PS1-01: OUTCOMES AND INFLUENCES OF RURAL-FOCUSED INTEGRATED CLERKSHIP PROGRAMS IN GENERAL SURGERY
Steven J Skube, MD1, Nicole Thorndal, BS1, James G Boulger, PhD1, Kirby Clark1, James G Coverdill, PhD2, Paula M Termuhlen1, Jeffrey G Chipman1, Robert D Acton1; 1University of Minnesota, 2University of Georgia
Background: A shortage of general surgeons is predicted in the future, with particular impact on rural surgery. It can be difficult to recruit and retain rural surgeons. Rural-focused longitudinal integrated medical student clerkships (LIC) geared towards students with interest in primary care and rural medicine have been developed but their influence on rural general surgery has not been evaluated. The objective of this study was to review the outcomes of a rural-focused LIC, with a focus on general surgery and to use this exploratory analysis to determine if such clerkships can be used to increase interest and recruitment in rural general surgery.
Methods: An institutional database was reviewed to identify students who became general surgeons after completing a rural-focused LIC. Demographic data, clerkship site data, practice patterns, and contact information were obtained. A phone interview script was developed after multiple iterations following input by the co-authors. Surgeons were contacted by email to participate in a phone interview. All surgeons who replied to the email were interviewed. Interviews were transcribed and reviewed.
Results: Fifty-seven students completing the rural-focused LIC became general surgeons (from 1972-2014). A similar percentage of students in this rural-focused LIC chose to become general surgeons (3.6%) as those in traditional clerkship program (4-5% institutionally). Most (84%) of these surgeons are male, 48% had a rural first practice location, and 35% had a rural second practice location. Ten surgeons agreed to phone interviews. All decided to become surgeons during their rural-focused LIC. Clerkship preceptors and positive operative experience most commonly cited as influences in this decision. All stated that preclinical years did not heavily influence their specialty decision. There was a mixed response (60% favoring) about using this LIC to recruit rural general surgeons.
Conclusion: Of students who chose general surgery and participated in a rural LIC, a substantial portion went on to practice in rural communities. A similar percentage of students in a rural LIC choose general surgery as compared to a traditional clerkship. An additional focus in rural general surgery for pre-existing rural/primary care-focused education could help to address the future projected shortage of rural general surgeons.