t know much about Franklin, but the practice was very nice, so I gave it a chance.”

Eighteen years later, Dr. Sheffield is not only an Instructor of Obstetrics and Gynecology at EVMS, she also oversees medical students who choose the new rural elective in obstetrics, the school’s first two-week clinical rotation in rural medicine.

“Our patients are just like patients I had in Norfolk,” Dr. Sheffield says. “They have the same problems and the same needs. The difference is, they don’t have the same access to care.”

In a recent report on women’s health disparities in rural areas, the American College of Obstetricians and Gynecologists (ACOG) found that only about 6 percent of obstetricians practice in the nation’s rural communities even though they are home to nearly 23 percent of women.

“When compared with their urban counterparts,” wrote Eliza Buyers, MD, of the ACOG, “U.S. rural women experience higher rates of cervical cancer, and they receive fewer preventive screenings, such as mammograms. They also have an increased risk of receiving inadequate, late or no prenatal care.” This disparity results in higher rates of low birth-weight babies and infant mortality.

Franklin is proof. In 2012, the most recent year for which data is available, the rate of infant mortality was twice as high in Franklin — 13 deaths per 1,000 births — as the infant mortality rate for all of Virginia.

“It’s difficult to find doctors who want to practice out here,” Dr. Sheffield says. “But it’s really a wonderful life — there’s not much traffic, it’s a great place to raise children, everybody knows everybody, and you’re close to your neighbors. Plus, it’s less than an hour away from bigger cities.”

There are career benefits, as well, she says. “I have a lot more independence than I would in a big city. Then there’s the closeness to the patients. We know our patients inside and out.”

The OB-GYN rural elective resulted from a collaboration between EVMS Diversity and Inclusion, EVMS Obstetrics & Gynecology and rural community providers. “Students rave about their experience,” says Khaled Sakhel, MD, Associate Professor of Obstetrics & Gynecology and OB-GYN Clerkship Director. “We’re working on developing other sites, including the Eastern Shore and Gloucester areas.”

Hugo Hua is a fourth-year medical student who chose the rural elective. “What I learned about rural medicine from the patients was eye-opening,” he says. “I couldn’t have asked for a more hands-on experience. I even delivered my first baby.”

On Wednesdays, Dr. Sheffield and her rural-elective student travel 45 minutes farther west to the smaller town of Emporia with a population of about 5,500. There, in a shopping-center office, they provide the only OB-GYN care in the area. “At times,” Dr. Sheffield says, “I have to act as psychiatrist, primary-care provider and surgeon because these patients don’t have anywhere else to go.”

Dr. Sheffield willingly mentors EVMS students because that’s how she learned best while training. “I enjoy trying to help students find their way,” she says. “Even if they decide not to pursue a rural practice, it’s important for students to understand that they might see patients who come from these areas. I do this because there’s a need.”

Before her first drive through Southampton County, third-year medical student Jennifer Burgart had never seen cotton fields. With a plan to specialize in obstetrics and gynecology, Ms. Burgart chose the rural elective because she’d heard the rotation was diverse and hands-on — training important to her future.

“These patients really trust and love Dr. Sheffield,” Ms. Burgart says, “and as an extension of that, they’re open to her students. She runs all over the place. She’s dedicated to this practice and this area. I asked her how she takes a vacation, and she said she doesn’t.”

Cultivating the rural experience

Soon, medical students will have other rural-medicine options. The focus of the second rural elective is psychiatry and behavioral sciences; the place is Virginia’s Eastern Shore.

Under the supervision of two psychiatrists there — Potter Henderson, MD, Assistant Professor of Psychiatry and Behavioral Sciences and an Eastern Shore native who trained at Yale University; and Nicholas McClean-Rice, MD, who trained at Imperial College in London — EVMS students will gain exposure over two weeks to mental-health care for Eastern Shore children, teens and adults.

“This psychiatry rotation will provide an unparalleled exposure to medical students,” Dr. Henderson says. “There are few opportunities for outpatient psychiatry rotations as a medical student to begin with. To have one that exposes students to the unique combinations of psychopathology and socioeconomic adversity we address here on the Eastern Shore, as well as the multifaceted treatment modalities we utilize to support our patients’ functions, I believe is extraordinary.”

In Virginia’s rural communities as in the rest of the nation, mental-health care is not easy to come by. The National Rural Health Association reports that nearly three-fourths of the nation’s rural counties lack a psychiatrist, and 95 percent have no child psychiatrist.

Even when mental-health care is available, the stigma associated with psychiatric disorders is harder to overcome in these areas. “Living in a small, isolated rural community where everyone knows each other heightens the stigma,” the report says. “As a result, a patient may refuse to go to the behavioral health provider’s office because everyone will recognize his truck.”

Lisa Fore-Arcand, EdD, Education Coordinator and Associate Professor of Psychiatry and Behavioral Sciences, is a member of EVMS’ rural-initiative work group. “Through these rotations,” she says, “we want to introduce students to the skills needed in rural settings and familiarize them with life in a rural community, helping them gain confidence and competence in assuming the role of a rural health-care physician.”

To help more medical students gain a comprehensive overview of health issues affecting small-town communities, the work group is exploring the possibility of rural-medicine electives in family medicine, internal medicine and pediatrics.

“The rural electives serve not only as rich learning opportunities for our students,” says work group member Mekbib Gemeda, Vice President for Diversity and Inclusion, “but they also engage community physicians in academic medicine and cultivate research targeted at improving health outcomes in the region.”

Dr. Sheffield hopes these rotations show students not only the need for physicians in small towns but the benefits of being one.

“We’re a small practice,” she says, “and sometimes we struggle. But it’s not all about how much you can earn. It’s about what we can do for the community, and it’s very rewarding.”