Project Summary/Abstract Non-urban populations are given little attention in many aspects of medical practice. Rural communities often lack the infrastructure for developing and sustaining a preventive approach to occupational disease and injury, particularly for specific work sectors such as agriculture, where the hired and/or migrant workforce may constitute the majority. Northeast Texas, home to about 1.5 million people spanning 35 counties, is considered the largest rurally distributed population in the state, and is also one of the unhealthiest. There is a considerable need to train medical students and graduates in general, and occupational medicine residents in particular, to be competent in knowledge and skills pertaining to rural and migrant populations, who have special cultural needs and considerations. As the region’s only university medical center, the University of Texas Health Science Center at Tyler (UTHSCT) is home to some of the latest developments in patient care and community health, medical and health education, and biomedical and clinical research. There is a physician shortage in rural counties throughout Northeast Texas, and UTHSCT has the responsibility of training the future generation of physicians. The occupational medicine residency program at Tyler (OMR) is one of seven ACGME-accredited graduate medical education (GME) programs sponsored by the institution. The overall objective and mission of the program is; ‘to increase the number of occupational medicine physicians who have adequate experience and sufficient competence to enter the practice without direct supervision, while adding a special focus on training in the occupational health needs of the rural workforce, to help serve the population of Northeast Texas and beyond’. This is in alignment with the overall mission of the institution. Specific aims of the program are to: 1. Increase the number of board certified occupational medicine graduates able to engage in evidence based and independent practice in various settings including the proportion remaining in Texas and rural areas, 2. Enhance a robust residency experience in rural / agricultural occupational health, safety, protection and promotion. There remains a recognized burden of occupational injury and illness in general and in agriculture specifically. This proposal is considered responsive to the Funding Opportunity Announcement PAR-15-352 by addressing a critical gap in Occupational Medicine Residency (OMR) trained physician workforce needs (core discipline). The proposed program will integrate agricultural safety and health by implementing a multi-faceted training approach that relies upon an inter-professional educational team effort, while also leveraging the strengths of the NIOSH-supported Southwest Center for Agricultural Health, Injury Prevention and Education to achieve a significant impact on continued workforce expansion.