An Integrated Rural and Urban Underserved Pathway in Medical School

Problem: The need to increase the number of culturally responsive physicians, particularly primary care physicians, serving in rural and urban underserved communities is well documented. To address this need, an increasing number of medical schools are implementing separate rural or urban underserved training programs or tracks. Intervention: The Rural and Urban Scholars Pathways program is designed as an integrated program, not as separated tracks, and includes critical reflection groups, professional development workshops, individual coaching, a scholarly project, and immersion experiences. The program does not separate students by initial interest in either rural or urban underserved practice settings, but rather promotes their interactions across all four years. Students can join (or leave) RUSP in any year of medical school and, although strongly encouraged toward eventual practice in an underserved community, students are not committed to a specific specialty or practice location. Context: The RUSP program was developed and implemented at the Heritage College of Osteopathic Medicine at Ohio University in 2013 with a grant from the Osteopathic Heritage Foundations. The program resides within the Office of Rural and Underserved Programs at the Heritage College and is one of many medical school programs across the country aimed at producing more physicians for rural and urban underserved communities. RUSP is now funded by the College. Impact: Overall, based on a 60% return rate in 2019-2020, students in all four years report that the RUSP program enhances their professional, personal, social, and academic development. Cumulatively, 67% have matched into specialties with primary care potential, including family medicine, pediatrics, general internal medicine and internal medicine-pediatrics. Of the 14 RUSP graduates in practice, six are practicing primary care in rural locations and five are practicing primary care in urban locations. Five of the fourteen are practicing in communities officially designated as underserved. Lessons Learned: Offering flexibility via a pathways model promotes continuing individual and program growth and expansion. A co-curricular strategy allows for nimble program refinement but requires significant volunteer time commitment from faculty and staff. Having clear program goals, a logic model, and mechanisms for gathering and analyzing student experiences help to maintain program focus and allow for ongoing formative and periodic summative evaluation of short-term and long-term objectives.