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Focus Factors Discussed References Geyman21 Curran22 Hsueh23 Ranmuthugala24 Rabinowitz4 Henry25 Program wide Mission x x X Decentralization x x x Rural location x Telehealth x x Premedical K through college X X Exam preparation X Rural background X X X X X X FM/PC interest x X X X Predoctoral FM/PC preceptors x X X FM faculty X X Faculty support x Rural experience x x X x X X Rural focus x X X FM focus x PBL x Obstacles Funding x x Accreditation x Urban influence x Specialist influence x Evaluation issues Selection bias x Confounders X x Recommendations Multiple interventions X X X x x * Limited to preresidency topics.
FM, family medicine; K, kindergarten; PBL, problem-based learning; PC, primary care; x, factor discussed; X, factor emphasized.
Program Component Track of Study Main Campus Branch Campus RMSP FM medical director X Pipeline recruitment programs* X Admissions programs Regular committee X X Rural subcommittee† X Special requirements 8 years in rural Alabama X FM/PC intent X GPA and MCAT thresholds‡ X Rural values/identity§ X Prematriculation Masters program Biochemistry‖ X Rural Community Health¶ X Rural FM preceptor X Medical school location Preclinical in Birmingham X X X Clinical in branch campus** X X * Rural Health Scholars Program for high school students and Rural Minority Health Scholars Program for college students.
† Composed of one-third rural family physicians, one-third minority health professionals, and one-third branch campus faculty. A candidate is interviewed by one of each.
‡ Thresholds for grade point average (GPA) and Medical College Admission Test (MCAT) are 3.3 and 24, respectively.
§ Values and identity are assessed through interview.
‖ Two semesters of Biochemistry are included.
¶ Courses include Rural Occupational and Environmental Health, Rural Community Clinical Process, Biostatistics, Epidemiology, Health Care Management, Behavioral Medicine, and Masters Major Paper.
** The 2 branch campuses emphasize family medicine (FM); the Birmingham campus emphasizes subspecialties and bench research.
PC, primary care.
- Table 3.
Level of Rural Medical Education (RME), Family Medicine Effect, and Student Characteristics Before and After Rural Medical Scholars Program (RMSP) Intervention
Campus/Track of Study Before RMSP Intervention (1989–1996) After RMSP Intervention (1997–2005) Before/After P* (a:b) RMSP Intervention† (1997–2005) Main Campus Branch Total (a) Main Campus Branch Total (b) RME level‡ Minimal Moderate Minimal Moderate Large N 838 294 1132 840 296 1136 84 Age (mean years) 24.0 23.8 24.0 23.9 24.0 23.9 .81 24.7 Race (% white) 88.4 83.7 87.2 83.8 79.7 82.7 .003 90.5 Sex (% male) 65.8 66.0 65.8 60.5 58.1 59.9 .003 64.3 Rural (%) 16.3 20.7 17.5 15.1 22.3 17.0 .75 43.2 MCAT (mean score) 29.2 28.4 29.0 30.1 29.2 29.9 <.001 25.7 4-year graduation rate (%) 85.8 84.7 85.5 88.7 87.8 88.5 .04 90.5 FM choice (%) 9.7 24.1 13.4 3.9 18.9 7.8 <.001 44.0 FM effect (odds ratio)§ 1.0 5.8 15.6 * Variables with significant pre/post differences were candidates for control variables in the analysis.
† The intervention was the RMSP, explained below as a large-level intervention.
‡ RME level represents the incremental commitment to rural medical education on the separate campus tracks: “Minimal” for the main campus, “Moderate” for the family medicine–oriented branch campuses, and “Large” for the RMSP with a special admissions program and a prematriculation masters degree on a family medicine–oriented branch campus.
§ These odds ratios, adjusted for sex, race, MCAT score, and graduation rate, compare the odds of a student choosing to become a family medicine resident after having completed tracks of study at campuses/programs offering different levels of RME. The RMSP odds ratio is significantly greater (P < .001) than the others, and the odds ratio for the family medicine–oriented branch campuses is greater than for the main campus (P < .001).
FM, family medicine; MCAT, Medical College Admission Test.
