The pipeline flows through pre-clerkship – the early exposure of medical learners to rural healthcare

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William N. Lampe
Michelle Hunter
Peter Wells



Introduction: We sought to investigate the influence of a 1-week rural clinical placement during pre-clerkship on participants’ decisions to pursue subsequent rural clinical training and rural practice, and the factors which influenced participants to participate in the placement.

Methods: A survey was sent to all physicians who: participated in the Rural Ontario Medical Program’s (ROMP) 1-week ROMP Week placement between 1999 and 2012; had completed postgraduate training; and were currently practicing medicine in Ontario. Survey items were rated on a Likert scale, and Mann-Whitney U Testing performed to identify differences between groups.

Results: Of the 407 surveys distributed, 154 were completed. 23.2% of physicians reported having a rural background, 59.2% completed a rural clinical rotation during clerkship or residency, and 21.3% currently practiced in rural communities at the time of survey completion. The learning opportunity and clinical experiences in rural healthcare were reported as the primary motivating factors for participating in ROMP Week. Better learning opportunities in rural rotations, meeting the communities’ needs, and support from rural communities were the primary motivating factors for participating in subsequent rural clinical rotations. Physicians practicing in rural communities at the time of survey completion had higher ratings of attraction to rural communities and desire to gain rural clinical experience as reasons for participating in ROMP Week.

Conclusion: A majority of ROMP Week participants subsequently undertook rural clinical rotations, and the proportion of participants currently practicing as rural physicians exceeds the proportion of Canadian physicians practicing in rural communities as a whole. 54% of respondents practicing in a rural community at the time of survey completion did not have a rural background, and ROMP Week may have been their first exposure to rural medical practice. Rural experiences during pre- clerkship offer an opportunity to increase the number learners in the rural physician pipeline.