Discerning applicants' interests in rural medicine: a textual analysis of admission essays.

BACKGROUND: Despite efforts to construct targeted medical school admission processes using applicant-level correlates of future practice location, accurately gauging applicants' interests in rural medicine remains an imperfect science. This study explores the usefulness of textual analysis to identify rural-oriented themes and values underlying applicants' open-ended responses to admission essays. METHODS: The study population consisted of 75 applicants to the Rural Physician Leadership Program (RPLP) at the University of Kentucky College of Medicine. Using WordStat, a proprietary text analysis program, applicants' American Medical College Application Service personal statement and an admission essay written at the time of interview were searched for predefined keywords and phrases reflecting rural medical values. From these text searches, derived scores were then examined relative to interviewers' subjective ratings of applicants' overall acceptability for admission to the RPLP program and likelihood of practicing in a rural area. RESULTS: The two interviewer-assigned ratings of likelihood of rural practice and overall acceptability were significantly related. A statistically significant relationship was also found between the rural medical values scores and estimated likelihood of rural practice. However, there was no association between rural medical values scores and subjective ratings of applicant acceptability. CONCLUSIONS: That applicants' rural values in admission essays were not related to interviewers' overall acceptability ratings indicates that other factors played a role in the interviewers' assessments of applicants' acceptability for admission.

Abraham Flexner of Kentucky, his report, Medical Education in the United States and Canada, and the historical questions raised by the report.

One hundred years ago, the time was right and the need was critical for medical education reform. Medical education had become a commercial enterprise with proprietary schools of variable quality, lectures delivered in crowded classrooms, and often no laboratory instruction or patient contact. Progress in science, technology, and the quality of medical care, along with political will and philanthropic support, contributed to the circumstances under which Abraham Flexner produced his report. Flexner was dismayed by the quality of many of the medical schools he visited in preparing the report. Many of the recommendations in Medical Education in the United States and Canada are still relevant, especially those concerning the physician as a practitioner whose purpose is more societal and preventive than individual and curative. Flexner helped establish standards for prerequisite education, framed medical school admission criteria, aided in the design of a curriculum introduced by the basic and followed by the clinical sciences, stipulated the resources necessary for medical education, and emphasized medical school affiliation with both a university and a strong clinical system. He proposed integration of basic and clinical sciences leading to contextual learning, active rather than passive learning, and the importance of philanthropy. Flexner's report poses several questions for the historian: How were his views on African American medical education shaped by his post-Civil War upbringing in Louisville? Was the report original or derivative? Why did it have such a large impact? This article describes Flexner's early life and the report's methodology and considers several of the historical questions.

Increasing the medical school applicant pool: a key to training more rural physicians.

CONTEXT: Workforce studies show shortages of physicians in many areas of the United States. These shortages are especially severe in states such as Kentucky with many rural counties and are predicted to worsen in the future unless there are changes throughout our educational system to build aspirations and prepare students for medical school education. PURPOSE: To examine rural-urban differences and community characteristics of applicants and matriculants to Kentucky's two allopathic medical schools and influences on the educational aspirations of young students who wish to become physicians. METHODS: The number of Kentucky applicants and matriculants to allopathic medical schools was obtained from the Association of American Medical College's data warehouse for the period from 2002-2006. A continuous, multidimensional measure was used to classify counties by degree of rurality. Socio-demographic variables were selected for the counties of residence for applicants and matriculants. Model variables were tested in a least squares multiple regression model for their ability to explain patterns among Kentucky's 120 counties in the number of both resident applicants and matriculants to medical school. Data from a survey of middle school participants in summer health camps were analyzed to help identify important influences on young students aspiring to a career as a health professional, especially becoming a physician, and how these might be supported to increase the supply of rural medical school applicants. FINDINGS: The low number of rural applicants to medical school was highly correlated with the relative rurality of their county of residence, a low physician-to-population ratio and a low number of total primary care physicians. The percentage of county residents having a bachelor's degree level of education or higher had a positive impact on the application rate. Respondents became interested in health careers at age 15 or younger, and parents and grandparents, teachers, and close associates stimulated their aspirations, with teachers being the most influential. CONCLUSIONS: Prospective students respond to their perception of need for physicians. Rural students are influenced by those who are more highly educated. To overcome the shortage of physicians in rural communities efforts must be made to increase the aspirations for medical education of prospective students from rural counties.

The impact of health on Kentucky's economy.

All states are strongly committed to economic development policies and activities as participants in national and global competition. However, a sometimes overlooked and perhaps under appreciated influence on economic development is the health of a state's citizens. This study focuses on how the health status of Kentucky profoundly influences its economy, workforce, productivity, and general quality of life. If Kentucky's economy is to improve significantly, as compared to other states, significant improvements in the health status of its citizens must be achieved in the near future and sustained over time. In an era of growing concern about rising health insurance costs and maintaining a reliable and productive workforce, employers are increasingly likely to locate in communities where measures of health status are strongly positive. The latest report from the United Health Foundation indicates that in 2007 Kentucky had the 8th worst health status in the nation based on a set of risk factors and outcomes. These risk factors include personal behaviors, community and environment, and public health policies that culminate in key health outcomes related to quality of life and longevity. While it is a serious challenge, our research demonstrates that many of these risk factors can be lowered through relatively low cost and effective interventions that produce substantial improvements in health and Kentucky's rank. Health education is very effective when it begins early in life and continues to emphasize the importance of healthy behaviors, such as not smoking, healthy diets and exercise, and weight control. Preventive health services that identify and treat diseases and conditions that lead to premature death increase both longevity and economic growth through lower treatment costs for chronic diseases and an increase in human capital. Policy changes, such as primary enforcement of motor vehicle seat belt use and encouragement of the use of safety equipment at work, also saves lives and contributes to economic development. Kentucky has already implemented many programs to begin the necessary transformation to a healthier Commonwealth. Creation of additional programs and expansion of those successful ones in place are keys to producing both significant health change and economic growth.

Physician computer skills: a prerequisite to the future in healthcare services.

Physicians in Kentucky have been slow to endorse and implement electronic medical records and other forms of information technology (IT), although this technology is available to them. Information was ob tained from medical relicensure data for all licensed Kentucky physicians and through two sample surveys to assess the use of IT in Kentucky medicine. Sixty-eight percent of licensed physicians recorded an e-mail address on their annual relicensure application, but more physicians were knowledgeable about IT than indicated by this relicensure response. A recorded e-mail address was more likely for younger physicians, physicians in hospital-based specialties, and those in larger medical specialty or academic physician groups. Those entering an email address were more likely to use IT for e-mail, word-processing, searching medical literature, and even consulting with other physicians. Only 10% of physicians with an e-mail address and 4.5% ofj those who did not list an e-mail address used e-mail to communicate with patients. Physicians entering an e-mail address were also more likely to employ an electronic medical record in their practice. Increased use of IT in medical practices is likely only if it can be associated with an increase in reimbursement or an improvement in quality of care.

Medical School Performance, Alumni Membership, and Giving: How Do Scholarship Recipients and Non-Recipients Differ?

PURPOSE: This study examines student recipients of merit, need-based, service, or minority scholarships, their performance in medical school, and the relationship to future alumni association membership and financial giving. METHOD: Retrospective data on grade-point average attained across the four-year curriculum and extracurricular activities reported at graduation were collected on students at the University of Kentucky College of Medicine from 1981-1991. Comparisons of academic performance and participation in institutional activities were made across scholarship recipients and non-recipients. These data were then linked to other data tracking alumni association membership and institutional giving. RESULTS: Compared to other scholarship recipients and non-recipients, merit scholars were more likely to be ranked above their class medians and be involved in extracurricular activities, including membership in Alpha Omega Alpha. However, seven years post-graduation, there was no difference between scholarship recipients and non-recipients in alumni association membership or donations to the medical school. Instead, students graduating in the upper half of their class, as compared to graduates in the lower half, and UKCOM graduates who attended the University of Kentucky as undergraduates, rather than students who attended other in-state or out-of state institutions, were more likely to join the medical alumni association. Alumni association members were more likely than non-members to make donations to the institution. CONCLUSIONS: More should be done to ensure that graduates who received scholarships are afforded meaningful ways to give back to the institution that supported them as students.

Buzzwords in medical education: what they are, what they mean, and what we are doing about them at the University of Kentucky College of Medicine.

This article defines common buzzwords used to describe innovations in teaching medical students. As background for outlining the innovative educational programs in place at the University of Kentucky College of Medicine, the dual, or bimodal, missions of the College and their historical antecedents are presented. Definitions of important educational outcomes, or standards of achievement expected from University of Kentucky College of Medicine graduates, including professionalism, active learning, evidence-based medicine, and cultural diversity are given. In addition, their relevance to the development of medical professionals is outlined, and examples of where and how these standards are introduced in the Kentucky Medical Curriculum are presented. Similarly, definitions and examples of educational methods or pedagogies used to teach our medical students are discussed including the use of problem-based learning, computer-based instruction, standardized patients, and performance-based assessment.