Although US medical schools have increased their enrollment by about 30%, most of the increase has occurred in urban areas. The affinity model proposes that rural training of a rural student will more likely result in a rural physician, but the exact role of these rural campuses is unclear. Do they solidify and reinforce a pre-existing career plan, do they create social and marital ties that make the transition to rural medicine easier, or could they be replaced with a briefer and more efficient rural rotation? We administered a questionnaire to students attending two different two year rural clinical campuses in the same state in order to explore their opinions regarding the advantages of a rural campus.
Two different rural M3-M4 year clinical campuses, affiliated with different medical schools in the same state, administered surveys to 70 medical students across all four years of medical school. Both schools selectively recruit rural students to the rural campuses, and require a campus decision at admission. Both schools require students to attend their first two years at an urban campus, and transfer to the rural campus for clinical education. Questions addressed student opinions on rural campus location, recommendations from others regarding attendance, campus atmosphere and social life, teaching methods and involvement in patient care. Comparisons were analyzed using the non-parametric Mann Whitney U test.
The top five reasons students chose a rural campus included three aspects of rural training and two features of being rural. There were small differences between the two campuses regarding the importance of more procedures during training and more outdoor activities, the opportunity to study with friends, and strength of local leadership, reflecting differences in the practice setting and the environment of the two campuses. Differences were also noted between upper-level and lower-level students regarding the importance of studying with friends, and the chances of meeting a future spouse. Finally, very rural students (30 miles from urban area) were less concerned with availability of scholarships, and lack of fine dining, but viewed the opportunity to study with friends more favorably.
This study adds to the published literature by surveying students at multiple rural campuses by year of training. There were many more similarities than differences, but there were differences between the two campuses, and there were also differences as the students progressed in their training, and differences between very rural students and other students attending the campus. Rural campuses provide both clinical and social support for students contemplating rural practice. Results of the survey indicate both are of importance to the students as well, with quality of training the most important factor.
Conflict(s) of Interest
References with DOI
1. Erikson C, Hampton S, Whatley M. Results of the 2014 Medical School Enrollment Survey [Internet]. 2015 [cited 2016 Aug 8]. Available from: https://members.aamc.org/eweb/upload/Results%20of%20the%202014%20Medical%20School%20Enroll ment%20Survey.pdf.
2. Deutchman M. Medical School Tracks in the U.S. Health Resources and Services Administration Policy Brief [Internet]. 2013 [cited 2015 Apr 20]. Available from: http://www.ruralhealthweb.org/index.cfm?objectid=28B352C5-3048-651A-FE2D53C27202BAF6.
3. Chen F, Fordyce M, Andes S, Hart LG. Which medical schools produce rural physicians? A 15-year update. Acad Med. 2010 85(4):504-598. http://dx.doi.org/10.1097/acm.0b013e3181d280e9
4. Crandall LA, Dwyer JW, Duncan RP. Recruitment and retention of rural physicians: Issues for the 1990s. J Rural Health. 1990 6(1):19-38. http://dx.doi.org/10.1111/j.1748-0361.1990.tb00188.x
5. Strasser RP, Lanphear JH, McCready WG, Topps MH, et al. Canada’s new medical school: The northern Ontario School of Medicine: Social Accountability through distributed community engaged learning. Acad Med. 2009 84(10):1459-1464. http://dx.doi.org/10.1097/acm.0b013e3181b6c5d7
6. Orzanco MG, Lovato C, Bates J, Slade S, et al. Nature and nurture in the family physician’s choice of practice location. Rural Remote Health. 2011 11:1849-1862.
7. Rabinowitz HK, Diamond JJ, Markham FW, Wortman JR. Medical school programs to increase the rural physician supply: A systematic review and projected impact of widespread replication. Acad Med. 2008 83(3):235-243. http://dx.doi.org/10.1097/acm.0b013e318163789b
8. Farmer J, Kenny A, McKinstry C, Huysmans RD. 2015. A scoping review of the association between rural medical education and rural practice location. Hum Resour Health. 2015 13(1):27-42. http://dx.doi.org/10.1186/s12960-015-0017-3
9. Crump WJ, Fricker S, Barnett D. A Sense of Place: Rural training at a regional medical school campus. J Rural Health 2004; 20(1):80-84. http://dx.doi.org/10.1111/j.1748-0361.2004.tb00011.x
10. Crump WJ, Fricker RS. A Medical School Prematriculation Program for Rural Students: Staying Connected With Place, Cultivating a Special Connection With People. Teach Learn Med. 2015 27(4):422- 30. http://dx.doi.org/10.1080/10401334.2015.1077709
11. Sesney JW, Kreher NE, Potts MJ. Graduates' Reflections on Their Rural Medical Education: The Upper Peninsula Campus Experience. J Rural Health. 1994 10(4):279–285. http://dx.doi.org/10.1111/j.1748-0361.1994.tb00242.x
12. Jones GI, DeWitt DE, Cross M. Medical students' perceptions of barriers to training at a rural clinical school. Rural Remote Health [Internet] 2007 [cited 29 Feb 2016];7: 685. Available from: http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=685.
13. Krahe LM, McColl AR, Pallant JF, Cunningham CE, DeWitt DE. A multi-university study of which factors medical students consider when deciding to attend a rural clinical school in Australia. Rural Remote Health [Internet]. 2010 [cited 29 Feb 2016]; 10: 1477. Available from: http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=1477
14. Mihalynuka T, Snadden D, Bates J, Scott I, Frinton V, Wilson G. Size matters: what influences medical students’ choice of study site? Med Teach [Internet]. 2008 [cited 29 Feb 2016]; 30(4): e108-e114. Available from: http://www.tandfonline.com/doi/full/10.1080/01421590801931170.
15. Brazeau NK, Potts MJ, Hickner JM. The Upper Peninsula Program: a successful model for increasing primary care physicians in rural areas. Fam Med. 1990 22(5):350–355.
16. Crump WJ, Fricker RS, Ziegler C, Wiegman DL. Rural Track Training Based at a Small Regional Campus: Equivalency of Training, Residency Choice, and Practice Location of Graduates. Acad Med. 2013 88(8):1122-1128. http://dx.doi.org/10.1097/acm.0b013e31829a3df0
17. Looney SW, Blondell RD, Gagel JR, Pentecost MW. Which medical school applicants will become generalists or rural-based physicians? Journal of the Kentucky Medical Association. 1998 96(5):189-193.
18. Crump WJ, Miller KH, Fricker RS, Pradip P, Ostapchuck M. An innovative Technique for Faculty Development at a Rural Kentucky Clinical Campus. J Ky Med Assoc. 2012 110(7):274-282.
19. Crump WJ, Fricker RS, Ziegler CH, Wiegman DL. Seeking the Best Dose of Rural Experience: Comparison of Three Rural Pathways Programs at One Medical School. J Ky Med Assoc. 2015 113(1):5- 15.
20. Arnett P, Weaver A, Elam C. Enhancing the physician pipeline to rural Kentucky: findings from a University of Kentucky rural recruitment summit. J Ky Med Assoc. 2013 111(June):159-164.
21. Crump WJ, Fricker RS, Crump AM. Just what are rural premedical students thinking? A report of the first 6 years of a pathways program. J Rural Health. 2010 26(1):97-99. http://dx.doi.org/10.1111/j.1748-0361.2009.00257.x
22. Crump WJ, Fricker RS, Flick KF, Gerwe-Wickham K, Greenwell K, Willen KL. A Rural Pathways Program for High School Students: Reinforcing a Sense of Place. Fam Med. October 2014, 46(9):713-717.
23. Crump WJ, Fricker RS, Ziegler CH, Wiegman DL. Increasing the Rural Physician Workforce: A Potential Role for Small Rural Medical School Campuses [Internet]. 2015 J Rural Health. [cited 29 February 2016]; Oct 30. doi: 10.1111/jrh.12156. Available from: http://onlinelibrary.wiley.com/doi/10.1111/jrh.12156/abstract;jsessionid=A6B0DD29398FB4824CCE8078 FE36D729.f02t01.
Crump, William; Weaver, Anthony D.; Fricker, R. Steve; and Crump, Alllison M.
"Why Medical Students Choose Rural Clinical Campuses For Training: A Report From Two Campuses At Opposite Ends Of The Commonwealth,"
Marshall Journal of Medicine:
4, Article 15.
Available at: http://mds.marshall.edu/mjm/vol2/iss4/15