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The impact of an early_exposure program on medical students’ interest in and knowledge of rural medical practices: a questionnaire survey

The impact of an early_exposure program on medical students’ interest in and knowledge of rural... Background: Many medical students in Japan were brought up in urban areas, thus rural medical practice is often unfamiliar to them. The University of Tsukuba created a one-day early_exposure program to provide freshman students with experience in rural practices. This study was designed to clarify how this one-day early_exposure program affected medical students’ attitudes toward and knowledge of rural practices. Findings: First-year medical students (n = 103) were assigned to one of seven rural clinics in which they experienced rural practice for one day. A pre- and post-program questionnaire, rated on a 5-point Likert scale, was administered to assess students’ interest in and knowledge of rural medical practice, with higher scores indicating greater interest and knowledge. Respondents who gave answers of 4 or 5 were defined as having high interest and knowledge. One hundred and one (98.1%) responses were received from students. After the program, the percentage of students interested in rural medical practices was increased (pre- and post-program: 39.0% and 61.0%, respectively; P < .001), as was the number of students who wanted to become physicians in a rural medical practice (pre- and post- program: 53.0% and 73.0%, respectively; P <.01). Conclusions: Our one-day early_exposure program demonstrated a positive impact on medical students’ interest in and knowledge of rural medical practice. Further follow-up surveys are needed to clarify whether these effects are sustained long-term. Keywords: Rural practice, Early exposure, Undergraduate education Introduction were raised in urban areas, while only 3.3% of medical The shortage of physicians in rural areas is a longstand- students were raised in rural areas [8]. ing and serious problem in Japan and worldwide [1,2]. Thus, a possible factor contributing to a one-sided National policymakers and educators continue their at- physician distribution is the lack of familiarity with rural tempts to overcome the challenge of retaining a physician experience. Recent reports suggested that exposing med- workforce in rural areas [3]. In this regard, community- ical students of urban backgrounds to rural medical based education (CBE) has been reported to have some practices increases their interest in opportunities for such positive effect on recruitment of rural physicians [4,5]. placement [9,10]. It has been suggested that medical students brought As a part of CBE, early_exposure programs for rural up in rural areas have a preference for rural medical areas have been introduced by many medical schools, in- practices [6] and are more likely to return to rural cluding those in Japan [11]. The University of Tsukuba, areas after training [7]. However, an observational study situated in a rural area with a severe shortage of physi- reported that many medical school students in Japan cians (1.5 practicing physicians per 1000 residents, well below the Organisation for Economic Co-operation and Development average of 3.1), recently created a CBE * Correspondence: maru-tkb@umin.ac.jp program (Figure 1). The curriculum is based on the con- Department of Internal Medicine, Akashi Medical Center, Ohkubo-cho Yagi, cept of spiral learning [12]. In their first year, every stu- Akashi, Hyogo 674-0063, Japan dent is required to take part in a one-day early_exposure Full list of author information is available at the end of the article © 2015 Ishimaru et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Ishimaru et al. Asia Pacific Family Medicine (2015) 14:3 Page 2 of 5 Figure 1 Community-based learning curriculum. In their first year, all students are required to take part in a one-day early_exposure program in order to become familiar with rural practices. In their second year, care conferences are held and care plans are designed according to a home- care scenario as part of a one-week course called the “In-home Medical Care Tutorial”. In their third year, the medical students discuss team- based care in collaboration with nursing, pharmacy, and clinical laboratory technician students in a one-week-long course called “Teamwork Training”. On-the-job training in a rural medical practice is also undertaken in each student’s fifth year during an eight-week course called the ‘Community-Based Medicine Clerkship’. In their sixth year, a one- to six-week optional rural practice training is also available as an elective. program to enable them to directly experience rural Students’ gender, attitudes toward and knowledge of practice. rural practices, and preferred future work location were Evidence has suggested that early experience in rural recorded in the questionnaire. Their preferences for each exposure programs can have a positive influence on stu- of the following work locations were recorded: large city, dents’ preferences for and attitudes toward working in major urban area, town or village, and rural area. These rural medical practices [13,14], as well as their percep- preferences were rated on a 5-point Likert scale ranging tions of rural primary care [15]. However, the duration from 1 (“I do not prefer”)to5(“I prefer very much”). of these exposure programs is generally over 75 hours, Responses of either 4 or 5 were considered to demon- and the impact of a one-day exposure program on strate a preference for that work location; the number of freshman students’ interest in rural practice remains students who preferred rural areas was thus calculated. uncertain [16]. In addition, their interests in and knowledge of rural The aim of this study was to clarify the effects of a practice were assessed with the following items, respect- one-day early_exposure program on medical students’ ively: “Are you interested in rural practice?” and “Do you interest in and knowledge of rural medical practices in understand the physicians’ roles in rural practice?” These terms of the following factors: interest in rural medical items were rated on a 5-point Likert scale ranging from practice and understanding the rural physician’s role. 1(“I have no interest” and “I do not understand”, re- spectively) to 5 (“I am very interested” and “I understand Methods very well”, respectively). Responses of either 4 or 5 were Design and subjects considered to indicate high interest in and knowledge of All first-year medical students at the University of Tsukuba rural medical practices. in 2010 were asked to complete a self-administered ques- tionnaire both during their classroom orientation before The early_exposure program the early_exposure program, and immediately following First-year students at the University of Tsukuba are the program but while still at the rural practice. assigned to one of seven rural clinics throughout Ibaraki Ishimaru et al. Asia Pacific Family Medicine (2015) 14:3 Page 3 of 5 Table 1 Students’ preference for rural area by basic work When given the questionnaire, participants were in- location preference (N = 101) formed that no personally identifiable information would Work location preference Subjects n (%) Students preferring be used in the results, that there was no penalty for rural practice n (%) non-participation, and that the questionnaire had no Large city 64 (63.4) 8/64 (12.5) bearing on their grade. Major urban area 64 (63.4) 12/64 (18.8) Findings Town or village 34 (33.7) 12/34 (35.3) Of the 103 students, responses were received from 101 Rural area 17 (16.8) ― (98.1%); 33 (32.7%) were women. A preference to work in All data are expressed as numbers with percentages in parentheses. a large city or major urban area in the future was reported by the majority of students pre-program (64; 63.4%), in four student units, where they can experience rural while the students’ preferences were lower for working practice for one day. Each unit is supervised by a faculty in a town or village (34; 33.7%) or rural area (17; 16.8%; physician. Table 1). The distribution of students who preferred a rural area, as stratified by their other basic work location Statistical analyses preferences, is shown in Table 1. For example, among the McNemar’s test was used to evaluate pre- and post- 64 students who preferred to work in a large city, a rural program differences in work location preferences and area was also preferred by only 8 (12.5%). the proportions of respondents with high interest and The numbers of students who reported high interest knowledge regarding rural practice. The Chi-square test in rural practice and good understanding of physicians’ was used to analyse differences in basic work location roles in rural practice pre- and post-program are shown preferences and the relationship between gender and in Figure 2. After the program, there was a significant post-program interest in and knowledge of rural medical increase in the number of students interested in rural practices. Statistical significance was set at P < .05. practice (pre- and post-program: 39.0% and 60.0%, re- spectively). Similarly, there was a significant increase in Ethical considerations the number of students who reported a good under- The original purpose of this questionnaire survey was to standing of the roles of physicians in rural practices evaluate an educational program for its improvement. (pre- and post-program: 52.0% and 72.0%, respectively). The data from the pre- and post-program evaluations These results and our comparison of the students’ pre- were used after removing all of the students’ personal and post-program interest and understanding of rural information. medical practices by work location preference are shown Figure 2 Students’ changes in interest and knowledge pre- and post-program (n = 101). All data are expressed as percentages of students both pre- and post-program who reported high interest in rural practice and good understanding of physicians’ roles in rural practice. Responses to these items of either 4 or 5 on a Likert scale were considered to indicate high interest in and knowledge of rural medical practice. McNemar’s test was used to examine the pre- and post-program differences in proportions of respondents with high interest and knowledge. Ishimaru et al. Asia Pacific Family Medicine (2015) 14:3 Page 4 of 5 Table 2 Pre- and post-program changes in students’ interest in and knowledge of rural practice by basic work location preference Interested in rural practice Understand physicians’ roles in rural practice Work location Subjects Pre-program Post-program P-value Pre-program Post-program P-value preference n n (%) n (%) n (%) n (%) Large city 64 17 (26.6) 35 (54.7) < .001 30 (46.9) 47 (73.4) .003 Major urban area 64 29 (45.3) 42 (65.6) .002 40 (62.5) 46 (71.9) .29 Town or village 34 25 (73.5) 29 (85.3) .22 22 (64.7) 27 (79.4) .23 Rural area 17 15 (88.2) 16 (94.1) 1.00 11 (64.7) 13 (76.5) .69 All data are expressed as numbers and percentages in parentheses. McNemar’s test was used to examine pre- and post-program differences in the proportions of respondents with high interest and knowledge. in Table 2. The results indicated that even among stu- large cities and rural areas was reported by only 12.5% dents who preferred large cities, there was an increase of students before the program; thus, this program could after the program both in the number of students inter- effectively influence such students towards considering ested in rural practices (pre- and post-program: 26.6% rural practices, which could in turn improve the geo- and 54.7%, respectively) and in those who had a good graphic distribution of physicians. understanding of physicians’ roles in rural practice (pre- The current study has several limitations. First, the im- and post-program: 46.9% and 73.4%, respectively). Fur- pact of this early_exposure program remains at Kirkpatrick thermore, pre-program data showed that students who level 1 [20], which corresponds to the participants’ reac- preferred towns or villages as well as rural areas reported tion after the program. There is no confirmatory evidence both a high initial interest in rural practice (towns or vil- that an early_exposure program produces any sustainable lages and rural areas: 73.5% and 88.2%, respectively) and a change in attitude or lasting change in knowledge of rural good understanding of physicians’ roles in rural practice practice. We conducted an eight-week community-based (towns or villages and rural areas: 64.7% and 64.7%, re- medicine clerkship for fifth-year students, and we wish spectively). Student gender was not associated with either to undertake further research to determine whether the post-program interest in or knowledge of rural medical current impact on interest in and knowledge of rural practice (P =0.89 and P = 0.38, respectively). practices can be sustained. Second, we describe a program that was implemented in only one medical school. How- Discussion ever, the institution surveyed was a local university that The impact of early_exposure programs on freshman stu- was applying a comprehensive community-based learning dents’ interest in rural practices and their understanding curriculum. Thus, the benefit of our findings may be of physicians’ roles in these practices was underscored by applicable to other short-term, compulsory, early_ these findings. The one-day early_exposure program also exposure programs in local universities. had a positive impact on their attitudes and knowledge to- wards rural practice. Conclusion Several Asia Pacific countries have now developed The one-day early_exposure program was found to be a CBE programs in rural areas [17,18] that are offered as valuable enrichment experience for new students. Fur- alternative curricular options for fourth-year and fifth- ther follow-up surveys are essential to clarify whether its year medical students. Although our program also con- impact can be sustained. tains a community-based medicine clerkship in the fifth year, the unique aspect of this early_exposure program is that all medical students participate in the first semester Competing interests The authors declare that they have no competing interests. of their first year. A previous study showed that early in- tentions at the start of a student’s medical training were associated with the expressed intention to pursue a rural Authors’ contributions placement [19], suggesting the importance of launching NI designed this study and wrote the first draft of the paper. AT provided advice on the content of the early_exposure program and helped draft the the early_exposure program just after medical course manuscript. TAM helped carry out the data analysis and was a scientific admission. consultant throughout the study. YK and HK collaborated in the Another important finding was that the positive im- development of the study questionnaire and the implementation of the early_exposure program. TEM participated in the study design and pact on interest in and knowledge of rural practices was coordination. The first draft was discussed and revised by all six authors until seen even among the students who preferred working in the final version was ready to be submitted. All authors read and approved large cities. A preference for future work options in both the final manuscript. Ishimaru et al. Asia Pacific Family Medicine (2015) 14:3 Page 5 of 5 Author details Department of Internal Medicine, Akashi Medical Center, Ohkubo-cho Yagi, Akashi, Hyogo 674-0063, Japan. Department of Primary Care and Medical Education, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan. Community-Based Medicine Training Station, Tsukuba University Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan. Received: 7 April 2014 Accepted: 7 April 2015 References 1. Kobayashi Y, Takaki H. Geographic distribution of physicians in Japan. Lancet. 1992;340(8832):1391–3. 2. Rivo ML, Kindig DA. A report card on the physician work force in the United States. N Engl J Med. 1996;334(14):892–6. 3. Matsumoto M, Inoue K, Kajii E. Policy implications of a financial incentive programme to retain a physician workforce in underserved Japanese rural areas. Soc Sci Med. 2010;71(4):667–71. 4. Community-based education of health personnel. Report of a WHO study group. World Health Organ Tech Rep Ser. 1987;746:1–89. 5. Dornan T, Littlewood S, Margolis SA, Scherpbier A, Spencer J, Ypinazar V. How can experience in clinical and community settings contribute to early medical education? A BEME systematic review. Med Teach. 2006;28(1):3–18. 6. AMWAC. Doctors in vocational training: rural background and rural practice intentions. Aust J Rural Health. 2005;13(1):14–20. 7. Hughes S, Zweifler J, Schafer S, Smith MA, Athwal S, Blossom HJ. High school census tract information predicts practice in rural and minority communities. J Rural Health. 2005;21(3):228–32. 8. Takayashiki A, Inoue K, Okayama M, Nakamura Y, Matsumoto M, Otaki J, et al. Primary care education in Japan: is it enough to increase student interest in a career in primary care? Educ Primary Care. 2007;18(2):156–64. 9. Tolhurst HM, Adams J, Stewart SM. An exploration of when urban background medical students become interested in rural practice. Rural Remote Health. 2006;6(1):452. 10. Strasser R, Hogenbirk JC, Lewenberg M, Story M, Kevat A. Starting rural, staying rural: how can we strengthen the pathway from rural upbringing to rural practice? Aust J Rural Health. 2010;18(6):242–8. 11. University ECoC-ihiJM. Chiiki-iryou hakusyo (the white paper on community health care). 2nd ed. Tochigi, Japan: Jichi Medical University; 2007. 12. Harden RM. What is a spiral curriculum? Med Teach. 1999;21(2):141–3. 13. Barley G, O’Brien-Gonzales A, Hughes E. What did we learn about the impact on students’ clinical education? Acad Med. 2001;76(4 Suppl):S68–71. 14. Vaz R, Gona O. Undergraduate education in rural primary health care: evaluation of a first-year field attachment programme. Med Educ. 1992;26(1):27–33. 15. Newbury JW, Shannon S, Ryan V, Whitrow M. Development of ‘rural week’ for medical students: impact and quality report. Rural Remote Health. 2005;5(3):432. 16. Ranmuthugala G, Humphreys J, Solarsh B, Walters L, Worley P, Wakerman J, et al. Where is the evidence that rural exposure increases uptake of rural medical practice? Aust J Rural Health. 2007;15(5):285–8. 17. Talbot J, Ward A. Alternative Curricular Options in Rural Networks (ACORNS): impact of early rural clinical exposure in the University of West Australia medical course. Aust J Rural Health. 2000;8(1):17–21. 18. Poole P, Bagg W, O’Connor B, Dare A, McKimm J, Meredith K, et al. The Northland Regional-Rural program (Pukawakawa): broadening medical undergraduate learning in New Zealand. Rural Remote Health. 2010;10(1):1254. Submit your next manuscript to BioMed Central 19. Jones MP, Bushnell JA, Humphreys JS. Are rural placements positively and take full advantage of: associated with rural intentions in medical graduates? Med Educ. 2014;48(4):405–16. 20. Donald K, James DK. Evaluating Training Programs: Four Levels. In: • Convenient online submission Berrett-Koehler San Francisco. 1994. • Thorough peer review • No space constraints or color figure charges • Immediate publication on acceptance • Inclusion in PubMed, CAS, Scopus and Google Scholar • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Asia Pacific Family Medicine Springer Journals

The impact of an early_exposure program on medical students’ interest in and knowledge of rural medical practices: a questionnaire survey

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Medicine & Public Health; General Practice / Family Medicine; Primary Care Medicine
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Abstract

Background: Many medical students in Japan were brought up in urban areas, thus rural medical practice is often unfamiliar to them. The University of Tsukuba created a one-day early_exposure program to provide freshman students with experience in rural practices. This study was designed to clarify how this one-day early_exposure program affected medical students’ attitudes toward and knowledge of rural practices. Findings: First-year medical students (n = 103) were assigned to one of seven rural clinics in which they experienced rural practice for one day. A pre- and post-program questionnaire, rated on a 5-point Likert scale, was administered to assess students’ interest in and knowledge of rural medical practice, with higher scores indicating greater interest and knowledge. Respondents who gave answers of 4 or 5 were defined as having high interest and knowledge. One hundred and one (98.1%) responses were received from students. After the program, the percentage of students interested in rural medical practices was increased (pre- and post-program: 39.0% and 61.0%, respectively; P < .001), as was the number of students who wanted to become physicians in a rural medical practice (pre- and post- program: 53.0% and 73.0%, respectively; P <.01). Conclusions: Our one-day early_exposure program demonstrated a positive impact on medical students’ interest in and knowledge of rural medical practice. Further follow-up surveys are needed to clarify whether these effects are sustained long-term. Keywords: Rural practice, Early exposure, Undergraduate education Introduction were raised in urban areas, while only 3.3% of medical The shortage of physicians in rural areas is a longstand- students were raised in rural areas [8]. ing and serious problem in Japan and worldwide [1,2]. Thus, a possible factor contributing to a one-sided National policymakers and educators continue their at- physician distribution is the lack of familiarity with rural tempts to overcome the challenge of retaining a physician experience. Recent reports suggested that exposing med- workforce in rural areas [3]. In this regard, community- ical students of urban backgrounds to rural medical based education (CBE) has been reported to have some practices increases their interest in opportunities for such positive effect on recruitment of rural physicians [4,5]. placement [9,10]. It has been suggested that medical students brought As a part of CBE, early_exposure programs for rural up in rural areas have a preference for rural medical areas have been introduced by many medical schools, in- practices [6] and are more likely to return to rural cluding those in Japan [11]. The University of Tsukuba, areas after training [7]. However, an observational study situated in a rural area with a severe shortage of physi- reported that many medical school students in Japan cians (1.5 practicing physicians per 1000 residents, well below the Organisation for Economic Co-operation and Development average of 3.1), recently created a CBE * Correspondence: maru-tkb@umin.ac.jp program (Figure 1). The curriculum is based on the con- Department of Internal Medicine, Akashi Medical Center, Ohkubo-cho Yagi, cept of spiral learning [12]. In their first year, every stu- Akashi, Hyogo 674-0063, Japan dent is required to take part in a one-day early_exposure Full list of author information is available at the end of the article © 2015 Ishimaru et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Ishimaru et al. Asia Pacific Family Medicine (2015) 14:3 Page 2 of 5 Figure 1 Community-based learning curriculum. In their first year, all students are required to take part in a one-day early_exposure program in order to become familiar with rural practices. In their second year, care conferences are held and care plans are designed according to a home- care scenario as part of a one-week course called the “In-home Medical Care Tutorial”. In their third year, the medical students discuss team- based care in collaboration with nursing, pharmacy, and clinical laboratory technician students in a one-week-long course called “Teamwork Training”. On-the-job training in a rural medical practice is also undertaken in each student’s fifth year during an eight-week course called the ‘Community-Based Medicine Clerkship’. In their sixth year, a one- to six-week optional rural practice training is also available as an elective. program to enable them to directly experience rural Students’ gender, attitudes toward and knowledge of practice. rural practices, and preferred future work location were Evidence has suggested that early experience in rural recorded in the questionnaire. Their preferences for each exposure programs can have a positive influence on stu- of the following work locations were recorded: large city, dents’ preferences for and attitudes toward working in major urban area, town or village, and rural area. These rural medical practices [13,14], as well as their percep- preferences were rated on a 5-point Likert scale ranging tions of rural primary care [15]. However, the duration from 1 (“I do not prefer”)to5(“I prefer very much”). of these exposure programs is generally over 75 hours, Responses of either 4 or 5 were considered to demon- and the impact of a one-day exposure program on strate a preference for that work location; the number of freshman students’ interest in rural practice remains students who preferred rural areas was thus calculated. uncertain [16]. In addition, their interests in and knowledge of rural The aim of this study was to clarify the effects of a practice were assessed with the following items, respect- one-day early_exposure program on medical students’ ively: “Are you interested in rural practice?” and “Do you interest in and knowledge of rural medical practices in understand the physicians’ roles in rural practice?” These terms of the following factors: interest in rural medical items were rated on a 5-point Likert scale ranging from practice and understanding the rural physician’s role. 1(“I have no interest” and “I do not understand”, re- spectively) to 5 (“I am very interested” and “I understand Methods very well”, respectively). Responses of either 4 or 5 were Design and subjects considered to indicate high interest in and knowledge of All first-year medical students at the University of Tsukuba rural medical practices. in 2010 were asked to complete a self-administered ques- tionnaire both during their classroom orientation before The early_exposure program the early_exposure program, and immediately following First-year students at the University of Tsukuba are the program but while still at the rural practice. assigned to one of seven rural clinics throughout Ibaraki Ishimaru et al. Asia Pacific Family Medicine (2015) 14:3 Page 3 of 5 Table 1 Students’ preference for rural area by basic work When given the questionnaire, participants were in- location preference (N = 101) formed that no personally identifiable information would Work location preference Subjects n (%) Students preferring be used in the results, that there was no penalty for rural practice n (%) non-participation, and that the questionnaire had no Large city 64 (63.4) 8/64 (12.5) bearing on their grade. Major urban area 64 (63.4) 12/64 (18.8) Findings Town or village 34 (33.7) 12/34 (35.3) Of the 103 students, responses were received from 101 Rural area 17 (16.8) ― (98.1%); 33 (32.7%) were women. A preference to work in All data are expressed as numbers with percentages in parentheses. a large city or major urban area in the future was reported by the majority of students pre-program (64; 63.4%), in four student units, where they can experience rural while the students’ preferences were lower for working practice for one day. Each unit is supervised by a faculty in a town or village (34; 33.7%) or rural area (17; 16.8%; physician. Table 1). The distribution of students who preferred a rural area, as stratified by their other basic work location Statistical analyses preferences, is shown in Table 1. For example, among the McNemar’s test was used to evaluate pre- and post- 64 students who preferred to work in a large city, a rural program differences in work location preferences and area was also preferred by only 8 (12.5%). the proportions of respondents with high interest and The numbers of students who reported high interest knowledge regarding rural practice. The Chi-square test in rural practice and good understanding of physicians’ was used to analyse differences in basic work location roles in rural practice pre- and post-program are shown preferences and the relationship between gender and in Figure 2. After the program, there was a significant post-program interest in and knowledge of rural medical increase in the number of students interested in rural practices. Statistical significance was set at P < .05. practice (pre- and post-program: 39.0% and 60.0%, re- spectively). Similarly, there was a significant increase in Ethical considerations the number of students who reported a good under- The original purpose of this questionnaire survey was to standing of the roles of physicians in rural practices evaluate an educational program for its improvement. (pre- and post-program: 52.0% and 72.0%, respectively). The data from the pre- and post-program evaluations These results and our comparison of the students’ pre- were used after removing all of the students’ personal and post-program interest and understanding of rural information. medical practices by work location preference are shown Figure 2 Students’ changes in interest and knowledge pre- and post-program (n = 101). All data are expressed as percentages of students both pre- and post-program who reported high interest in rural practice and good understanding of physicians’ roles in rural practice. Responses to these items of either 4 or 5 on a Likert scale were considered to indicate high interest in and knowledge of rural medical practice. McNemar’s test was used to examine the pre- and post-program differences in proportions of respondents with high interest and knowledge. Ishimaru et al. Asia Pacific Family Medicine (2015) 14:3 Page 4 of 5 Table 2 Pre- and post-program changes in students’ interest in and knowledge of rural practice by basic work location preference Interested in rural practice Understand physicians’ roles in rural practice Work location Subjects Pre-program Post-program P-value Pre-program Post-program P-value preference n n (%) n (%) n (%) n (%) Large city 64 17 (26.6) 35 (54.7) < .001 30 (46.9) 47 (73.4) .003 Major urban area 64 29 (45.3) 42 (65.6) .002 40 (62.5) 46 (71.9) .29 Town or village 34 25 (73.5) 29 (85.3) .22 22 (64.7) 27 (79.4) .23 Rural area 17 15 (88.2) 16 (94.1) 1.00 11 (64.7) 13 (76.5) .69 All data are expressed as numbers and percentages in parentheses. McNemar’s test was used to examine pre- and post-program differences in the proportions of respondents with high interest and knowledge. in Table 2. The results indicated that even among stu- large cities and rural areas was reported by only 12.5% dents who preferred large cities, there was an increase of students before the program; thus, this program could after the program both in the number of students inter- effectively influence such students towards considering ested in rural practices (pre- and post-program: 26.6% rural practices, which could in turn improve the geo- and 54.7%, respectively) and in those who had a good graphic distribution of physicians. understanding of physicians’ roles in rural practice (pre- The current study has several limitations. First, the im- and post-program: 46.9% and 73.4%, respectively). Fur- pact of this early_exposure program remains at Kirkpatrick thermore, pre-program data showed that students who level 1 [20], which corresponds to the participants’ reac- preferred towns or villages as well as rural areas reported tion after the program. There is no confirmatory evidence both a high initial interest in rural practice (towns or vil- that an early_exposure program produces any sustainable lages and rural areas: 73.5% and 88.2%, respectively) and a change in attitude or lasting change in knowledge of rural good understanding of physicians’ roles in rural practice practice. We conducted an eight-week community-based (towns or villages and rural areas: 64.7% and 64.7%, re- medicine clerkship for fifth-year students, and we wish spectively). Student gender was not associated with either to undertake further research to determine whether the post-program interest in or knowledge of rural medical current impact on interest in and knowledge of rural practice (P =0.89 and P = 0.38, respectively). practices can be sustained. Second, we describe a program that was implemented in only one medical school. How- Discussion ever, the institution surveyed was a local university that The impact of early_exposure programs on freshman stu- was applying a comprehensive community-based learning dents’ interest in rural practices and their understanding curriculum. Thus, the benefit of our findings may be of physicians’ roles in these practices was underscored by applicable to other short-term, compulsory, early_ these findings. The one-day early_exposure program also exposure programs in local universities. had a positive impact on their attitudes and knowledge to- wards rural practice. Conclusion Several Asia Pacific countries have now developed The one-day early_exposure program was found to be a CBE programs in rural areas [17,18] that are offered as valuable enrichment experience for new students. Fur- alternative curricular options for fourth-year and fifth- ther follow-up surveys are essential to clarify whether its year medical students. Although our program also con- impact can be sustained. tains a community-based medicine clerkship in the fifth year, the unique aspect of this early_exposure program is that all medical students participate in the first semester Competing interests The authors declare that they have no competing interests. of their first year. A previous study showed that early in- tentions at the start of a student’s medical training were associated with the expressed intention to pursue a rural Authors’ contributions placement [19], suggesting the importance of launching NI designed this study and wrote the first draft of the paper. AT provided advice on the content of the early_exposure program and helped draft the the early_exposure program just after medical course manuscript. TAM helped carry out the data analysis and was a scientific admission. consultant throughout the study. YK and HK collaborated in the Another important finding was that the positive im- development of the study questionnaire and the implementation of the early_exposure program. TEM participated in the study design and pact on interest in and knowledge of rural practices was coordination. The first draft was discussed and revised by all six authors until seen even among the students who preferred working in the final version was ready to be submitted. All authors read and approved large cities. A preference for future work options in both the final manuscript. Ishimaru et al. Asia Pacific Family Medicine (2015) 14:3 Page 5 of 5 Author details Department of Internal Medicine, Akashi Medical Center, Ohkubo-cho Yagi, Akashi, Hyogo 674-0063, Japan. Department of Primary Care and Medical Education, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan. Community-Based Medicine Training Station, Tsukuba University Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan. 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Journal

Asia Pacific Family Medicine – Springer Journals

Published: Apr 14, 2015

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