Rural community health agencies as primary care clerkship sites for medical students.

Abstract

BACKGROUND AND OBJECTIVES: This study describes a student-centered third-year clerkship involving student choice and on-site investigation of rural community health care agencies. The objective of the clerkship was student understanding of how to explore and use community agencies to enhance the care of patients. METHODS: The course was evaluated through pre- and postcourse surveys of attitudes about primary care, care of the socially disadvantaged, knowledge of social agencies, and specialty orientation. Also analyzed were student clerkship evaluation forms, student performance evaluations, and review by external consultants. RESULTS: Students reported statistically significant increases in knowledge about social agencies (P = .0001). Attitudes of social responsibility for health care and greater concern about patients' social well-being were reported but were not statistically significant. While students agreed with the philosophy of the experience, they felt the course would have been more valuable later in their training. Student performance exceeded faculty expectations in all cases. External evaluators felt the community agency contacts were crucial experiences for future caregivers. CONCLUSIONS: A student-centered clerkship using community-based agencies can provide a valid educational experience, even in remote rural areas. Students develop facility in contacting and using community resources. Participation can give new perspectives on patient care not achievable in other sites. The long-term benefits of this early community exposure remain to be investigated.