Nothing is more exciting to a medical student than experiencing hands-on medicine for the first time. Unfortunately, most medical students typically wait for that first experience until clinical education begins in the third year of medical school. The Summer Rural Externship (SRE) at the Oklahoma State University (OSU) Center for Health Sciences gives first year medical students the chance to close the books and experience real patient care much earlier. The SRE is an elective three-week rotation after the first year of medical school that is designed to give students a first taste of clinical practice in a rural setting. This unique experience, sponsored by the Oklahoma Area Health Education Center (OKAHEC) at the OSU Center for Rural Health, also includes a community service component and interdisciplinary shadowing.
The SRE takes place in a family physician's office in a rural community. Students shadow physicians to begin learning the basics of bedside manner, communicating with patients, and working in interdisciplinary teams. Included are out-of-office experiences, such as attending hospital staff and committee meetings, taking house calls, joining hospital rounds, taking hospital emergency room calls, and attending community and public health functions.
The students not only observe rural medicine in action, they also experience other integral facets of rural practice. They witness the close relationships rural physicians have with their patients and the leadership roles they play in their communities. Students have accompanied their preceptors to little league games where they provide first aid, and they have served as guest speakers at the local Lion’s Club. Students in the SRE also participate in health related community service, such as staffing a health fair or volunteering in a free clinic. These experiences allow them to gain an understanding and appreciation for how involved rural health professionals become in the health and viability of their communities. Lessons such as these drive home the rewards of rural practice while providing medical students real world experience that they cannot obtain from a textbook.
A two-hour interdisciplinary shadowing experience with non-physician clinicians is also required during the SRE. Through this activity, students work with other disciplines to gain a better understanding of the role allied health professionals play in the care of patients. They learn very quickly that caring for patients is not solely the responsibility of a physician; it takes an entire team working together.
During the summer of 2011, OSU began a pilot program asking participants to document and track the medical skills they observed while on the SRE. Students completing the skills cards recorded a wide variety of experiences for a total of 72 unique procedures observed. The number of procedures observed ranged from 7 to 25 with an average of 14. Students will use these skills cards in future 3rd and 4th year clinical rotations, which they may ultimately compile into individual competence reports that will contain a comprehensive set of skills that students have experienced during their education. These cards essentially become part of their resumes when they apply to residency programs.
In addition to the skills cards, students also complete an online evaluation of their experience. Overall, feedback has been overwhelmingly positive. All students who have participated have indicated that the experience both increased their understanding of practice in rural communities and increased their knowledge and skills in accessing community resources to impact quality of care. Eighty-eight percent of students responded that their interest in rural practice had increased as a result of the SRE experience; none of the students indicated a decreased interest in practicing in a rural area.
Since 1995, one hundred and twenty-two SRE students have experienced rural medicine in 49 Oklahoma communities (see map below). Participation has grown from three students per summer to 17 students in the summer of 2011. At the end of each rotation, students write a paper to describe their experiences (if you are interested in reading one of these papers, two of them are available here and here). Students also submit a brief article to the local newspaper, including a photo of themselves with their preceptor.
The SRE experience is a vital component of the mission of OSU-CHS to train primary care physicians for rural and underserved Oklahoma. Beyond the early clinical experience, students begin to conceptualize the idea of being a leader in a rural community. In the words of an SRE student, “I am learning that medicine is a medical community, not a one woman show…rural medicine has evolved …I find myself loving the community, the people, and the way of life available to a rural physician.”