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Where Should Rural Doctors Be Trained?

By Dr. Robyn Liu

Are big-city academic institutions really necessary to train excellent clinicians? What irreplaceable benefits do they provide?

When I attended medical school a decade ago, there was a group of students comprising about 50% of my classmates that I rarely ever saw. Most of these were students who had come to medical school straight out of college, and still denied that anything important in the world happened before noon. They skipped the lectures, opting instead to watch them on video on their own schedules, or pay into the transcript service that poorer students like myself maintained to make some extra cash. My friend Kristi often opined that the first two years of medical school should be done as correspondence courses. This was a pretty radical idea at the time, but I could see that it definitely made some sense.

Now, with things like ITV, podcasts and 4G smartphones being the norm, a student's physical presence at basic science lectures is even less necessary. My alma mater has spotted this trend and is using it as an opportunity to take an innovative step to help fill the gap in rural primary care.

Last month saw the inauguration of the University of Kansas School of Medicine-Salina, a new 4-year campus that admitted eight MS1s and will continue adding eight students per class until it reaches a full roster of 32 students. According to KU, this is now the nation's smallest medical school. This is a huge step, and KU should be applauded and emulated across the nation.

Salina, Kansas, is a city just shy of 50,000 residents, which doesn't sound like much until you look at the surrounding area and realize it's the largest city in central Kansas until you get down to Wichita.  The Salina Regional Health Center serves as a health care hub for all of central and north-central Kansas, and offers the     full spectrum of sub-specialty services to complement a strong primary care base. Before the medical school campus, there was already an academic structure in place with the Smoky Hill Family Medicine Residency,       a small but highly effective program that has produced eight winners of the prestigious AAFP/Bristol-Myers-Squibb Award in the past seven years and is leading the way in patient-centered medical home practice      redesign for residency clinics.

I can personally vouch for the fact that these students will receive excellent training, as I completed my own MS3 and MS4 years in Salina. Thanks to education technology, their basic science training will lack nothing that they would get at the Kansas City campus. Their clinical education will be extraordinarily hands-on as they work one-on-one with compassionate and skilled physicians in every specialty, physicians who consider themselves a part of the community and accountable to its overall well-being. For example, I rotated with an interventional cardiologist who kept on providing care for an uninsured man who made payments to him of just five dollars a month, because he understood that this was what the man could afford and appreciated that he even tried. On my Anesthesiology rotation, I did just about every intubation in the OR and became very comfortable with central lines. On Cardiothoracic Surgery, I helped harvest dozens of saphenous veins. In the ER, I had a great deal of autonomy (with appropriate oversight, of course) to formulate diagnosis and treatment plans. I really believe my clinical training was unparalleled. My time in Salina definitely had an impact as I left residency and chose to begin my practice in an extremely rural area of Kansas.

It's an age-old question: how you gonna keep 'em down on the farm, after they've seen Paree? Research demonstrates that medical students who grew up in rural communities are the ones most likely to return to that environment. However, if kids from small-town America only get exposure to health care big-city-style, they still might not recognize the significant personal and professional benefits to be gained from a rural medical practice. Students at the Salina campus will have the opportunity to birth their medical careers in a very different culture, after which Kansas City might not look quite so appealing. Many other states are struggling with the rural clinician pipeline issue - perhaps it's time they followed the lead of the Jayhawks.

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