One of the most important factors in recruitment to a rural community is the spouse. If a spouse is from a rural community or interested in living there, the probabilities increase for a rural location. Programs and policies that take advantage of these factors are important. Some states set up special admission programs from small colleges. The real value of these programs lie in improving the educational quality of the small college and increasing the potential for marrying a rural spouse. Without such a link, many rural background students are forced to select major urban colleges with a better track record for getting students in to professional school.
Remember that students start 90+% unmarried in early college and go to high percentages married by graduation from residency. If they are training in urban areas during college and professional school at this time, they will likely meet and marry an urban spouse. Since they are in professional training and higher education, their contacts are likely to be those who have also chosen careers in highly specialized areas. Either way, this means little or no chance of rural practice or long term rural practice. The long term rural practitioners that we interviewed in one study almost all met and married their spouses before medical school.
The Jefferson program in Philadelphia depends on small college advisors and students. Nebraska has a small program that works with two small colleges. This program has leveled the playing field so that a small college with students from small towns can get students into professional school through early admissions. Missouri took an approach that worked with all small colleges and did not get a desired effect. Missouri worked more directly with the students instead of the college, however, and their program was a also a program to end the brain drain of those leaving the state. I suspect they got the intellectual crowd rather than the service-oriented types we want and need for primary care, family practice, and rural locations.
Other studies agree that the higher the MCAT and GPA, the less likely the choice of rural practice. Also no surprise, the schools with more National Institutes of Health funding graduate fewer into rural practice. Now that it looks likely that NIH funding will double, it bodes poorly for those of us hoping to squeeze more rural candidates in. Deans are screaming for more MD/PhD folks.
For the rural folks..... This does not mean we are dummies, however. Rockford recently graduated a student with an average MCAT of 7 at the top of the class. Some of the rural folks apparently did not get the chance to face the challenges to see what stuff they had inside. Would rather take a rural college student who did better over 4 years of college to get a 3.5 than an urban student who started strong but declined to a 3.5 over time. Studies in the US noted that the larger the school district, the better the gifted kids do. Smaller school districts tend to penalize the gifted to deal with the more needy students. This is especially true for students in poverty.
Previous studies of rural choice note recreational activities preference to be important, with hunting and fishing high on the rural likely list.
In other words, use small college advisors to choose the kids likely to stay on a rural course.
If you have a rural or urban background student that says that they want to go rural, question them carefully about what type of recreational activities, housing, and practice that they want to have.
Work at the local levels to encourage health professions exposures in rural communities.
Medical schools working with small colleges and outreaching to rural high schools can change state education, just as the Flexner reforms changed high school and college education patterns a century ago.
Robert C. Bowman, M.D,
Email: rbowman@unmc.edu
http://www.unmc.edu/Community/ruralmeded/
Rural school consolidation problems - Main one is moving kids around which means that they are less likely to bond with their town and experience the kind of lifestyle that they would want to return to. There are also educational problems.
More than ABCs offered at 'full-service' schools: Dental care, exercise, therapy, other programs provided to communities
AP Originally published November 16, 2002
BENNINGTON, Vt. - Wander down a certain hallway at Molly Stark Elementary School, and before you see it, your nose will know it's there: The air is sweet, antiseptic, a bit minty.
It's ... a dentist's office?
In this southern Vermont town, nearly half of the school's 400 students visit dentist Michael Brady regularly.
"They go to gym, they go to reading, they go to the dentist - it's all the same to them," Brady said.
At a time when schools are being asked to focus on academic essentials more than ever, a small but growing number are embracing the radical idea of a "full-service" school: one that doubles as a place for community medical and dental care, exercise, family counseling - even wedding receptions.
Besides meeting their students' needs, such schools are opening their doors to people who wouldn't ordinarily set foot in a public school and finding new ways to extend services for students with after-school needs.
Molly Stark's dental clinic was logical in a rural area where many low-income families never visit the dentist, and then only after their children's teeth have become badly decayed, said Principal Sue Maguire.
Some students as old as 10 had never sat in a dentist's chair before doing so at school. Maguire recalled talking to one student who, after having several rotten teeth extracted, said he had never known what it was not to be in pain.
"We were really doing what seemed to be the right thing to do for families, to create successful learners," she said.
The approach seems to be working. Molly Stark, one of about 30 schools flagged last spring by state officials as "needing improvement" under President Bush's education plan, came off that list this fall when test scores improved.
Maguire, who has been at Molly Stark for 26 years, also said she is "doing less crisis intervention" since bringing in a preschool program, a consulting pediatrician and part-time psychologist, mentoring, before- and after-school care, parenting classes and a center for family counseling.
"You can pull a poor school up ... if you give the kids what they need to do well," Maguire said.
Schools in New York, Boston, Chicago and Portland, Ore., have brought in similar services, generally with the help of local nonprofit groups.
In New York, a handful of full-service schools provide a mix of medical and dental care, parenting courses and even help for pregnant women. A few stay open on weekends, providing sports, arts and other recreation programs.
"I think this is what schools should be," said Jane Quinn of the Children's Aid Society, which operates 10 community schools in the city. "Why schools are closed at 2:30 in the afternoon is beyond me."
In Boston, one school holds after-school English sessions for immigrant parents. Such programs are available elsewhere but often have long waiting lists, said Matt LiPuma of the Home for Little Wanderers, a Boston child-welfare agency that works with 35 schools.
"The parents were the ones who tipped us off to the need for this," he said.
At an elementary school in Iuka, Miss., the auditorium serves as the community's performing arts center. The library is open to the public, and families book the school for wedding receptions in the center courtyard. The gym opens its doors to adults who want to work out after school.
"It's basically a community center," said New Orleans architect Steven Bingler, who worked on the project.
The model has been catching on slowly nationwide, said Joy Dryfoos, a New York sociologist who has been pushing the full-service idea for decades.
"If principals were taught how to do this, they could do a lot more than they're doing," she said. "They just don't realize it's out there. They're under so much pressure to perform."
At Molly Stark, Maguire cobbled together the funding for the dental clinic and after-school programs through state, federal and private funding. Brady, who retired from his private dental practice after 28 years in Bennington, sees only Medicaid-eligible children - about 600 between Molly Stark and others referred from other schools.
It's a good deal for Brady, who pays no rent for the clinic. His practice is self-sustaining, assuring him a good income.
Dryfoos, who co-wrote a recent book on full-service schools with Maguire, said principals often are hesitant to invite agencies in.
"It's not anything that comes under educational mandates," she said, "but on the other hand, if you have a bunch of kids with achy teeth, you're not going to be able to teach them."
Copyright © 2002, The Baltimore Sun
Education - the entire pipeline