Ten-year outcomes from the Columbia-Bassett program: a model for strengthening the underserved health workforce

Longitudinal integrated clerkships (LICs) are associated with positive educational and workforce outcomes in the short term, but their influence on long-term career choice remains uncertain. The authors report results from an LIC-based curricular track at Columbia University designed to recruit medical students into socially oriented careers, including practice in medically underserved settings.

The authors reviewed educational and workforce outcomes among all physician graduates from Columbia between 2014-2023, comparing participants in the Columbia-Bassett (CB) rural LIC track (N = 96) with those completing the traditional curriculum (N = 1449). The authors assessed outcomes using data from institutional records, government databases, published analyses of the American Medical Association Physician Masterfile, and a cross-sectional survey of alumni completed in 2024.

CB participants were similar to peers in age, gender, and socioeconomic status but more likely to report rural background. They scored similarly to peers on U.S. Medical Licensing Exam Step 1 but higher on Step 2 CK and measures of patient-centeredness after LIC completion. Upon graduation, participants were more likely to enter rural or primary care-compatible residencies. At 8-10 years post-graduation, participants were more likely to practice in rural areas (20.8% vs 1.2%, P < .001) and health professional shortage areas (54.2% vs 17.1%, P < .001); a non-significantly higher proportion were also practicing primary care (29.2% vs 14.8%, P = .054). Participation was strongly associated with self-reported rural practice among alumni (adjusted odds ratio 23.4, P = .011) and robust to adjustment for factors including rural upbringing and pre-medical practice interests.

These findings add evidence that LIC-based curricular interventions may produce desirable medical school outcomes in both the short and long term, especially to address workforce disparities in rural and other underserved areas.