1) The document discusses a study analyzing changes in demographics and attitudes of medical students towards a rural longitudinal integrated clerkship (LIC) program over time. 2) Initial concerns about the personal implications of moving for the rural LIC were validated, though program responses aimed to provide more education, support and flexibility. 3) A comparison of student attitudes in 2009, 2010 and 2015 found that more recent classes were more positively inclined towards rural LICs, non-metro origins predicted greater interest, and interest in family medicine strongly predicted interest in rural LICs.

1. Rural Longitudinal Integrated
Clerkships:
Changing Demographics
of Medical Students
D. Myhre, P. Adamiak, W. Woloschuk
Cumming School of Medicine,
University of Calgary

2. Background
• CSM three year intensive medical school
• UC LIC is the final year before graduation
• I year rural LIC established in 2008
• Established as a pedagogical alternative
• Minimum 32 weeks rural
• Applicant selection is random
• Outcomes are heavily weighted towards
primary care and rural communities

3. Initial study 2008
• Students perceived educational benefits
for rural UC LIC
• Concerns:
• related to the personal implications of
moving
• ability to maintain existing professional
relationships
• Marital and parental status significantly
linked to the social and practical aspects

4. Initial study 2008
• Students’ perceived career path as a family
physician or specialist had a significant
influence
• Community of origin did not influence
students’ responses toward the LIC option
• First year students more likely to consider
rural LIC
• Can J Rural Med 2009; 14 (3)

5. Follow-up
• Program:
• Implemented responses based on social concerns
• Education
• Support
• Research:
• Repeat cross sectional analysis
• Focused on first year students
• Purpose to evaluate program responses and evolution
of student body
• Same evaluation tool

6. Method
• Same seven factor instrument consisting
of 35 positively worded questions
• Class 2009, 2010 and 2015
• Logistical regression analysis
• Pearson’s Chi Square (χ2) or Fisher’s Exact
test
• Independent samples t tests
• Cronbach’s α

7. Survey 7 factors
• Physician rural role and preparation
• Practice exposure/exam preparation
• Collaboration with other healthcare providers
• Exposure to rural community overall
• Support by the medical school
• Personal implications for rural community
placements
• Maintain existing/develop new professional
relationships

8. Results
• Overall response rate 68%
• High internal reliability Cronbach α = 0.9
• Participant demographics reflected that of
class
• 2010-2015 significant change in
community of origin
• 49% to 33% <50,000
• p < 0.05

9. Overall Results
• 134 students (42%) indicated they would
consider participating in the UCLIC program
• 42 (13%) reported that they would not
consider participating
• 142 (45%) stated they were undecided
• If decided then age significant
• >25 yrs positive
• If decided then no difference in gender
• No difference in marital status

10. Overall Results
• Non metro origin predicted interest P<0.05
• Career discipline family medicine
predicted interest P<0.001
• No association with level of decisiveness
of career intent on interest

11. Trends between classes
• Class of 2009 (65%)
• 39% yes, 25% no, 36% undecided
• students interested in family medicine more interested
• p < 0.001
• Class of 2010 (71%)
• 41% yes, 8% no, 51% undecided
• Change in specialty interest 45% to 15% no
• p <0.05
• Class of 2015 (69%)
• No significant difference from 2009
• Trend 45% yes

12. Factor analysis
• Student attitudes were most in agreement
towards:
• Factor 4 - UCLIC would provide them exposure
to rural medicine
• Student attitudes least in agreement
towards:
• Factor 6 - manageable personal implications of
a rural community placement and,
• Factor 7 - ability to maintain existing/develop
new professional relationships

13. So…..
• Unable to distinguish shift in attitude over
time vs. change in attitude between classes
• First year students increasingly positive
towards rural LIC
• Significant shift in students interested in
specialty careers
• Community of origin returns as an important
predictor
• Previous concerns of social implications
validated

14. • As UC LIC outcomes are heavily weighted to
primary care and rural communities…..
• A shift in interest may impact UCLIC social
accountability outcomes, or,
• If selected urban origin applicants or early
career specialty applicants do not change
outcomes, the determinants of this career
impact must be determined in order to
translate them to other programs

15. Doug Myhre
Associate Dean
Distributed Learning & Rural Initiatives (DLRI)
dmyhre@ucalgary.ca