The Development, Administration and Success of Optional and Required Rural Medical Education Experiences

IntroductionPhysician workforce remains a significant issue in the United States (1). Especially concerning is the future for rural primary care physicians. Significant numbers of rural physicians are over the age of 55 and contemplating retirement (2). Rural populations are aging with a shifting demographic towards the elderly. Aging populations require increased primary care and other health services. Medical student interest in primary care is falling across the US (3). Interest in rural practice is also decreasing. The Robert Graham Center recently published a monograph describing the factors that influence medical students' decisions for selecting primary care (4). One of their recommendations is to increase student training opportunities in rural practice settings.Rural medical education programs can significantly enhance the opportunities for medical learning (5-7). Clinical teaching with one-on-one experiences especially lends itself well to the rural setting. Students benefit from the rural experience whether they are based in a tertiary care academic medical center for the bulk of their education or are in community-based programs (8). However, rural program success in terms of meeting the educational needs of students largely depends on the infrastructure that has been developed to support the preceptor and student (9). In addition, there are strains on the local health care system that must also be addressed to assure success and longevity of rural education programs. Students, preceptors and staff need the benefit of systematic support to set the stage for a rewarding educational experience.Administration over large geographic areasDistribution of training sites over large geographic areas is typical for rural programs associated with large urban medical schools. In this setting, it is unlikely that a single administrator will be able to travel the region to function effectively in day to day program operations. At the University of Kansas School of Medicine we have found that a ratio of approximately one site director for each 4-5 students assigned to a region allows the regional director to be most effective. In our institution, with a 60 year experience in placing students in rural locations, we conclude that the administration for rural programs be in a central location in the school of medicine rather than located in any of the academic departments. As a result the primary focus is on the student and the educational experience. This structure allows for immediate response to students' needs but also allows for access to administration by faculty in the network sites (see figure 1).On our main campus we found it very effective to establish an Office of Rural Medical Education (ORME). The establishment of a -rural" office on the main campus offers increased visibility for students, faculty and staff. It establishes one source for rural medical education activities and information about programs.To avoid confusing communication channels, official communication with rural sites is directed through ORME and then into the appropriate medical education network site. Another important aspect of this network funnel is that students and school of medicine departments and clerkships are not all approaching the preceptors' sites with requests for student placements. ORME also handles placements for the nurse practitioner program and helps to coordinate other rural student placements.Establishment of network sitesEarly in the development of rural programming, it became obvious that supporting the preceptors in rural areas distant from the main campus was ineffective. There were complaints from the remote sites that they felt disconnected and poorly supported in their faculty development, educational resources and student support. Regional administration was piloted and found to be successful at addressing the issues raised. With the success of this pilot the state was divided into six Medical Education Network Sites (MENS) (10). …