POSTER

Does a Rural Pediatric Clerkship Experience Have an Impact on Medical Students' Attitudes Toward Serving The Underserved?

Authors: Rani S Gereige, M.D. MPH1, Antoinette C Spoto-Cannons, M.D. 1 and Ellyn P Theophilopoulos, M.D. 1. 1 Pediatrics, University of South Florida, St. Petersburg/Tampa, Florida, United States.

Background: Over 50 million (20%) of the US live in rural area but only 9% of US physicians do so. In 2004, 25 of 51 rural track NRMP positions went unfilled. Rural exposures are important teaching activities, however, do not alone provide an understanding of rural practice.

Objective: 1. Assess the impact of a rural third year pediatric clerkship experience on medical students' activities toward rural medicine 2. Estimate an optimal exposure “dose” that maximizes the impact

Design/Methods: Between 1999-2001, pre and post rotation surveys were anonymously administered to USF third year medical students during Pediatric Clerkship. Some were assigned to a rural site for all or part of their 2 week clinic experience. Students' attitude toward and willingness or plan to work in underserved setting, and the importance of barriers facing rural providers were assessed. The post survey looked for a relationship with rural time spent (zero, = 6 half days, > 6 half days)

Results: A total of 164 (52% M) and 80 students completed the pre and post surveys respectively. Irrespective of gender or exposure, 72-99% of students agreed or strongly agreed that there remains US medically underserved areas, health services access is a right, and underserved work is rewarding. A low percentage expressed willingness (45% pre, 28% post) or plan (18% pre, 16% post) to work full-time in underserved setting, more so in female and part-time. Percentages were higher in students planning a primary care career and with longer exposure time. Only exposure > 6 half days resulted in decreased importance of barriers such as lack of support (90% to 79%), community resources (82% to74%) and tertiary care (69% to 64%). Primary care career plan was associated with decreased importance of parent education (47% to 30%), and community resources (45% to 20%) particularly with > 6 half days exposure. Financial reimbursement and geographic remoteness increased in importance with exposure regardless of career choice. No gender differences noted

Conclusion: Despite a positive attitude toward rural medicine, students' rural exposure, is educational but should be comprehensive, for substantial time (> 6 half days), and promote rural medicine as a career. Substantial gains in eliminating disparities might be achieved by preferentially targeting planning a primary care career