The maldistribution of physicians in the United States has led to a shortage of healthcare providers in rural areas and rural patients being underserved. A physician’s connections to rural settings, including upbringing and medical training, often influence the decision to practice in rural areas. This study examines opinions from medical students who participated in a regional rural campus track, which includes summer immersion programs, rural-focused sessions, and clinical rotations. The authors hypothesized that Rural Track students experience urban disruption, and their opinions about rural living and practice would become increasingly less positive over time while students lived at the urban campus for preclinical coursework.
Materials and Methods
The Rural Health Opinion Survey (RHOS), a previously published measure of opinions concerning living and practicing in rural areas, was administered to students at one public medical school located in Louisville, Kentucky. Factor analysis was performed on each of the three sections of the survey (items related to rural living, patients in rural areas, and physicians in rural areas), and composite subscale scores were calculated for each student. The first phase of this large longitudinal study reported here uses t-tests to compare pre- and post-test scores for 36 students in the Rural Track program. Scores of M1/M2 students who were based at the urban campus were also compared to M3/M4 students who had returned to the rural campus.
Ninety-two percent (36/39) of Rural Track students completed both pre- and post-surveys, and of these respondents, 89% percent (32/36) grew up in a hometown with fewer than 30,000 people. Overall scores were not significantly different between Rural Track M1/M2 in the urban setting and the Rural Track M3/M4 students based at the rural campus. M3/M4 students showed a differential positive opinion over time of rural comfortable living that approached significance and agreed less that the rural physician workload is heavier. M1/M2 students expressed more positive opinions over time about availability of quality service. Both groups showed strong agreement over time that rural patients are more motivated.
Our hypothesis that Rural Track students on the urban campus would show increasingly less positive opinions about rural health and practice was not supported. Students may not have experienced urban disruption because of the Rural Track curriculum elements, and/or time in the urban environment may have reinforced rural affinity by providing new perspective on the positive aspects of rural settings. Further research and efforts are necessary to identify critical points of reconnection for medical students and to support rural affinity within medical school curriculum. Upcoming research efforts will address the overall hypothesis that Rural Track students’ continued connection to rural settings generates more positive opinions about rural living and practice as compared to opinions from students with rural backgrounds who spend all four years of medical school in the urban setting.
Conflict(s) of Interest
References with DOI
1. Bureau of Health Professions. Rural Health Professions Facts: supply and distribution of health professions in rural America. Rockville, MD, Health Resources and Services Administration; 1992.
2. Phillips RL, Dodoo MS, Petterson S, Xierali I, Bazemore A, Teevan B, et al. Specialty and geographic distribution of the physician workforce: what influences medical student and resident choices? Washington, DC, The Robert Graham Center: Policy Studies in Family Medicine and Primary Care; 2009.
3. Deutchman M. Medical School Rural Tracks in the US: US Medical School Rural Track Policy Brief. Aurora, CO, Health Resources and Services Administration Policy Brief; 2013.
4. Crump WJ, Fricker RS, Ziegler CH, Wiegman DL. Increasing the rural physician workforce: a potential role for small rural medical school campuses. J Rural Health. 2016;32(3):254-9. https://doi.org/10.1111/jrh.12156
5. Crandall LA, Dwyer JW, Duncan RP. Recruitment and retention of rural physicians: issues for the 1990s. J Rural Health. 1990;6(1):19-38. https://doi.org/10.1111/j.1748-0361.1990.tb00188.x
6. Strasser RP, Lanphear JH, McCready WG, Topps MH, Hunt DD, Matte MC. Canada’s New Medical School: The Northern Ontario School of Medicine: social accountability through distributed community engaged learning. Academic Medicine. 2009;84(10):1459-64. https://doi.org/10.1097/acm.0b013e3181b6c5d7
7. Orzanco M, Lovato C, Bates J, Slade S, Grand'Maison P, Vanasse A. Nature and nurture in the family physician's choice of practice location. Rural Remote Health. 2011;11:1849.
8. Vaughn D, Vaughn P. Preparing rural students for an urban work environment: A handbook for educators. Las Cruces, New Mexico, Educational Research Information Center (ERIC) Clearinghouse on Rural Education and Small Schools; 1986.
9. Crump WJ, Barnett D, Fricker S. A sense of place: rural training at a regional medical school campus. J Rural Health. 2004;20(1):80-4. https://doi.org/10.1111/j.1748-0361.2004.tb00011.x
10. Crump WJ, Fricker RS, Ziegler CH. Outcomes of a preclinical rural medicine elective at an urban medical school. Fam Med. 2010;42(10):717-22.
11. Crump WJ, Fricker RS, Ziegler C, Wiegman DL, Rowland ML. Rural track training based at a small regional campus: equivalency of training, residency choice, and practice location of graduates. Acad Med. 2013;88(8):1122-8. https://doi.org/10.1097/acm.0b013e31829a3df0
12. 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. https://doi.org/10.1080/10401334.2015.1077709
13. Lynch DC, Willis SE. Can a 3-Day preceptorship change first-year medical students' opinions about living and working in small towns? Fam Med. 2000;32(7):495-500.
14. Moss S. Item deletion before factor analysis: Sicotests; [updated June 2 2016]. Available from: http://www.sicotests.com/psyarticle.asp?id=161.
Crump, William J.; Ziegler, Craig H.; Martin, Leslee J.; Fricker, R. Steve; Shaw, M. Ann; Crump, Alllison M.; and Sawning, Susan
"Changes In Rural Affinity Among Rural Medical Students As They Experience Education In An Urban Setting,"
Marshall Journal of Medicine:
1, Article 11.
Available at: https://mds.marshall.edu/mjm/vol3/iss1/11