Interdisciplinary health education and career choice in rural and underserved areas

To assess the association between an educational rural health interdisciplinary programme (RHIP) and subsequent practice in US rural and underserved locations.

We carried out a longitudinal cohort study of RHIP students and randomly selected classmate controls for the years 1990-2001, using a mailed survey.

Main outcome measures were first rural, any rural, first underserved and any underserved practice locations. Multivariate statistical methods were used to calculate prevalence ratios (PRs) by discipline while controlling for possible extraneous variables.

Of 1396 surveys delivered, 820 were returned, giving a response rate of 59%. After exclusions, results from 255 RHIP and 534 control students were analysed for outcomes. Pharmacy students on the RHIP chose first and any rural practice locations more often than reference controls (PRs = 2.59 and 1.97, respectively; P < 0.05). Therapies (occupational, physical and speech therapy) RHIP students were associated with all 4 practice outcomes more often (PRs = 2.07, 1.85, 1.68 and 1.65, respectively; P < 0.05). Pharmacy and Therapies control students with rural training chose first rural and any rural practices more often (PRs = 2.58 and 1.62, respectively; P < 0.05 for both). Medicine and Nursing students did not choose outcome practice locations more often, but had small sample sizes and large numbers of controls with rural training. Rural health interdisciplinary students rated participation in rural training more highly as a factor in choosing first rural practices than did the controls who chose similar practices.

Participation in RHIP and other rural training experiences may stimulate subsequent career choices in rural and underserved locations for Pharmacy and Therapies students. Other studies are needed to confirm these findings and answer questions raised by these data.