Student perception about working in rural United States/Canada after graduation: a study in an offshore Caribbean medical school

Abstract

Introduction: Rural residents of the United States (US) and Canada face problems in accessing healthcare. International medical graduates (IMGs) play an important role in delivering rural healthcare. IMGs from Caribbean medical schools have the highest proportion of physicians in primary care. Xavier University School of Medicines admits students from the US, Canada and other countries to the undergraduate medical (MD) course and also offers a premedical program. The present study was conducted to obtain student perception about working in rural US/Canada after graduation. Methods: The study was conducted among premedical and preclinical undergraduate medical (MD) students during October 2014. The questionnaire used was modified from a previous study. Semester of study, gender, nationality, place of residence and occupation of parents were noted. Information about whether students plan to work in rural US/Canada after graduation, possible reasons why doctors are reluctant to work in rural areas, how the government can encourage rural practice, possible problems respondents anticipate while working in rural areas were among the topics studied. Results: Ninety nine of the 108 students (91.7%) participated. Forty respondents were in favor of working in rural US/Canada after graduation. Respondents mentioned good housing, regular electricity, water supply, telecommunication facilities, and schools for education of children as important conditions to be fulfilled. The government should provide higher salaries to rural doctors, help with loan repayment, and provide opportunities for professional growth. Potential problems mentioned were difficulty in being accepted by the rural community, problems in convincing patients to follow medical advice, lack of exposure to rural life among the respondents, and cultural issues. Conclusions: About 40% of respondents would consider working in rural US/Canada. Conditions required to be fulfilled have been mentioned above. Graduates from Caribbean medical schools have a role in addressing rural physician shortage. Similar studies in other offshore Caribbean medical schools are required as Caribbean IMGs make an important contribution to the rural US and Canadian health workforce.

Measuring the reasons that discourage medical students from working in rural areas

“…The earlier few studies have either considered a limited spectrum of items in the questionnaire or were conducted in developed nations. [ 4 , 12 , 16 , 17 , 35 , 36 ] After rigorous literature review and expert Delphi consultations, a questionnaire consisting of 33 items was developed which was named the MSDRI questionnaire. Interestingly, our analyses highlight 5 factors/subscales for the items listed in the questionnaire.…”

“They don’t have the history and the stature:” examining perceptions of Caribbean offshore medical schools held by Canadian medical education stakeholders

“…Research activities at training institutions was intuitively and personally understood as a signal of educational quality, while the absence of research stood out as a concern. The absence of research programs at Caribbean offshore medical schools has been problematized elsewhere in the literature, 4 , 9 , 18 and thus participants are not alone in this concern. Some participants indicated that the lack of research engagement at offshore institutions is preventing those in the international medical education community from gaining familiarity with the quality and nature of training they offer through opportunities for research collaboration.…”

“… 3 - 7 Furthermore, undergraduate clinical training often takes place in the US due to limited capacity in the Caribbean. 7 - 9 The offshore medical school industry has grown substantially in recent decades; for example, 20 new offshore medical schools have opened since 2007, representing 36 percent of medical schools currently operating in the Caribbean. 2 In turn, this industry is quickly transforming the landscape of global medical education.…”

Psychosomatic Factors Impinge on the Medical Students’ Choice of Rural Practice – A Systematic Review

“…poor living conditions (Saini et al, 2012 (Pati et al, 2015) were listed by many authors. The shortage of basic amenities like electricity, water and telecommunication facilities(P Ravi Shankar et al, 2015) were indicated for frustration. Financial incentives, political interference, lack of drug supplies and poor accommodation facilities (Goel et al, 2019) (Goel, Angeli, Singla, & Ruwaard, 2018), Poor standard of living (Saini et al, 2012), rural areas are difficult place to work (Aydin et al, 2015)poorly functioning health facilities (Arscott-Mills et al, 2016), A lack of social amenities, financial and material resources; (Anthony Amalba et al, 2018).…”

“…(Jain et al, 2016) were demonstrated in major works. The problem of schools for the education of children(P Ravi Shankar et al, 2015), lack of education opportunities for children (Jain et al, 2016) were mainly reasoned for non-acceptance of rural practice in future (Han & Humphreys, 2005). Lesser research opportunities (Goel et al, 2019) lack of learning opportunities (Arscott-Mills et al, 2016) difficult to gain experience (Tolhurst et al, 2008)in clinical practice is perceived as hindrances for their advancements.…”