RPAP and UMN-Duluth provide significant, complementary educational programs that lead more graduates to choose rural and primary care practices. Efforts across the nation to address the crisis in rural primary care should build on these successful efforts.

Purpose: Rural general surgery experiences during medical school appear to have influenced the decision of prospective general surgery applicants to pursue residency programs that provide rural surgery opportunities. This is an analysis of a single cohort, rural-focused, longitudinal integrated clerkship to determine if there is an association between type of residency program and completion of a rural-focused longitudinal integrated clerkship. Methods: An institutional database of de-identified, self-reported data was reviewed to identify rural-focused longitudinal integrated clerkship alumni who matched into a surgical residency program.  Findings: Of the seventy-five alumni who chose a surgical residency program, 40 (53.3%) matched into a university-affiliated residency program, and 32 (42.6%) matched into an independent-academic program. There was no association between type of residency program and completion of a rural-focused longitudinal integrated clerkship. Conclusions: A rural-focused longitudinal integrated clerkship can help increase the rural physician workforce within both the state and region of the sponsoring institution. To facilitate heightened interest in rural general surgery, these types of programs should continue to be promoted.

Background: The Health of People Everywhere (HOPE) Clinic is a student-run free triage and urgent care clinic that has operated in a Duluth, Minnesota homeless shelter since 2008.  More than 100 University of Minnesota medical and pharmacy students volunteer at the clinic annually. The unpredictable nature of clinical interactions have highlighted the need to better prepare students on preventing escalation of difficult patient situations to crises.   Methods: HOPE Clinic student leaders developed a Crisis Prevention Training Module around the themes of drug-seeking behavior, suicidal ideation and sexual harassment. A didactic presentation was followed by role-playing scenarios utilizing Theater Arts students as patients. A pre-training email survey was sent out to all 120 medical students and 180 pharmacy students on campus to evaluate students’ confidence to handle difficult patients. Medical students (n=60) and pharmacy students (n=116) who volunteer at the free clinic then had the chance to participate in crisis prevention training through the school. A post-training survey was sent out to all medical and pharmacy students on campus to compare the change in student confidence among students who participated in the training and students who did not.  Results: On the pre-training survey, 40% of medical students and 17% of pharmacy students reported receiving previous crisis-prevention training (p=0.023). ANOVA of post-training survey results revealed a significant increase in student confidence to prevent a crisis compared to the pre-training survey among pharmacy students (p=0.001), but not among medical students.  Conclusions: Pharmacy students perceived that crisis-prevention training increased their confidence to prevent uncomfortable patient interactions from escalating to a crisis.

Background and Objectives: Clinical reasoning is developed sometime during medical school training. When and how this knowledge is attained is less clear. This study looks at clinical reasoning development after initiation of a rural experiential course for first-year medical students at the University of Minnesota Medical School, Duluth (regional) Campus. Methods: The Rural Medical Scholars Program course (RMSP) was developed to create a longitudinal rural family medicine experience for first and second-year students at the University of Minnesota Medical School Duluth. Sixtythree first year medical students participated in this required course and their clinical reasoning levels were measured using the Diagnostic Thinking Inventory (DTI). The DTI was given to the medical students after one year of participation in the RMSP course. A previous cohort before the RMSP course was developed was used as a control. A literature search was used for comparison to other schools that measured the DTI in their students. Results: Student diagnostic thinking performance as measured by the DTI after one year of the Rural Medical Scholars Program course significantly increased when compared to a previous cohort of first-year students who did not take the RMSP course. When compared to previously published DTI data, students after one year of RMSP had clinical reasoning levels of second through fourth-year students from other schools. Conclusions: The addition of a rural experiential course with family medicine preceptors significantly increased clinical reasoning levels of first-year medical students.