Search

Background: Medical schools worldwide are challenged to address the rural primary care workforce shortage by creating community-engaged curricula to nurture student interest in rural practice. Aim: To examine the personal characteristics of six consecutive rural longitudinal integrated clerkship student cohorts to understand whom the programs attract and select and thus inform the development of such programs. Method: A cross-sectional cohort design was used. Six cohorts (2007-2012) completed a survey on demographics and factors that influenced their choice of rural primary care. The Temperament and Character Inventory was used to measure personality. Analysis was mainly descriptive. Where appropriate univariate analysis compared variables between groups. Results: Sample size was 205 with the majority female (61%), between 25 and 29 years (64%), single (60%) and lived longest in rural communities with populations less than 20,000 (60%). Rural lifestyle, background and desire to work in underserved areas were noted to impact rural medicine interest. Professional satisfaction, personal and professional goals and family needs had the highest impact on career decisions, and financial concerns lowest. Conclusion: The stability of students' personal characteristics across cohorts and the workforce outcomes of this program suggest the recruitment process successfully nurtures students who will fit well into future rural practice. [ABSTRACT FROM AUTHOR]

Introduction: The success of rural longitudinal integrated clerkship (LIC) programs has contributed to our understanding of selecting and training students for rural practice. Studies have explored the personality traits of students who participate in rural LICs although few have compared them with classmates who have not. The purpose is to compare personalities of four successive cohorts of students in the LIC Rural Physician Associate Program (RPAP) with their non-RPAP classmates. Methods: In a longitudinal cross-sectional design, medical students RPAP and non-RPAP, from 2013 to 2017 completed identical questionnaires comprising measures of personality, perfectionism, ambiguity tolerance, and resilience. T-tests, ANOVA, and post-hoc tests compared groups. K-means cluster analysis identified profiles of traits. Results: Total sample 286; RPAP = 128; non-RPAP = 158. Gender and age proportions were not different between groups. RPAP students were significantly lower in levels of perfectionism and higher in cooperativeness compared to non-RPAP classmates. Similar proportions of both groups were distributed across three personality profiles detected. Conclusions: Lower perfectionism implies advantages for rural practice. Nevertheless, similarities between groups suggest that most students would be successful in rural practice. More encouragement to all students may improve uptake of rural LICs. Greater attention to issues that affect decisions to explore rural medical education, particularly for our next generation of students, is required.

Purpose: Rural physicians wrestle with professional boundary issues routinely in everyday interactions, and their situation differs from the experience of their urban colleagues. Medical students receive limited exposure to professional boundary management in preclinical training. Increasingly, schools are implementing rural longitudinal clinical clerkships which expose students to rural boundary setting. This qualitative study explored the management of professional boundaries integral to rural practice and how this management may differ from their urban colleagues., Method: Semistructured interviews were conducted in 2010 with 12 rural physicians across Minnesota exploring their perceptions of professionalism in rural practice. A social constructivist approach to grounded theory was used to analyze the data., Results: Five primary themes regarding rural professionalism emerged from the data: centrality of care, rural influences on choice, individualization of boundary setting, advantages of dual relationships, and disadvantages of them. These themes served to illustrate rural boundary management., Conclusions: This study's findings indicate that rural physicians are routinely confronted with professional boundary issues in everyday situations, and these circumstances do not always reflect those of their urban colleagues. Given the increase in longitudinal immersion clinical clerkship programs to nurture student interest in future rural practice, acknowledgment and acceptance of the nuances of dual relationships and boundary setting in different clinical learning contexts are vital to help students identify their personal needs for privacy and be better prepared to negotiate the realities of rural practice. These findings may inform future medical education initiatives on professional boundary setting as an aspect of professionalism.