Predoctoral Training in Primary Care

The University of Kentucky lies at the heart of a state dominated by rural demographics. Eightyfour of the state's 120 counties report a population ofless than 30,000; sixty-four percent are currently designated as Health Professions Shortage Areas and 79% as Medically Underserved Areas. The College of Medicine at the University takes seriously its mission to provide quality graduates to serve as providers in all areas of Kentucky, induding these underserved communities. Unfortunately, the College has experienced the same dramatic decline in students choosing Family Medicine as a career as the rest ofthe nation, and this despite an aggressive policy of recruiting medical students from rural Kentucky. In response, this proposal seeks to complete 2 innovative objectives aimed at improving not only entry into Family Medicine, but also entry into the rural environment from all primary care specialties. In order to facilitate this goal, the following objectives will be implemented: 1. Creation of a longitudinal rural track within current curricular structure for rural-minded matriculants, and 2. Implementation of electronic clinical encounter tracking among this cohort of students to facilitate study of rural clerkship variation and its relation to student outcomes. The pre-clinical curriculum (years 1 and 2) will be designed in consultation with rural practitioners. They will be involved with case creation and problem set design as well as the evaluation of the resultant product. A new rural12-week 3rdyear clerkship will be created that blends internal medicine, pediatrics and family medicine. This clerkship will be enhanced with conferences led by community leaders, locally facilitated reflection groups and presentations from allied health organizations. Finally, 2 new Rural Acting Internships in Family Medicine will be created and required of the cohort. Electronic tracking of clinical encounters will be accomplished using palm-top computers. Use of these devices will enable students to generate individual databases that may then be analysed to better characterize each student's experience. Hypothesis testing regarding the relation between student experience, satisfaction and career choice is planned.