A Proposed Shared Vision for Leadership Development for all Medical Students: A Call from a Coalition of Diverse Medical Schools.

Issue: Despite clear relevance, need, descriptive literature, and student interest, few schools offer required curriculum to develop leadership skills. This paper outlines a proposed shared vision for leadership development drawn from a coalition of diverse medical schools. We advocate that leadership development is about self (looking inward), teams (not hierarchy), and change (looking outward). We propose that leadership development is for all medical students, not for a subset, and we believe that leadership curricula and programs must be experiential and applied. Evidence: This paper also draws on the current literature and the experience of medical schools participating in the American Medical Association's (AMA) Accelerating Change in Medical Education Consortium, confronts the common arguments against leadership training in medical education, and provides three cross-cutting principles that we believe must each be incorporated in all medical student-centered leadership development programs as they emerge and evolve at medical schools. Implications: By confronting common arguments against leadership training and providing a framework for such training, we give medical educators important tools and insights into developing leadership training for all students at their institutions.

An interprofessional programme to culturally sensitise students to the needs of patients and realities of practice in rural areas.

The University of North Dakota programme, Students/residents Experiences And Rotations in Community Health (SEARCH), was implemented to address recruitment and retention problems and stereotypes associated with practicing in rural areas by providing an opportunity for health profession students to gain experience living and practicing in rural areas and observing interprofessional practice. Each health profession student in the programme (n = 181) from 2001 to 2011 (excluding 2009) kept a four-week journal detailing daily or weekly interactions, general thoughts, and experiences. Students who participated were from medical, psychology, dental, social work, nurse practitioner, and physician assistant professions. Results were grouped into three major themes around whether the experience increased their knowledge of healthcare issues in rural areas in North Dakota, increased their knowledge about interprofessional teams, and expanded their rural awareness. Overall, students valued this interprofessional experience, learned how to work in collaborative teams, and reported having a better understanding of the needs and problems in rural healthcare. Recruitment and retention of healthcare professionals in rural healthcare exhibit many challenges. The SEARCH programme has helped to alleviate some of these challenges; however, continued support for these programmes is necessary to sustain the delivery of interprofessional healthcare in rural areas.

The Rural Physician Associate Program: successful outcomes in primary care and rural practice.

The Rural Physician Associate Program (RPAP) has trained 1063 medical students in rural communities for the past 34 years and produced 658 primary care physicians and 521 physicians who currently practice in rural communities. While the students' experience in this nine-month clerkship is primarily clinic-based, they see patients in the emergency room, assist in surgery, deliver babies, attend physician meetings and participate in community health education. They experience real continuity of care by following a patient from the clinic or emergency room to the operating room and throughout their recovery. They diagnose a pregnancy, deliver the baby and then do the well-child examination in the clinic. The students recognize the value of this experience, as expressed in their final essays. They value the mentoring of the physicians, the relationship with the patients and the experiences in health care in which they play integral part. While the trend toward primary care in medical education is decreasing, the outcome of the RPAP program is holding steady at approximately 80%. Selection is certainly a factor, because many of the students who apply for RPAP have already expressed an interest in primary care. Additionally, the mentoring relationship with their preceptor, professionally and personally, and the ability to observe the lives of other practising physicians provides a reality check that may guide decisions. The enthusiasm for teaching, and the significant engagement with and impact on the community of the physicians may be another factor in deciding on primary care. Practising alongside physicians who find intellectual challenge and rewarding relationships in primary care is essential in continuing to produce primary care physicians of future.

The rural physician associate program: the value of immersion learning for third-year medical students.

CONTEXT: Changes in health care and new theories of learning have prompted significant changes in medical education. Some US medical schools employ immersion learning in rural communities to increase the number of physicians who choose to practice in these areas. Founded in 1971, the rural physician associate program (RPAP) is a longitudinal immersion learning experience for students during their third year of medical school. Students are assigned to a primary care preceptor(s) in a rural community ranging in population from 1,000 to 30,000 for 36 weeks. PURPOSE: To describe students' perceived value of this immersion learning experience. METHODS: Data from 3 classes (2004, 2005, 2006) of students (n = 95) were analyzed, including final essays that reflect on their experiences and logs of their patient encounters and procedures. Themes from students' essays related to the hands-on learning experience are presented. Frequencies of ambulatory encounters and procedures were calculated and compared with those of metropolitan area colleagues where possible. FINDINGS: The continuity experience allows for one-to-one mentoring and long-term relationships. Students see physicians, clinic/hospital staff, and patients as their teachers. The environment is nurturing, but nudges them outside their comfort zone. Students gain increasing competence with their skills and do best if they are independent and seek out learning opportunities. They report more hands-on experience, more confidence and autonomy than their peers in the metropolitan area. CONCLUSIONS: The RPAP experience provides a nurturing, longitudinal, immersion learning experience that facilitates the gradual but steady development of clinical skills alongside a personal and professional mentor.