John R. Wheat

Admission Factors Predicting Family Medicine Specialty Choice: A Literature Review and Exploratory Study among Students in the Rural Medical Scholars Program.

PURPOSE The Rural Medical Scholars Program (RMSP) was created to increase production of rural family physicians in Alabama. Literature review reveals reasons medical students choose careers in family medicine, and these reasons can be categorized into domains that medical schools can address through admission, curriculum, and structural interventions. We examine whether admission factors can predict family medicine specialty choice among students recruited from rural Alabama. METHODS We developed a questionnaire to study the ability of admission factors to predict family medicine specialty choice among Rural Medical Scholars (RMS). Eighty RMS graduates were surveyed by mail and 64 (80%) responded. FINDINGS Student characteristics of humanitarian outlook with commitment to rural or underserved populations, family medicine decision or intention made before or at medical school admission, and community influence were positive associations with RMS choosing family medicine residencies; shadowing in an urban hospital was a negative association. CONCLUSIONS Statements of interest, intentions, plans, and decisions regarding family medicine should be elicited at the time of RMSP admission interview. Strong attachment to home community and commitment to serving and living in a rural area are also important. Students whose introduction to medicine was informed through shadowing or observing in urban hospitals should be considered less likely to become family physicians. Larger sample size studies are needed to assess the role of gender, race, marital status, size of rural town, and MCAT score of candidates in affecting residency choices of students selected for this rural medical education track.

The Rural Medical Scholars Program Study: Data to Inform Rural Health Policy

Introduction: Medical education to produce rural physicians hinges on the characteristics of students, educational programs, and rural experiences. Family physicians are key components of rural medicine. This study tested the effectiveness of multiple, combined strategies of the Rural Medical Scholars Program to produce family medicine residents. Methods: We compared the relative effectiveness of the Rural Medical Scholars Program, family medicine–oriented branch campuses, and a traditional urban campus to produce family medicine residents using a prospective quasi-experimental design. Logistic regression was used to account for covariates. Results: The relative effectiveness of 3 educational modalities to produce family medicine residents was examined: Rural Medical Scholars Program (44.0%; odds ratio [OR], 15.6), family medicine–oriented branch campuses (18.9%; OR, 5.8), and a traditional urban campus (3.9%; OR, 1). These differences were significant (P < .05) after controlling for sex, race, Medical College Admission Test scores, and graduation rate. Conclusions: The findings are consistent with the literature, which recommends multiple strategy interventions to produce rural physicians (e.g., admit rural students who have an interest in family medicine, use family medicine faculty, and provide rural experiences). Further study will determine whether rural practice follows training in family medicine among Rural Medical Scholars.

Farmers’ Concerns: A Qualitative Assessment to Plan Rural Medical Education

CONTEXT Limited research suggests that translational approaches are needed to decrease the distance, physical and cultural, between farmers and health care. PURPOSE This study seeks to identify special concerns of farmers in Alabama and explore the need for a medical education program tailored to prepare physicians to address those concerns. METHODS We conducted 2 focus groups with 20 farmers from diverse communities, backgrounds, and farming operations. The sessions were audio-recorded, transcribed, coded, and analyzed for determined patterns. FINDINGS The following categories were developed as areas of importance to farmers: the need for physicians to understand the culture of farming, occupational exposures in farming, and recommendations for improving the health of farmers. CONCLUSION Findings suggest that to adequately serve farmers, medical students interested in entering practice in rural areas should have or develop a relevant and adequate understanding of farming practices.

Agromedicine focus group: cooperative extension agents and medical school instructors plan farm field trips for medical students.

Background Current medical education policy seeks to address the health care needs of underserved populations, among whom are individuals associated with agriculture. Methods This paper describes a focus group approach to planning farm field trips whereby medical students accompany agricultural extension agents to study the personal, occupational, and environmental health concerns of farmers. Results The resulting plan joins a states cooperative extension system, medical school, and farm community in partnership to provide an experiential approach to agricultural medicine and rural health education. Conclusion The planning exercise and the field trips are successful examples of agromedicine, a partnership approach to preventive agricultural medicine involving professionals in medicine and in agriculture.

What's in a name? Revisited: terms used to describe activities related to the health and safety of agricultural-associated populations and consumer

Abstract The fundamental role of an academic journal is to facilitate a dialogue among scholars to advance the knowledge and art of practice related to the journals subject, and consequently, to raise the human condition. As the Journal of Agromedicine begins to chart a course under new management and to enlarge the numbers of contributing scholars and sustaining subscribers, the editor has discovered a variety of concepts, historical developments, and terms used by scholars and practitioners in pursuit of health and safety of agriculture-associated populations and consumers. Each of these concepts, developments, and terms reflect the interests of different scholars and practitioners, who represent a surprisingly broad set of disciplines committed to this large endeavor.

Preventive Agricultural Medicine: A Student's Perspective of Farmers' Mental Health

Abstract As a medical student completing a required rural community medicine clerkship, I discovered my home communitys concern for mental health of farmers. A local economic downturn affects everyone, but especially the farmers. One farmer had recently committed suicide. Leaning heavily on work presented at a Nebraska summit on the farm crisis and mental health and on the National Rural Health Association issue paper on rural mental health, I found farmer and rural mental health to be a widespread concern, exacerbated by a scarcity of rural mental health resources. In my recommendations for rural Alabama, I endorse recommendations of others, including strengthening the local family physician role as “front door” to the mental health system, outreach with such agents as extension personnel and ministers, and farm crisis hotlines.

Reevaluation of Medical Education A Behavioral Model to Assess Health Promotion/Disease Prevention Instruction

More than half of graduating seniors rate their curricula inadequate in health promotion and disease prevention (HPDP) topics, and available data suggest that current medical school curricula turn students away from career choices that foster prevention. Data are needed to show that prevention education works to encourage students to pursue HPDP in practice and thus support greater emphasis on prevention in medical school curricula. This article presents a model that relates health promotion and disease prevention education to desired characteristics of medical school graduates including knowledge and sense of ability in HPDP, specialty preference, and residency choice, while accounting for other factors that influence those characteristics. The model willfacilitate evaluation ofprograms by using NBME, AAMC, and other standardized datasets and may be used to find exemplary programs from among experimental efforts in U.S. medical schools and to evaluate their replication.

Medical Education to Improve Rural Population Health: A Chain of Evidence From Alabama

PURPOSE To provide evidence that medical education is associated with population health in order to support adaptation of medical school programs to address populations with health disparities. We explored medical education efforts, local physician supply, and life expectancy in Alabama. METHODS County-level public data of the number of students accepted to medical schools in 2008 and 2011, primary care physicians, life expectancy, and demographic/contextual variables were analyzed to develop a model for hypothesized associations. Correlational analysis, ANCOVA modeling, and path analysis were employed to identify, reduce, and organize significant variables in this cross-sectional ecologic study. FINDINGS The path model, which met criteria for goodness of fit, found significant relationships among medical students per 10,000 population, primary care physicians per 10,000 population, life expectancy, and contextual variables for rurality and poverty. ANCOVA models showed that geographic region was significant. CONCLUSIONS Within limitations of the study design, these findings support the proposition that the number of medical students produced in a county is related to the number of primary care physicians, which is related to life expectancy. Recommendations are to confirm the findings in other populations and inform public health policy concerning the utility of medical education to address population health by producing local medical students.

Medical connections: use of the internet and traditional sources of health information by rural Alabama households.

Abstract Rural household adoption of the PC and Internet for accessing medical and healthcare information was investigated using survey data collected from 305 households randomly selected from non-metropolitan, rural counties across Alabama. The diffusion-adoption model for new technologies was employed to create five adoption stages relevant to this technology and its applications to communication of information in the health field. Descriptive household characteristics of age, education, income, and children revealed differences between adoption stages, with age and education having major impacts. Use of traditional sources of health information and the Internet were compared in relation to age and availability of medical services. Older, less educated households lagged behind in use of the Internet for health information. Medical professionals, doctors and pharmacists, were the most utilized information source by rural households; but those households connected to the Internet used on-line sources, even e-mail to communicate with their doctors.

The Bibb County Child Caring Foundation (BCCCF): A Story that Needs to be Shared

Health care policy makers and health reformers have become increasingly concerned with improving access to health care for children. Health insurance, often referred to as an “enabling factor,” is a crucial component of health care access. Health insurance facilitates the use of health services by providing financial access to the health care system (Simpson, Bloom, Cohen, & Parsons, 1997). Nearly 11 million children went without health insurance in 1996—the highest number and proportion of uninsured children since 1987 (Bennefield, 1997; General Accounting Office, 1996).