Joseph Florence, MD, Professor and Director of Rural Health Programs

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Dr. Florence works closely with the rural programs at East Tennessee State University, which include the medical school's Rural Primary Care Tract - community partnerships program, Rural Health Fairs, and the Rural Family Practice Fellowship. Since 1983, Dr. Florence has been training medical students, family practice residents, and other health care professionals including nurse practitioners, paramedics, and physician's assistants in an effort to prepare them for practicing in rural, underserved areas. Dr. Florence grew up in Virginia, completing a Bachelor's degree in Chemistry and Religion at Duke University and a Masters degree in Biology prior to medical school at the Medical College of Virginia.  After completing his family practice residency at Roanoke Memorial Hospitals in Roanoke, Virginia, he practiced as a National Health Service Corps doctor in Central Appalachia, in and around Hazard, Kentucky. During this time he worked as Medical Director of the SE Kentucky Area Health Education Center. In 1991, Dr. Florence accepted a full-time position with the University of Kentucky to help develop the East Kentucky Family Practice Residency Program. As Program Director of this rural training program, his duties also included directing clinical programs at the UK Center for Rural Health, which in 2000, received honors from the National Rural Health Association as the Outstanding Rural Health Program in the United States. Dr. Florence was also a member of the faculty of the Appalachian Osteopthic Postgraduate Training Institute Consortium. Early in 2002, Dr. Florence was appointed Vice-Chair of the Department of Family Practice at the University of Kentucky. During his tenure he had the distinction of being the first medical director of the East Kentucky Veteran's Center, a recently opened long-term care facility serving the veterans of Central Appalachia. Dr. Florence's scholarly interests include rural health, public policy, diabetes, advanced cardiac life support and the use of technology to enhance rural health. Dr. Florence can be reached at .

Scholarly Activities 

 2013

Book and/or Book Chapters

Florence J. Varicose veins. In Domino F, Baldor RA, Grimes JA, Golding J (eds). 5-Minute Clinical Consult. Lippincott Williams & Wilkins: Philadelphia, PA .

Florence J, Flores EK. Hypoglycemia and diabetes. In Domino F, Baldor RA, Grimes JA, Golding J (eds). 5-Minute Clinical Consult. Lippincott Williams & Wilkins: Philadelphia, PA. 

Florence J, Gerayli F. Statis dermatitis. In Domino F, Baldor RA, Grimes JA, Golding J (eds). 5-Minute Clinical Consult. Lippincott Williams & Wilkins: Philadelphia, PA.

Papers, Abstracts and/or Presentations:
Regional and National

Florence J, Bennard B. Developing scholarly rural connections. Presented at the RME Pre-Doctoral Conclave, February 2013, Rockford, IL.

Florence J. Interprofessional education update at ETSU tours de force. Presented at the RME Pre-Doctoral Conclave, February 2013, Rockford, IL.

Florence J. ETSU rural interprofessional rural community assessment & projects courses, tour of rural medical education 2013. Presented at the National Rural Medical Educator's annual meeting, May 2013, Louisville, KY.

Florence J, Silver K, Loury S, Bradfield M. Integrating cultural competency, experiential learning into interdisciplinary education. Presented at the National Rural Health Association's annual conference, May 2013, Louisville, KY.

Bishop TW, Florence J. Teaching rural behavioral health to 3rd year medical students, an innovative approach using simulations & rural clinical immersion experiences in instruction. Presented at the National Rural Health Association's annual conference, May 2013, Louisville, KY.

Carter L, Littleton MA, Florence J. Rural partnerships: a student perspective. Presented at the National Rural Health Association's annual conference, May 2013, Louisville, KY.

Childress C, Shelton S, Sliger C, Florence J. Rural health fair, migrant workers, remote area medical. Presented at the National Rural Health Association's annual conference, May 2013, Louisville, KY.

Gerayli F, Florence JA. Teaching rural women's health issues to third year medical students, an innovative approach using simulators and rural clinical immersion experiences. Presented at the National Rural Health Association's annual conference, May 2013, Louisville, KY.

Invited Presentations:

Florence J, Silver K. So you can't work: Disability determination for the family doc. Presented at the Family Medicine Department Residency Teleconference, April 2013, Johnson City, TN.

Florence J. Health promotion and disease prevention in rural Appalachia. Presented at the Gatton College of Pharmacy, April 2013, Johnson City, TN.

Florence J, Silver K. Occupational health – a case study of a rural NC community. Presented at the ETSU Family Medicine Residencies Teleconference, May 2013, Johnson City, TN.

Grant Funded Project Participation:

Florence J (PI)
Expanding Primary Care and Community Medicine to Third-Year Medical Students
Funding: U.S. Department of Health and Human Services: HRSA
Amount funded: $172,651 for 7/1/12 – 6/30/13
Total Award: $967,465 over 5 years
Start and End Dates: 9/1/10 – 6/30/15 

2012

Journal Publications:

Lennon-Dearing, R., Florence, J., Halvorson, H. and Pollard, JT.  "An interprofessional educational approach to teaching spiritual assessment".  The Spears Research Institute.  Journal of HealthCare Chaplaincy

Longenecker R, Zink T, Florence J. Teaching and learning resilience: Building adaptive capacity for rural practice. Rural Health, 28(2), 122-127, 2012.

Papers, Abstracts and/or Presentations:

Florence J and Bennard B. Elevating community perspectives in the curriculum: The evolution of a community preceptor working group. Presented at the 45th Annual Spring Conference, Society of Teachers of Family Medicine (STFM). April 26, 2012; Seattle, Washington.

Bennard B, Florence J, Silver SM. Integrating occupational health into a third year medical clerkship in community medicine. Presented at the American Public Health Association annual meeting, October 2012, San Francisco, CA.

Littleton MA, Florence J, et al. Interprofessional community-based rural track program at ETSU: rural projects as pedagogy. Presented at the American Public Health Association annual meeting, October 2012, San Francisco, CA.

Manz N, Silver K, Fethke N, Hoffman K, Loury S, Florence J. Building a consensus for tomato worker ergonomics: a community-expert panel study. Presented at the American Public Health Association annual meeting, October 2012, San Francisco, CA.

Silver K, Manock S, McQueen S, Florence J. Occupational health issues among migrant and seasonal farm workers in East Tennessee. Presented at the Rural Multiracial and Multicultural Health Conference, December 2012, Asheville, NC.

Florence J, Loury S, Bradfield M. Integrating cultural competency and experiential learning into interdisciplinary education. Presented at the Rural Multiracial and Multicultural Health Conference, December 2012, Asheville, NC.

Invited Presentations:

Florence J, Watson J, White J, Lauderback K, Goodnight J, Bradfield, M. Home Remedies – folk medicine of Appalachia and of our new Hispanic community. Presented at the Rural Health Association of Tennessee annual meeting, November 2012, Pigeon Forge, TN.

2011

Journal Publications:

Longenecker, R., Zink, Therese, & Florence, J. (2011).  Teaching and Learning Resilience:  Building Adaptive Capacity for Rural Practice.  A Report and Subsequent Analysis of a Workshop Conducted at the Rural Medical Educators Conference, Savannah, GA.  May 18, 2010.  The Journal of Rural Health. doi:  10.11.111/j.1748-0361.2011.00376.x

Papers, Abstracts and/or Presentations:
Regional and National

Silver, K and Florence, J. "A Campus-Community Partnership for Migrant Tomato Workers' Health".  Presented at the National Occupational Injury Research Symposium 2011.  Morgantown, West Virginia.  October 19, 2011.

Loury, S, Florence, J and Silver, K.  "Hispanic Migrant Farmworker Health in Rural East TN:  Interprofessional Education and A University/Community Partnership.  Presented at The Decker School of Nursing, the Rural Nurse Organization and Binghamton University Continuing Education and Outreach - Rural Health Conference, "The Canopy of Health Care for Rural and Underserved Populations:  Strengthening the Root System." Binghamton, New York.  October 5, 2011.

Florence JA. Teaching and Learning Resilience: Building Adaptive Capacity for Rural Practice. A report and subsequent analysis of a workshop conducted at the Rural Medical Educators Conference. May 18, 2011; Savannah, GA.

Grant Submissions:

Project Title:  Expanding Primary Care and Community Medicine to Third-Year Medical Students.  Funding Agency:  HRSA.  ProjectPeriod/Grant Amount:  September 1, 2010 - June 30, 2015/$233,073 for year 1; $234,197 for year 2; 172,651 for year 3; $162,868 for year 4; $164,676 for year 5.

 2010

Invited Presentations:

Florence JA, Bennard B. A Community-based participatory research course for health professions students: An effective model for inter-professional education. Presented at the 36th Annual Predoctoral Education Conference. Jan. 28-31, 2010; Jacksonville, FL. 

Grant Submissions:

Funding Source: HRSA - Pre-doc
Role: Principal Investigator - Florence, J
Title: Expanding Primary Care and Community Medicine to Third-year Medical Students
Dates: 2010-2015, Funded
Summary: The project strengthens the capacity of the Department of Family Medicine (DFM) to lead large scale curricular changes in the COM that will 1) provide all 3rd year medical students with a 6-week community medicine clerkship in a new community academic center; 2), provide 3rd year medical students with two week DFM or community-based, primary care specialty selectives (e.g. women's health, inter-professional care for the geriatric patient) as part of a new specialty/subspecialty rotation; and 3) modify current 3rd year rural and primary care curricular experiences to fit the new 3rd year schedule.

2009

Journal Publications:

Wu TJ, Snider JB, Floyd MR, Florence JA, Stoots JM, Makamey MI. Intention for healthy eating among southern Appalachian teens. Am J Health Behav. 2009;33(2):115-124. PDF

2008

Journal Publications:

Wu TJ, Stoots JM, Florence JA, Abernethy C, Mckamey MI, Floyd MR, Snider JB. A peer education program for healthy eating and physical activity among Appalachian teens: A pilot study. J Sch Health. Submitted for publication.

Florence JA., Varicose Veins. In: Domino F, ed. 5 minute Clinic Consult 2009. Hagerstown, MD: Lippincott Williams and Wilkins; 2008.1372-1373.

Papers, Abstracts and/or Presentations:
Regional and National

Florence, JA"Addressing Needs of Rural Communities: Participatory Research for First and Second Year Medical Students," lecture-discussion presented at 34th annual STFM Predoctoral Education Conference, Portland, Oregon, Jan 26th, 2008 (with Bruce Bennard).

2007

Journal Publications:

Florence, JA, Goodrow,B; Wachs J; and Olive K. "Rural Health Professions Education at East Tennessee State University: Survey of Graduates from the First Decade of the Community Partnership Program" Journal of Rural Health, Winter 2007, Vol. 23, No.1)

Edwards JB, Wilson JL,  Behringer BA,  Smith PL, Ferguson K,  Blackwelder R,  Florence JA,  Bennard B and Tudiver F.."Practice Locations of Graduates of Family Physician Residency and Nurse Practitioner Programs: Influence of the Context of Institutional Culture and Curricular Innovation Through Titles VII and VIII".  The Journal of Rural Health, Winter, 2007, 22(1):69-77).

Florence JA, MD; Goodrow B, EdD; Wach J, PhD, Grover S, PhD and Olive K, MD.  Rural Health Professions Education at East Tennessee State University: Survey of Graduates From the First Decade of the Community Partnership Program.  The Journal of Rural Health 78 Vol. 23, No.1 Winter 2007 pp77-83.

Papers, Abstracts and/or Presentations:
Regional and National

Florence J and Bennard B.   "Results from a two semester Rural Track Health Professions Participatory Research Course". Presented at the 2007 Primary Care Research Day, September 8, 2007.

Florence JA, M.D, ShineJ, M.D and Bennard B, PhD.  Providing Comprehensive Faculty Development to Community-based Faculty Using Continuous Quality Improvement.  Lecture-Discussion Presentation for: 33rd Annual Predoctoral STFM Education Conference, January 27, 2007, Memphis, TN

Books or Chapters:

"Dermatitis, Stasis", Griffith's 5-Minute Clinical Consult 2007, Dambro, M., editor.
"Hypoglycemia, diabetic", Griffith's 5-Minute Clinical Consult 2007, Dambro, M.,editor.
"Varicose veins", Griffith's 5-Minute Clinical Consult 2007, Dambro, M., editor.

Other Scholarly Activities:

Department of Public Health Advisory Board – 2006 – present.
Office of Cultural Affairs Advisory Committee – 2006 – present
Study Abroad Group – 2007 - present
Division of Health Science
Interdisciplinary Curriculum Committee, Chair – monthly meeting.
Division of Health Sciences Meetings – present and discuss issues related to the Interdisciplinary Curriculum on an as needed basis.
Governing Board Office of Rural and Community Health and Community Partnerships, faculty member for meetings 2004-present.

Invited Presentations:

Attended and served as co-chairman of the 2007 NRHA Rural Medical Educators Annual Conference in Anchorage, Alaska, May 15, 2007; also, presented "Integrating Rural Training: Initiatives in Tennessee."

Other Accomplishments:

Recevied the prestigious Leonard Tow Humanism in Medicine Clinical Faculty Award.

Grant Submissions:

Submitted: 02/28/07. Funding Source: Steele-Reese Foundation. Title: A Proposal to Support Activities of the Rural Programs Division: Rural Health Fairs and Appalachian Preceptorship. Principal Investigator: Dr. Joseph Florence. Summary of the Project: Multi-year operating support to continue to provide rural health fairs and The Appalachian Preceptorship Program. Date of the project: 09/01/07-08/31/12

2006

Journal Publications:

Practice Locations of Graduates of Family Physician Residency and Nurse Practitioner Programs: Considerations Within the Context of Institutional Culture and Curricular Innovation Through Titles VII and VIII, National Rural Health Association, 2006 Joellen B. Edwards, Ph.D.; Jim L. Wilson, M.D.;Bruce A. Behringer, MPH ; Patricia L. Smith, EdD; Kaethe P. Ferguson, MS;Reid B. Blackwelder, M.D.; Joseph A. Florence, M.D.;Bruce Bennard, Ph.D.; and Fred Tudiver, M.D.M JRH article

Papers, Abstracts and/or Presentations:
Regional and National

Wu, T., Stoots, J.M., Florence, J., Floyd, M., Snider, J.B., Ward, R., "Perceived Eating of Significant Others, Experience of Weight Teasing, Social Support for Healthy Eating, and Eating Habits among Adolescents in Rural Southern Appalachia"

Stoots, J.M., Wu, T., Florence, J., Floyd, M., Snider, J.B., "Physical Activity and Psychosocial Perceptions among Adolescents in Rural Southern Appalachia"

Lennon-Dearing, R., Florence, J., "Exploring Health Literacy in Northeast Tennessee"

Floyd, M., Snider, J.B., Wu, T., Stoots, J.M., Florence, J., Ward, R "Attitude and Perceptions of Behavioral Control for Health Eating and Physical Activity among Adolescents in Rural Southern Appalachia"
Presentation Title: Addressing Quality Improvement for Ensuring Successful Rural Medical Education Programs

Presenters: Joseph Florence, Bruce C. Bennard, James D. Leeper, Matthew L. Hunsaker

Feb 3, 2006 STFM Predoctoral Conference, Charleston, SC

International

"Advanced Cardiac Life Support" Gandhi Medical College, Secunderabad, AP, India January, 2006

2005

Journal Publications:

"Dermatitis Stasis," Griffith's 5-minute Clinical Consult, 11th Edition.

"Hypoglycemia, Diabetic" Griffith's 5-minute Clinical Consult, 11th Edition"

"Varicose Veins", Griffith's 5-minute Clinincal Consult, 11th Edition

Florence, JA, MD, Goodrow, B, Ed.D, Wachs, J, PhD, Grover, S, PhD and Olive, K. MD.  "Community Partnership: A 10-Year Outcome Analysis of Rural Health Professions Education at East Tennessee State University". (submitted April 2004 to the Journal of Rural Health)

Leeper, S, Wilson, JL, Florence, JA, Kukulka, G and Ferguson, KP.  "The Legacy of Congressman James H. Quillen: Preparing Medical Students for Practice in Tennessee".  (submitted September 2004 to Tennessee Medicine)

Edwards, JB, Wilson, JL, Behringer, BA, Smith, PL, Ferguson, KP, Blackwelder, RB, Florence, JA, Bennard, B and Tudiver, F.  "Practice Locations of Graduates of Family Physician Residency and Nurse Practitioner Programs: Influence of the Context of Institutional Culture and Curricular Innovation".  Under revision for The Journal of Rural Health, (Submitted September 2004)

Books or Chapters:

"Dermatitis, Stasis", Griffith's 5-Minute Clinical Consult, 11th edition, Dambro, M., editor, 2004

"Hypoglycemia, diabetic", Griffith's 5-Minute Clinical Consult, 11th edition, Dambro, M., editor, 2004

"Varicose veins", Griffith's 5-Minute Clinical Consult, 11th edition, Dambro, M., editor, 2004

Papers, Abstracts and/or Presentations:

Providers Meeting/RHSC Annual Staff - 2 hour CME presentation on drugs, December, 19, 2005

"What is Rural Medicine" High School Medical Camp, Johnson City, TN, June 21, 2004

"Rural Medicine", Health Careers Opportunity Program (HCOP) Presentation, Johnson City, TN, June 30, 2004

Florence J, MD, Gerdiing G, PhD, RN and Wilson S, PhD.  "Community Partnerships – A 10-Year Outcome Analysis of Rural Health Professions Education at East Tennessee State University", Poster Presented at the Rural Health Association of Tennessee, Dec 1-3, 2004 Chattanooga, TN.

Florence J, MD and Sliger C, MSEH et al.  "Rural Health in Ecuador – A Community Partnership Between ETSU and Ecuador to Promote Health Professions Education", Presented at the Rural Health Association of Tennessee, Dec 1-3, 2004 Chattanooga, TN.

"Rural Primary Care Track – Interdisciplinary Medical Training Experience in East Tennessee", Inter-Institutional Workshop, Shaker Village, KY, October 3, 2003

"Preparing the New Country Doctor", special topic breakfast presentation, 30th Anniversary Society of Teachers of Family Medicine Pre-doctoral Education Conference, New Orleans, LA, Jan 30, 2004

"Student/Resident Interest in Family/Rural Medicine." Presented with John Wheat (University of Alabama) National Rural Health Association Rural Medical Educators Group, Washington, DC., Feb 22, 2004