Does an AHEC-Sponsored Clerkship Experience Strengthen Medical Students’ Intent to Provide Care for Medically Underserved Patients?

Abstract

Background: The mission of Area Health Education Centers (AHECs) is to recruit and educate students to serve as practicing health care professionals in rural, primary care, and medically underserved communities. Purpose: We sought to determine if participation in an AHEC-sponsored family medicine clerkship experiences during medical school are significantly associated with a self-reported intent to practice primary care in a medically underserved environment upon graduation. Method: The study was a prospective cohort study comparing third-year family medicine students with the Indiana University School of Medicine who participated in either an AHEC-sponsored family medicine clerkship to those who completed their required family medicine clerkship outside of the AHEC setting. Following the 160-hour clinical clerkship, all students completed a mandatory, electronic survey and were asked to self-report their intent to the following question: "Which of the following statements best describes the impact of the family medicine clerkship on your intention to provide care to underserved patients when you complete residency training?" The question was integrated into a mandatory post-clerkship evaluation form required by the Indiana University School of Medicine, Department of Family Medicine. A Chi square test of independence as well as a multivariate logistic regression analysis was used to determine the independent association of AHEC clerkship participation and reported intent. Results: A total of 1,138 students completed the survey. There were not significant differences in age, gender, race, and ethnicity between students that completed an AHEC clerkship and those that did not. After adjusting for gender, race, and ethnicity, AHEC participants were significantly more likely to report an intention to practice primary care in a medically underserved setting upon graduation. Female students were found to be 1.2 to 3.4 times as likely to report increased intent compared to male students (95% CI 1.241 to 3.394). Discussion: Participation in an AHEC-supported clerkship was associated with a significant increase in self-reported intent to practice primary care in a medically underserved setting. Additional research is required to determine if participation and/or reported intent are predictive of practice selection after graduation.

Rural Employment of Health Care Workers: A Longitudinal Cohort Study

“…17,18 Other interventions focus on recruiting health care workers to move to rural areas, and include exposing health professions students to rural clinic sites and incentivizing health professionals to work in rural areas. [18][19][20][21] More research is needed to investigate the group of health care workers that work in both rural and urban areas over the course of their careers. Prior research on primary care physicians suggests that while circular migration takes place between rural and urban areas, it favors migration out of rural locations, especially locations without a hospital or a large physician supply.…”

How partnerships for community-based health professions training were affected by national changes in funding

“…After adjusting for gender, race, and ethnicity, these medical students were significantly more likely to report an intention to practice primary care in a medically underserved setting upon graduation. Female students were 1.2 to 3.4 times as likely to report increased intent compared to male students (95 % CI 1.241-3.394) [8]. A weakness of this study was that no follow-up was conducted to determine how many students actually pursued this career path.…”

“…Unfortunately, there is a paucity of literature on the impact AHEC programs have on career decisions. We found three such papers, one of which involved a study that surveyed 1,138 medical students who completed an AHEC sponsored four-week family medicine clerkship [8]. After adjusting for gender, race, and ethnicity, these medical students were significantly more likely to report an intention to practice primary care in a medically underserved setting upon graduation.…”

Advancing Social Mission Research: A Call to Action

“…Researchers have also examined student characteristics 24 and institutional factors 25–27 associated with social mission–oriented practice and workforce outcomes as well as the contribution of community-sponsored partnerships to increase interest in and enhance provision of care for the underserved. 28 Social mission activities originating or operating outside of health professions schools, such as funding for federal workforce training, 29 accreditation standards, 6,30 and school rankings conducted by the research community, 31 comprise a smaller component of the social mission literature, yet demonstrate the ecosystem of influencing factors that contribute to it.…”

“…While theoretically it makes sense that social mission efforts will contribute to health equity, we lack direct evidence of whether any of the social mission inputs outlined above reduce health disparities or improve population health. Much of the research at the time of writing has focused on short-term outcomes, such as the diversity of applicants to or matriculants at health professions schools, 6,36 practice intent before entering the workforce, 22,28,37 or student knowledge, competencies, and attitudes. 19,35,38 Research examining distal social mission outcomes that may shed light on the contributions of health professions education programs to postgraduate practice patterns 12,13 or on population health 39 is comparatively scarce and a recognized area of need.…”