Strong institutional support helps MD students thrive in rural placements

Mark Prins, director of the Office of Rural and Regional Health in

This is the second in a two-part series exploring how the FoMD is responding to the province’s need for rural and remote health practitioners. Read Part 1 here.

At the University of Alberta, it’s never too early for MD students to head out of the city for rural and remote learning experiences. In the Rural Shadowing Experience, funded through the Alberta Rural Health Professions Action Plan (RhPAP), weekend experiences pair a first-year MD student with one of more than 150 physicians on call across about 50 rural sites. The Pre-Clinical Networked Medical Education Program (PNME) in second year provides a more in-depth experience, with four weeks spent in one of six smaller towns throughout central and northern Alberta. Since it began in 2010, 137 students have successfully completed the PNME program, says Mark Prins, director of the Office of Rural and Regional Health. Finally, the third-year ICC program allows students to spend the first year of their clerkship in a rural community. There is also an option for students to complete their fourth year in Grande Prairie.

These in-house initiatives have been proven to work, says Prins, especially with learners who have come from a rural background themselves. “If you put students through our current system, they’re more likely to practise rurally,” he says. “In fact, after the ICC program, they’re two and a half times as likely to practise rurally.” In annual surveys of participants, 86 per cent said they would do ICC again, 92 per cent were more likely to consider a rural community as a future practice after completing ICC, and respondents were 3.6 times more likely to end up in a rural practice after going through ICC, he adds. Ponoka physician Sawisky credits ICC with putting him on his highly satisfying career path. “The ICC program was instrumental in confirming that rural family medicine was what I wanted to do with my medical career,” he recalls. “The diversity of skills required as well as the experience was a huge draw.” 

Setting students up for success

What makes the faculty’s rural placements such a success? To ensure students in ICC don’t feel alone or isolated, they are sent in pairs to their placements, and Prins’ office checks in on them regularly. There are also several physicians who head out to the communities every six to eight weeks to visit the students in person. There’s little stress about housing, as the Rural Health Professions Action Plan (RhPAP) rents accommodation for participants. The years invested in building community partnerships that bolster this program, says Prins, especially with longtime leaders such as Jill Konkin—former associate dean of rural and regional health—also ensure learners will receive a warm welcome from an engaged and enthusiastic preceptor. And, to help them truly embed in the community, each student is expected to participate in a longitudinal volunteer engagement outside of their medical work. This last piece is crucial to building potentially lasting relationships, says Prins. “Contributing time makes students feel like important change agents who are invested in the community.”

Early outreach

It’s important to reach prospective rural health practitioners well before they arrive at medical school, says vice-dean Schipper. “Outreach as early as possible is essential,” says Schipper, noting that there are many faculty initiatives aimed at reaching high school students in rural and Indigenous communities. Every year, MD students act as ambassadors to area high schools, and last year did 25 presentations about the MD admissions process, including several in rural locations that included Westlock and Lacombe, among others. A handful of outreach events even target children in elementary and junior high, something that Schipper would like to see a lot more of. For example, the Medical Students Association’s annual Virtual Science Fair gathers kids in grades four through 12 from across the province who do not have access to a school science fair. The faculty also participates in the annual USchool program, which invites rural, underrepresented and Indigenous students in grades four through 12 to a weeklong immersion experience on campus (or virtually, due to COVID). 

Expanding opportunities

While much energy is being invested in bolstering the rural and remote learning opportunities for medical students, faculty leaders believe there is more to be done. Schipper’s ambitious vision entails far more learners—25 per cent of the class or more—doing the majority of their third- and fourth-year clerkships in rural and remote communities. An ultimate goal would be for interested students to have the chance to complete their entire medical training outside of an urban centre. Prins would also like to see opportunities expand, including more communities opening their doors for third- and fourth-year clerkships. “One thing I’d also really like to see is an increase in the number of specialty residents in postgrad education doing part of their training in a rural or remote setting,” he says, and he already has plans to speak to Postgraduate Medical Education Royal College program directors about how that could become a reality. Currently, the GI block can be done in one of six rural communities, but Prins would like to see that expand to include many more blocks.  

In the meantime, the more students learn about the rewards of a rural or remote career, the more they will be encouraged to see themselves in that future, says Sawisky. His experience is the perfect example. “As a rural generalist I am rewarded every day with the richness of interacting with my patients,” he says. “I see parents, grandparents, and children. I am richly rewarded and privileged to share in their lives. This shared experience across years provides a sense of satisfaction and joy that no other facet of medicine offers.”