Medical
students from rural communities are the most likely candidates
to practice in a rural setting upon completion of training.
The High School Rural Scholars program provides an opportunity
for high school students from a rural area with interest
in health careers to gain exposure to health professions
as well as improve their chances for success in post-secondary
education.
A student who begins with an affinity for small town
practice often attends college in a larger city. Next,
many students enter training programs that require them
to be in large medical centers for another 4-12 years.
By the end of this phase, termed "urban disruption",
the student has become accustomed to big-city amenities,
met new friends and perhaps become engaged or married
to someone who is more likely to have ties to a larger
city environment. The result is that although the basic
affinity was present, recent experiences overwhelm the
affinity and the student chooses urban or suburban practice.
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So for the affinity model to be optimized, an intervention
is needed no later than high school. In Kentucky, the
Professional Education Preparation Program (PEPP) was
designed to meet this need. After graduation from high
school, students from designated underserved areas interested
in medicine or dentistry are brought together in Lexington
and Louisville for an intense six-week summer program
that includes preparation in math and science and some
health career shadowing opportunities. This program has
been very successful for those who attend, but many of
the targeted counties had few participants, and some
very rural counties are not in the designated group.
An earlier informal assessment had shown that high school
students and counselors agreed on the reasons that so
few students had applied for the PEPP. The consensus
was that many students had scheduled activities during
the post-senior year, many needed to produce income in
summer jobs, and for many the idea of not being able
to return home, even on the weekends, during the six-week
program was not appealing. In addition, the unstated
message of the program was clear: to do something really
special in health care, one must go to a big city.
The High School Rural Scholars Program is the inverse
of PEPP. HSRS participants are engaged in observations
of health care services in their home counties while
being able to live at home for the duration of the summer
program. In the HSRS, students divide their time between
shadowing health care professionals in their home counties
and college entrance exam preparation. Students are engaged
in a virtual classroom with college professors available
via the Internet to improve their knowledge base as well
as test-taking skills for improved performance on standardized
tests. Each day the HSRS students complete a chapter
in an ACT prep book; each student is responsible to post
a question regarding a different topic each day to the
virtual classroom website where the problem is addressed
by one of their online tutors. Students spend a few hours
each day at their assigned "host site" in their
home county, helping with clerical work.
The Trover Campus serves as the central support site
for the program (1). Students from Hopkins County and
the four contiguous counties are considered for the program.
All 5 counties are rural, and 3 are designated as Health
Profession Shortage Areas (HPSA). Each county manages
its own selection process, with all choosing to interview
the top candidates after initial application review.
Each county also has a shadowing coordinator who schedules
and manages the multiple shadowing opportunities. Students
are evaluated both by the host site and the health professionals
shadowed. The students work 30 hours each week and receive
a $650 stipend for participating in the 4-week program.
To date, 113 students have participated in this program.
For the opening day of the program, an orientation is
scheduled in Madisonville. A survey is distributed that
measures existing awareness of community health issues
and current interest in rural health careers. Project
coordinators explain the layout of the course, and the
students are allowed to ask questions. Speakers from
health-related
occupations that not all of the students would have
the opportunity to shadow address the audience briefly.
The HSRS program both begins and ends with a practice
ACT exam. On the final day, the survey is repeated as
a "post test" (2).
The High School Rural Scholars program allows students
entering their senior year of high school to experience
health care professions without having to leave home.
It is held during the same time period as Governor's
Scholars, thus targeting the "second tier" of
students most likely to benefit from the virtual classroom.
Surveys show that HSRS students perceive that they have
learned about various health professions during the program
as well as positively changed their opinions about rural
health care. This program has been shown to foster interest
in rural health care as well as to improve students'
performance on practice ACT tests (see graphs). The HSRS
program continues to make students aware of the need
for rural health care providers and encourages these
students to return to rural areas to practice in the
future. To date, 83% of former HSRS are in some kind
of health career training program, and 2 are currently
enrolled in the Trover Rural Scholar program as pre-medical
students.
References
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Crump W, McCall L, Phebus C, England L. The Rural
Health Career Pipeline Program. Report of a Pilot Project,
Summer, 2000. Kentucky Academy of Family Physicians
Journal 2001; 47(2):16-18
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Crump WJ, Fricker S, Moore A, Coakley V. "An
Innovative Method for Preparation for Rural Practice:
The High School Rural Scholars Program". Journal
of the Kentucky Medical Association, November 2002; 100(11):499-504.
