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Country Doctors in Literature: Helping Medical Students Understand What Rural Practice is All About

Shapiro, Johanna PhD; Longenecker, Randall MD

Featured Topic: Rural Health: Featured Topic Article

Rural family medicine residencies and practices continue to have difficulty attracting applicants and practitioners. Students facing decisions about rural training or practice may be deterred by negative stereotypes or a lack of understanding about rural experience. Renewed efforts to foster students’ interest and influence students’ intent toward rural practice are sorely needed. The authors report one such innovative strategy that used literary sources, many written by rural physicians, to trigger discussion and reflection among a group of 11 medical students who volunteered in 2004 to participate in a two-day retreat sponsored by The Ohio State University College of Medicine Rural Health Scholars program. Participants first attended a presentation designed to help them understand the relevance of textual study of narratives by and about country doctors to their own experiences (during rural clerkships) in rural practice and as a vehicle for clarifying their concerns and questions. Through small-group study and discussion of excerpts from these texts, participants identified notable characteristics of rural inhabitants and their physicians; distinctive attitudes toward illness and medical care; and stresses and rewards of rural practice. They also wrote poems and essays in response to prompts about rural doctoring. Students used reading and writing as triggers to better comprehend and reflect on intangibles such as the nature of small-town life, relative professional isolation, and the unique aspects of the doctor–patient relationship in rural practice. Quantitative and qualitative evaluations suggest that this literature-based approach was enjoyable and stimulating for students, provided useful insights, and reinforced their interest in rural practice.

Dr. Shapiro is professor, Department of Family Medicine, and director, Program in Medical Humanities and Arts, University of California, Irvine, School of Medicine, Irvine, California.

Dr. Longenecker is clinical associate professor of family medicine and assistant dean for rural medical education, The Ohio State University College of Medicine, and residency program director, The Ohio State University Rural Program, West Liberty, Ohio.

Correspondence should be addressed to Dr. Shapiro, Department of Family Medicine, University of California, Irvine, College of Medicine, 101 City Dr. South, Route 81 Room 512, Orange, CA 92868-3298; e-mail: 〈jfshapir@uci.edu〉.

© 2005 Association of American Medical Colleges