Original Article

Teaching Medical Students in the Rural Setting Long Term: Physicians’ Attitudes and Perceptions

Authors: John Wheat, MD, MPH, John Brandon, MD, Melissa Cox, PhD, Scott Thomas, MD, Susan Guin, MSN, James Leeper, PhD

Abstract

Objectives: The University of Alabama School of Medicine Tuscaloosa Regional Campus conducted a 2-month block in rural family practice, but committed to expanding to an 8-month longitudinal rural curriculum. We wanted to explore how rural physicians feel about teaching students in a prolonged rural preceptorship.

Methods: We brainstormed with colleagues, reviewed the literature, and conducted two focus groups supplemented by five interviews with rural physicians. The focus groups explored satisfaction and dissatisfaction in teaching, medical school and community support, evaluation of preceptors, and the sharing of information between students and preceptors. The analysis sought common themes among study participants and colleagues.

Results: Twenty-one study participants included 19 family physicians, 15 in private practice. Eleven had taught medical students. Our key finding, combining four themes, was that a satisfactory context within which to teach medical students long term in rural sites depends on the optimization of the roles of preceptors, students, communities, and educational institutions. There were comments addressing each of these roles. This finding cannot be generalized beyond the study group because of the qualitative methodology using a convenience sample.

Conclusions: These physicians’ concerns foment hypotheses about engaging rural physicians in their own unique local networks involving preceptors, students, community, and educational institutions to conduct satisfactory long-term medical education in rural sites. We recommend investigations to substantiate a prevalence among rural physicians of concern about the four roles and to describe various contexts in which these roles produce satisfactory long-term preceptorships, perhaps as best practices in different settings.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. World Health Organization. Increasing access to health workers in remote and rural areas through improved retention: global policy recommendations. https://www.who.int/hrh/retention/guidelines/en. Published 2010. Accessed March 4, 2019.
2. Ranmuthugala G, Humphreys J, Solarsh B, et al. Where is the evidence that rural exposure increases uptake of rural medical practice? Aust J Rural Health 2007;15:285-288.
3. Rabinowitz HK, Diamond JJ, Markham FW, et al. Medical school programs to increase the rural physicians supply: a systematic review and projected impact of widespread replication. Acad Med 2008;83:235-243.
4. Downey LH, Wheat JR, Leper JD, et al. Undergraduate rural medical education program development: focus group consultation with the NRHA Rural Medical Educators Group. J Rural Health 2011;27:230-238.
5. Wheat JR, Leeper JD, Murphy S, et al. Educating physicians for rural America: validating successes and identifying remaining challenges with the rural medical scholars program. J Rural Health 2018;34:s65-s74.
6. Rackley BP, Wheat JR, Moore CE, et al. The Southern Rural Access Program and Alabama' Rural Health Leaders Pipeline: a partnership to develop needed minority health care professionals. J Rural Health 2003;19s:354-360.
7. Wheat JR, Brandon JE, Leeper JD, et al. Rural health leaders pipeline, 1990-2005: case study of a second-generation rural medical education program. J Agromed 2007;12:51-61.
8. Wheat JR, Leeper JD, Brandon JE, et al. The rural medical scholars program study: data to inform rural health policy. J Am Board Fam Med 2011;24:93-101.
9. Wheat JR, Coleman VL, Murphy S, et al. Medical education to improve rural population health: a chain of evidence from Alabama. J Rural Health 2015;31:354-364.
10. Stagg P, Prideaux D, Greenhill J, et al. Are medical students influenced by preceptors in making career choices, and if so how? A systematic review. Rural Remote Health 2012;12:1832.
11. Kane KY, Quinn KJ, Stevermer JJ, et al. Summer in the country: changes in medical students’ perceptions following an innovative rural community experience. Acad Med 2013;88:1157-1163.
12. Caygill R, Peardon M, Waite C, et al. Comparing a longitudinal integrated clerkship with traditional hospital-based rotations in a rural setting. Med Teach 2017;39:520-526.
13. Cooke M, Irby DM, O'Brien BC. Educating Physicians: A Call for Reform of Medical School and Residency. San Francisco:Jossey-Bass;2010.
14. Johnson P, Fogarty L, Fullerton J, et al. An integrative review and evidence-based conceptual model of the essential components of pre-service education. Hum Resour Health 2013;,11:42.
15. Murakami M, Kawabata H, Kisa K, et al. What rural physicians need to engage in community based education: a qualitative interview study. J Rural Med 2012;7:38-41.
16. Mann KV, Holmes DB, Hayes VM, et al. Community family medicine teachers’ perceptions of their teaching role. Med Educ 2001;35:278-285.
17. Shannon SJ, Walker-Jeffreys M, Newbury JW, et al. Rural clinician opinion on being a preceptor. Rural Remote Health 2006;6:490.
18. Goertzen J, Stewart M, Weston W. Effective teaching behaviours of rural family medicine preceptors. CMAJ 1995;153:161-168.
19. Neher JO, Stevens NG. The one-minute preceptor: shaping the teaching conversation. Fam Med 2003;35:391-393.
20. Bannister SL, Hanson JL, Maloney GC, et al. Using the student case presentation to enhance diagnostic reasoning. Pediatrics 2011;128:211-213.
21. Walters L, Worley P, Prideaux D, et al. The impact of medical students on rural general practitioner preceptors. Rural Remote Health 2005;18:338-355.
22. Scott SM, Schifferdecker KE, Anthony D, et al. Contemporary teaching strategies of exemplary community preceptors-is technology helping? Fam Med 2014;46:776-782.
23. de Villiers M, van Schalkwyk S, Blitz J, et al. Decentralised training for medical students: a scoping review. BCM Med Educ 2017;17:196.
24. Beck Dallaghan GL, Alerte AM, Ryan MS, et al. Recruiting and retaining community-based preceptors: a multicenter qualitative action study of pediatric preceptors. Acad Med 2017;92:1168-1174.
25. McCullough B, Marton GE, Ramnanan CJ. How can clinician-educator training programs be optimized to match clinician motivations and concerns? Adv Med Educ Pract 2015;6:45-54.
26. Latessa R, Beaty N, Colvin G, et al. Family medicine community preceptors: different from other physician specialties? Fam Med 2008;40:96-101.
27. Teherani A, O'Brien BC, Masters DE, et al. Burden, responsibility, and reward: preceptor experiences with the continuity of teaching in a longitudinal integrated clerkship. Acad Med 2009;84(10 suppl): S50-S53.
28. Latessa R, Colvin G, Beaty N, et al. Satisfaction, motivation, and future of community preceptors: what are the current trends? Acad Med 2013;88:1164-1170.
29. Anthony D, Jerpbak CM, Margo KL, et al. Do we pay our community preceptors? Results from a CERA clerkship directors’ survey. Fam Med 2014;46:167-173.
30. Ricer RE, Van Horne A, Filak AT. Costs of preceptors’ time spent teaching during a third-year family medicine outpatient rotation. Acad Med 1997;72:547-551.
31. Tang TS, Skye EP. When patients decline medical student participation: the preceptors’ perspective. Adv Health Sci Educ Theory Pract 2009;14:645-653.
32. Drowos J, Baker S, Harrison SL, et al. Faculty development for medical school community-based faculty: a Council of Academic Family Medicine Educational Research Alliance study exploring institutional requirements and challenges. Acad Med 2017;92:1175-1180.
33. Latessa R, Beaty N, Landis S, et al. The satisfaction, motivation, and future of community preceptors: the North Carolina experience. Acad Med 2007;82:698-703.