See below for preparation for medical school
If I had to set up an ideal rural medical school to maximize those who would go rural and stay rural and do well in rural areas, this is what I would set out to do:
1. Admissions - Inputs from state or province small colleges to be sure that we pick the most likely rural candidates, the ones who want to serve, not just those in pursuit of a means to stimulate their minds. (Rabinowitz PSAP) Latest research soon to be published notes that 78% of the location decision of a rural physician is admitting those with rural background and family practice interest.
2. Retention-priority model - Internet-based training for much of first two years (see any one of several internet sites). There would be lowered tuition costs, some attrition rate, also some may take two years whereas others may take up to 4 years to finish and pass boards and be ready for the clinical years. Internet training allows candidates to stay in their rural locations as long as possible. It allows the school to pick candidates that are already in underserved locations.
3. Longitudinal rural training for 3rd year. (See the Rural Physician Associate Program in Minnesota, a premier means of training people for rural family practice).
4. FP internship year This year would be adapted to transit students from medical school to residency over the year. This also means there is no real need for a match. Puts two great learning years back to back, the M-3 year and PGY-1 year. Puts a premium on good supervision of the first year housestaff. The Nebraska Accelerated program demonstrates the value of such an effort.
5. Rural-based or RTT training as per current rural training options. Dispersed medical education does lead to rural locations for graduates.
6. Optional extra fellowship months that would be funded by federal funds. This allows grads to tailor their training to the needs of their upcoming location
7. Support interviews and contacts for first year of practice to help retain physicians in practice. Makes sure that new physicians have help adapting to some difficult situations.
8. Intergenerational contacts, establishing traditions - Use of graduates in training the next generation. RPAP profits from this recurrent cycle of grads training students to great effect. Also makes rural faculty development much easier. Helps faculty because they met grads as students and work with them throughout.
There are additional opportunities. Since there is not a need for a match or a regular yearly cycle of students, the remaining on site courses could be taught 2 or 3 times a year to a much smaller class. This allows more personal attention and also rewards teachers who want to teach full time. Current incentives are much different. The focus would be on learning, not just jumping through the next hoop at the prescribed time.
What Should the Next Generation of Medical Schools Look Like
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