Education Columns

by Jon Kyle Melvin, MD; Gary L. Beck Dallaghan, PhD; Meredith Horne Bazemore, MPA; Sherry S. Hay, MPA; Kelly Lacy Smith, MD; Catherine Louw Coe, MD;  University of North Carolina School of Medicine, Department of Family Medicine

Background

Due to the geographic maldistribution of primary care physicians, rural areas are predicted to be more impacted by the impending primary care physician shortage, therefore furthering the disparity for health outcomes between rural and urban communities.^2,3  Studies demonstrate that exposure to family medicine before medical school and growing up in a rural area were positive predictors of pursuing a career in family medicine and probability of practicing in a rural area, respectively.^{1, 4-9} However, students from rural areas were likely to suffer from differential preparation for college, lack of knowledge of a career in health professions, and decreased access to mentorship/exposure opportunities.^4-6 

Intervention

We developed the University of North Carolina Family Medicine Summer Academy (UNC FMSA) to expose students from rural North Carolina to family medicine and the various pathways to a career in medicine. We developed an experiential curriculum for graduating high school and early college students to explore a career in family medicine. The curriculum delivered a combination of both didactic and experiential opportunities for the participants who were housed on UNC’s campus over a 2-day experience. See Table 1 for a sample curriculum. Age restrictions for on-campus housing without overnight supervision limited applicants to those between 18 and 20 years old. Pre- and postparticipation surveys were collected using an online survey tool. Students were asked to rate their knowledge on how to become a health care professional, what a family physician does, and their interest in pursuing a career in family medicine.

Table 1: Sample Curriculum for the FMSA Experience

Results

Thirty-four students attended FMSA between 2018 and 2019. Of those 34 students, 31 (91%) were female and three (9%) were male. Further demographic background of the 34 students included 22 (64%) Caucasian, five (14%) African American, five (14%) Asian, one (2%) Hispanic, and two (5%) other.

Participants were asked to express their level of agreement with the following statement:  “I know what a family medicine doctor does for patients and communities.” Mean scores pre/post were 3.77 and 4.75. Comparisons pre/post were statistically significant in aggregate (z=-4.72 P=.001).

Participants were asked to express their level of agreement with the following statement: “I know what I need to do in order to get a job in the medical field as a doctor, nurse or other health professional.” Mean scores pre-/post- were 3.28 and 4.43. Comparisons pre/post were statistically significant in aggregate (z=-4.25, P=.001).

Participants were asked to express their level of interest with the following question: “How interested are you in getting a job as a family medicine physician?” Mean scores pre/post were 4 and 4.43. Comparisons pre/post were statistically significant in aggregate (z=-2.20, P=.028).

Conclusions

Following participation in the FMSA, scholars reported increased knowledge of the possible career paths to enter a health professions school and the specialty of family medicine, as well as the role of a family medicine physician within the community. Scholars were more interested in becoming a family physician as a potential career choice. However, there were several limitations to this study including the use of novel survey questions, incomplete sampling due to some participants not completing or misinterpreting the Likert scale, and the small sample size.

Future directions include continued mentorship through biannual contact with assessment of career goals and objectives and assistance with course selection and volunteer, extracurricular, and shadowing opportunities. Long-term outcomes from the experience include progress of scholars along the pipeline to primary care and matriculation into a health care profession school. Ultimately, the goal would be to see scholars practicing as health care professionals in rural parts of North Carolina.

References

1. Lee DM, Nichols T. Physician recruitment and retention in rural and underserved areas. Int J Health Care Qual Assur. 2014;27(7):642-652. doi:10.1108/IJHCQA-04-2014-0042
2. Brooks RG, Walsh M, Mardon RE, Lewis M, Clawson A. The roles of nature and nurture in the recruitment and retention of primary care physicians in rural areas: a review of the literature. Acad Med. 2002;77(8):790-798. doi:10.1097/00001888-200208000-00008
3. Spero JC, Fraher EP. Running the numbers: the maldistribution of health care providers in rural and underserved areas in North Carolina. N C Med J. 2014;75(1):74-79. doi:10.18043/ncm.75.1.74
4. Rourke J, Dewar D, Harris K, et al; Task Force of the Society of Rural Physicians of Canada. Strategies to increase the enrollment of students of rural origin in medical school: recommendations from the Society of Rural Physicians of Canada. CMAJ. 2005;172(1):62-65. doi:10.1503/cmaj.1040879
5. Curran V, Rourke J. The role of medical education in the recruitment and retention of rural physicians. Med Teach. 2004;26(3):265-272. doi:10.1080/0142159042000192055
6. Whalen D, Harris C, Harty C, et al. Should I apply to medical school? High school students and barriers to application. Can J Rural Med. 2016;21(2):46-50.
7. MacQueen IT, Maggard-Gibbons M, Capra G, et al. Recruiting rural health care providers today: a systematic review of training program success and determinants of geographic choices. J Gen Intern Med. 2018;33(2):191-199. doi:10.1007/s11606-017-4210-z
8. 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. doi:10.1097/ACM.0b013e318163789b
9. Senf JH, Campos-Outcalt D, Kutob R. Factors related to the choice of family medicine: a reassessment and literature review. J Am Board Fam Pract. 2003;16(6):502-512. doi:10.3122/jabfm.16.6.502