James J. Stevermer

Influencing Residency Choice and Practice Location Through a Longitudinal Rural Pipeline Program

Purpose The University of Missouri School of Medicine developed the Rural Track Pipeline Program (MU-RTPP) to increase the supply and retention of rural physicians statewide. The MU-RTPP features a preadmissions program for rural students (Rural Scholars), a Summer Community Program for rising second-year students, a six-month Rural Track Clerkship (RTC) Program for third-year students, and a Rural Track Elective Program for fourth-year students. The purpose of this study is to report the specialty choices and first practice locations of Rural Scholars, RTC-only participants, and Rural Track Clerkship Plus (RTC+) participants (students who participated in the RTC Program plus an additional MU-RTPP component). Method The authors compared the residency specialty choices of 48 Rural Scholars (tracked since 2002) with those of 506 nonparticipants and the residency specialty choices of 83 RTC participants and 75 RTC+ participants (tracked since 1997) with those of 840 nonparticipants. The authors calculated the relative risk (RR) for the likelihood of participants matching into primary care compared with nonparticipants and analyzed first practice location. Results Rural Scholars were more than twice as likely to match into family medicine (RR = 2.6; 95% confidence interval 1.5–4.4). RTC and RTC+ participants entered primary care, especially family medicine, at rates significantly higher than nonparticipants. Over 57% of students who participated in the RTC program (and potentially other MU-RTPP offerings) chose a rural location for their first practice. Conclusions The longitudinal MU-RTPP successfully recruits students for rural and primary care practice to address the health care needs of Missouri.

Summer in the Country: Changes in Medical Students' Perceptions Following an Innovative Rural Community Experience

Purpose The University of Missouri School of Medicine developed the Summer Community Program through which rising second-year medical students work alongside rural, community-based physician preceptors. This program is part of a comprehensive, longitudinal pipeline designed to increase student interest in rural practice. The authors describe the Summer Community Program, explain changes in students’ perceptions of rural practice and rural lifestyle post program, and report participants’ specialty choices and first practice locations. Method The authors analyzed 229 participant responses (1996–2010) to pre- and postexperience questionnaires focused on perceptions of rural practice and lifestyle. The authors calculated the likelihood of participants matching into primary care compared with nonparticipants and analyzed participants’ first practice locations. Results After the experience, participants’ perceptions toward rural practice and lifestyle changed favorably, and 72% (n = 208) reported more interest in rural practice. Compared with nonparticipants, summer participants were more likely to enter a primary care residency (relative risk [RR] = 1.31; 95% confidence interval [CI]: 1.12–1.50) and twice as likely to choose specifically family medicine (RR = 2.21; 95% CI: 1.68–2.88). Forty-six percent (n = 78) of participants chose rural locations for their first practices. Conclusions This program has positively influenced students’ perceptions of rural practice and lifestyle and increased their interest in rural practice. Participants entered primary care and family medicine residencies at higher rates than nonparticipants, and nearly half started their medical practices in rural locations. Replicating this program may increase interest in rural medicine and address rural physician workforce needs.

How we incorporated service learning into a medical student rural clinical training experience

Abstract Background: Many medical schools have developed admission policies and clinical training programs designed to address the rural physician workforce shortages in their state. Aim: To enhance medical student rural clinical training experiences, and assist in preparing students for living and working in rural communities. Methods: As part of their Rural Track Clerkship (RTC) Program, the University of Missouri School of Medicine developed the Community Integration Program (CIP). Students, individually or in groups, voluntarily identify a health need and implement a community-based project to meet that need. Results: From 2007 to 2013, 80 (53%) students participated in the CIP and 86% completed the 11-item post-experience questionnaire. After the experience, participants reported a deeper understanding of the broad impact of a rural physician and the impact of rural culture on physician interactions. Participants reported they felt more integrated into the community, had a greater understanding of community health needs and resources, and were more likely to participate in future community service activities. Conclusions: The CIP exposes students to rural culture and helps them understand community health needs. Replication of this program can increase student interest in rural medicine and better prepare students for rural practice.

Characterization of Licensees During the First Year of Missouri's Assistant Physician Licensure Program

Discussion | More than 1000 medical crowdfunding campaigns for 5 treatments that are unsupported by evidence or potentially unsafe raised more than

Answering family physicians' clinical questions using electronic medical databases.

6.7 million. Another study found that 408 campaigns raised more than

Intention-to-treat analysis: Who is in? Who is out?

1 million for unproven stem cell interventions.6 The present study included a broader set of treatments and suggests that medical crowdfunding is being used for multiple problematic treatments. These results reveal that a wide scope of campaigns for unsupported, ineffective, or potentially dangerous treatments are moderately successful in obtaining funding. Assuming that the funds raised are spent to pay for these treatments, donors indirectly contributed millions of dollars to practitioners to deliver dubious, possibly unsafe care. This study has limitations. Only 5 treatments and 4 platforms were analyzed. These were selected because of clinical experience and visibility. Whether the results generalize is unknown. Native search engines vary in quality; an external search engine may have yielded more results. Despite expressed intent, campaigners may not have used funds on specified treatments.