A Medical School Prematriculation Program for Rural Students: Staying Connected With Place, Cultivating a Special Connection With People

Problem:

Rural medical students who attend urban medical schools experience urban disruption that may make it less likely that they will return to rural practice. Most prematriculation programs focus on academic preparation and are in urban areas, potentially adding to urban disruption. Most initial learning experiences concerning communication with patients are also in urban areas. Intervention: Fifty-nine rural preclinical students completed a 3-week summer rural prematriculation program from 2009 to 2014. The focus was on learning a holistic approach to interviewing patients and experiential learning based in a rural practice. Group reflection sessions focused on understanding health beliefs, psychosocial details of the patient's life, and the importance of the sense of place. Measures included student reports, program evaluations, and a pre- and post- 10-item opinion survey focused on the students' perceived importance of traditional biomedical and psychosocial knowledge. Context: The program was based at the Trover Campus, a regional clinical campus of the University of Louisville School of Medicine, in a town of 20,000 in the western Kentucky coalfields that is 150 miles from the main urban campus. Practice site assignments were in surrounding medically underserved towns in family medicine practices. Outcome: After the 3-week experience, students became comfortable with interviews concerning health habits using the Prochaska model of lifestyle modification and expressed an increased importance of some psychosocial factors and a corresponding decrease in importance of traditional biomedical factors in choosing treatment for an individual patient (significant results by Mann–Whitney, two-tailed, ranged U = 1136.0, p = .001 to U = 1377.5, p ≤ .05). Student reports showed that the students gained a new detailed understanding of rural practice. Students also expressed an appreciation for having developed a support network of fellow rural students with whom they would begin medical school on the urban campus. Lessons Learned: These results support the value of a summer prematriculation program for rural students based in a rural area. New appreciation for psychosocial patient factors, new skills in communication with patients, new understanding of the details of rural practice, and new relationships with other rural classmates were perceived as positive aspects of the program. Longer term measures of whether the program decreased urban disruption significantly will require continued tracking of the students until they make a practice choice 7 to 9 years later. Wider collaboration with other medical school rural programs is necessary to determine which aspects of rural-focused training are most effective.

Keywords:

• rural health and training
• communication skills
• clinical instruction
• community medicine
• primary care

ACKNOWLEDGMENTS

This activity could not have been successful without the cooperation and support of the practices and their patients. Dr. Bill Klompus was responsible for taking the very large literature on the Prochaska model and distilling it down to a set of brief training materials that we continue to use each summer. Craig Ziegler, biostatistician with ULSOM, provided statistical consultations on the analysis.